Alcohol abuse and dependence in Latinos living in the United States - Validation of the CAGE (4M) questions

Background: Brief alcoholism screening questionnaires have not been adequat ely studied in the rapidly growing Latino population living in the United S tates. Objective: To assess (1) the prevalence of alcoholism and (2) the performan ce 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-ident ified Latino subjects provided informed consent. All subjects were intervie wed 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 depen dence, the Composite International Diagnostic Interview. Results: Of 210 subjects interviewed, 36% had a lifetime diagnosis of alcoh ol abuse or dependence by the criterion standard. Thirty-one percent were c urrently drinking hazardous amounts of alcohol. A CAGE (4M) score of 1 or m ore was 92% sensitive and 74% specific, and a score of 2 or more was 80% se nsitive and 93% specific for a lifetime diagnosis of alcohol abuse or depen dency. CAGE (4M) scores of 0, 2, 3, and 4 were associated with likelihood r atios (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 9 5%, respectively) of a diagnosis of alcohol abuse or dependency. At the sta ndard 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 depende nce are common and the CAGE (4M) is a brief, valid, screening tool for dete cting alcohol use disorders.