Screening for Alcohol Problems in the U.S. General Population: Comparison of the CAGE, RAPS4, and RAPS4‐QF by Gender, Ethnicity, and Service Utilization

Background The purpose of this study was to compare the performance (sensitivity and specificity) of two brief screening instruments, CAGE and the Rapid Alcohol Problems Screen 4 (RAPS4), against ICD‐10 and DSM‐IV criteria for alcohol dependence and abuse in a representative sample of the U.S. adult household population by gender, ethnicity, and service utilization (emergency room and primary care) in the last year. Methods Data are from the Alcohol Research Group's 2000 National Alcohol Survey ( n = 7612), which is a computer‐assisted telephone interview survey of the U.S. general population 18 and over in all 50 U.S. states and the District of Columbia. Results Sensitivity of the RAPS4 (0.86) was better than the CAGE (0.67) given similar specificity (0.95 vs. 0.98) and outperformed the CAGE for alcohol dependence across all gender, ethnic, and service utilization groups, except among blacks and Hispanics. The RAPS4 also performed equally well for females and males (0.88 vs. 0.85), whereas sensitivity of the CAGE was lower for females. Although sensitivity of the RAPS4 was better than the CAGE for alcohol abuse, sensitivity was low for both (0.56 and 0.36, respectively). When quantity‐frequency (QF) questions (drinking five or more drinks on at least one occasion during the last year and drinking as often as once a month during the last year) were added to the RAPS4, the RAPS4‐QF performed significantly better for alcohol abuse and outperformed the CAGE at a cut point of one across all gender, ethnic, and service utilization groups. The RAPS4‐QF appeared to be most sensitive for alcohol abuse among both males and females reporting emergency room use (0.90). Conclusions The data suggest that the RAPS4 outperforms the CAGE in this general population sample. The addition of a QF question to the RAPS4 improves performance in relation to sensitivity for alcohol abuse, and the RAPS4 and RAPS4‐QF may be the instruments of choice in brief screening for alcohol use disorders. Additional research is needed to further explore these issues.