Screening for alcohol-related problems in the general population using CAGE and DSM-IV: Characteristics of congruently and incongruently identified participants

Abstract

This study examines the role of age, gender, and drinking patterns in inconsistent identification of alcohol-related problems by CAGE and DSM-IV criteria. Data come from a nationally representative sample of the noninstitutionalized German general adult population (N=8020) surveyed through self-administered questionnaires in 1997. Current drinkers who were classified positive for a DSM-IV (abuse or dependence) and/or CAGE diagnosis (n=942) were included in the descriptive analysis and multinomial logistic regression. Among current drinkers with at least one positive classification, only 31.7% were "congruently" classified; that is, they were consistently identified by corresponding CAGE and DSM-IV criteria. Analyses on item level support findings of incongruence on scale level. Overall, we found that younger age groups were more likely to meet DSM criteria without reporting CAGE items. For older age groups, the reverse seems to be true. Women were found to respond more readily to CAGE items whereas men seem to respond more readily to DSM criteria. Intensive drinking patterns more often lead to congruent classification, yet surprisingly, participants with less intensive drinking patterns were found more often to be CAGE positive than to fulfil DSM abuse criteria. Moreover, binge drinkers with alcohol-related problems were neither more likely to receive a DSM nor a CAGE diagnosis. We conclude that heightened awareness is needed when employing the studied instruments in certain groups. © 2004 Elsevier Ltd. All rights reserved.