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Alcohol Abuse and Dependence in Latinos Living in the United States
Validation of the CAGE (4M) Questions
Richard Saitz, MD, MPH;
Mark F. Lepore, BA;
Lisa M. Sullivan, PhD;
Hortensia Amaro, PhD;
Jeffrey H. Samet, MD, MA, MPH
Arch Intern Med. 1999;159:718-724.
Background Brief alcoholism screening questionnaires have not been adequately studied in the rapidly growing Latino population living in the United States.
Objective To assess (1) the prevalence of alcoholism and (2) the performance of 2 alcohol screening instruments in Latinos.
Subjects and Methods We performed a cross-sectional interview study in an urban teaching hospital–based primary care practice. Consecutive self-identified Latino subjects provided informed consent. All subjects were interviewed in English or Spanish using 2 alcoholism screening tools, the CAGE (or the Spanish version, the 4M), and the Alcohol Use Disorders Identification Test, and a criterion standard for the diagnosis of alcohol abuse and dependence, the Composite International Diagnostic Interview.
Results Of 210 subjects interviewed, 36% had a lifetime diagnosis of alcohol abuse or dependence by the criterion standard. Thirty-one percent were currently drinking hazardous amounts of alcohol. A CAGE (4M) score of 1 or more was 92% sensitive and 74% specific, and a score of 2 or more was 80% sensitive and 93% specific for a lifetime diagnosis of alcohol abuse or dependency. CAGE (4M) scores of 0, 2, 3, and 4 were associated with likelihood ratios (0.1, 4.8, 18.5, and 36.8, respectively) that resulted in substantial changes from pretest (36%) to posttest probability (to 6%, 73%, 91%, and 95%, respectively) of a diagnosis of alcohol abuse or dependency. At the standard cutoff point, the Alcohol Use Disorders Identification Test detected only 51% of subjects with alcohol disorders.
Conclusions In Latinos in primary care settings, alcohol abuse and dependence are common and the CAGE (4M) is a brief, valid, screening tool for detecting alcohol use disorders.
From the Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine (Drs Saitz, Sullivan, and Samet), Boston University School of Medicine (Drs Saitz, Sullivan, Amaro, and Samet and Mr Lepore), Boston Medical Center (Drs Saitz, Amaro, and Samet), and the Departments of Social and Behavioral Sciences (Drs Amaro and Samet), Biostatistics and Epidemiology (Dr Sullivan), Boston University School of Public Health, Boston, Mass.
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