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A Critical Review

Katharine A. Bradley, MD, MPH; Jodie Boyd-Wickizer, BA; Suzanne H. Powell; Marcia L. Burman, MD

JAMA. 1998;280:166-171.

Objective.— To describe the performance of alcohol screening questionnaires in female patients.

Data Sources.— We searched MEDLINE from 1966 to July 1997 for alcoholism or alcohol-drinking and for CAGE, AUDIT, BMAST, TWEAK, T-ACE, MAST, SMAST, or SAAST; Citations Indexes for newer screening questionnaires and those without acronyms; and MEDLINE from 1996 to July 1997 for alcoholism or alcohol-drinking and screening.

Study Selection and Data Extraction.— Reviewed studies presented data for women comparing brief alcohol screening questionnaires with valid criterion standards for heavy drinking (2 drinks per day) or alcohol abuse or dependence in US general clinical populations. Sensitivities, specificities, and areas under receiver operating characteristic curves (AUROCs) were extracted.

Data Synthesis.— Thirteen articles (9 studies) were reviewed. The CAGE questionnaire had AUROCs of 0.84 to 0.92 for alcohol abuse and dependence in predominantly black populations of women, but using the traditional cut point of 2 or more resulted in low sensitivities (38%-50%) in predominantly white female populations. The TWEAK and Alcohol Use Disorders Identification Test (AUDIT) questionnaires had high AUROCs (0.87-0.93) for past-year alcohol abuse or dependence in black or white women, but had sensitivities less than 80% at traditional cut points. For detecting heavy drinking, the AUDIT questionnaire had AUROCs of at least 0.87 in female primary care patients. The TWEAK and T-ACE questionnaires had higher AUROCs (0.84-0.87) than the CAGE questionnaire (0.76-0.78) for detecting heavy drinking before pregnancy was recognized in black obstetric patients.

Conclusions.— The CAGE questionnaire was relatively insensitive in predominantly white female populations. The TWEAK and AUDIT questionnaires have performed adequately in black or white women, using lower cut points than usual.

From Health Services Research and Development (Drs Bradley and Burman and Mss Boyd-Wickizer and Powell) and the Medicine Service (Drs Bradley and Burman), VA Puget Sound Health Care System (Seattle Division), and the Departments of Medicine and Health Services, University of Washington (Dr Bradley), Seattle.

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