Screening for alcohol abuse using CAGE scores and likelihood ratios

Ann Intern Med. 1991 Nov 15;115(10):774-7. doi: 10.7326/0003-4819-115-10-774.


Objective: To assess the performance of the CAGE (acronym referring to four questions, see below) questionnaire in discriminating between medicine outpatients with and without an alcohol abuse or dependence disorder.

Design: A cross-sectional design of a sample of consecutive patients who received both the alcohol module of the diagnostic interview schedule and the CAGE (Cut down, Annoyed, Guilty, Eye-opener) screening questionnaire.

Setting: The outpatient medical practice of an urban university teaching hospital.

Patients: All patients 18 years or older who signed a consent form approved by the university's institutional review board.

Measurement: Calculation of the sensitivity, specificity, receiver operating characteristic (ROC) curve, and likelihood ratio for CAGE scores of 0 to 4.

Results: Thirty-six percent of the sample group met criteria for a history of alcohol abuse or dependence. A CAGE score of 2 or more was associated with a sensitivity and specificity of 74% and 91%. The calculated area under the ROC curve was 0.89, whereas the likelihood ratios for CAGE scores of 0 to 4 were 0.14, 1.5, 4.5, 13, and 100, respectively. These ratios were associated with posterior probabilities for an abuse or dependence disorder of 7%, 46%, 72%, 88%, and 98%, respectively.

Conclusion: Clinicians can improve their ability to estimate a patient's risk for an alcohol abuse or dependence disorder using likelihood ratios for CAGE scores.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Alcoholism / diagnosis*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Likelihood Functions
  • Male
  • Mass Screening*
  • Primary Health Care
  • Probability
  • ROC Curve
  • Sensitivity and Specificity
  • Surveys and Questionnaires