The utility of the Brief MAST' and the CAGE' in identifying alcohol problems: results from national high-risk and community samples
R. R. Crowe, J. R. Kramer, V. Hesselbrock, G. Manos and K. K. Bucholz
Department of Psychiatry, University of Iowa College of Medicine, Iowa City 52242-1000, USA.
BACKGROUND: The CAGE and the Brief MAST questionnaires are widely used to
screen for alcohol problems. We tested the performance of these instruments
in 2 population-based groups: a high-risk sample composed of relatives of
alcoholic subjects and a community sample consisting of families not
selected for alcoholism (ie, alcohol dependence disorder). METHODS: A total
of 3435 relatives of alcoholics and 795 control subjects were interviewed
with the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA)
semistructured interview in a multicenter collaborative study on the
genetics of alcoholism. The performance of "CAGE" and "Brief MAST"
equivalent items in the SSAGA was characterized by their positive
predictive value, sensitivity, specificity, and percentage of the sample
who screened positive. RESULTS: Both questionnaires performed well in the
highrisk sample, where the base rate of alcoholism was 35%. However, in the
community sample, where the 16% rate of alcoholism was comparable to that
of the US population (14%), an acceptable positive predictive value could
be achieved only through a substantial reduction in sensitivity. Results
were similar when men were compared with women and when lifetime alcoholics
were compared with current alcoholics. CONCLUSION: The "Brief MAST" and
"CAGE" can be effective instruments to screen for significant alcohol
problems in both community and high-risk patients; as expected, their
positive predictive value increases with the base rate of alcoholism in the
population being screened.
