Predicting problem drinking in college students: gender differences and the CAGE questionnaire

Alcohol consumption among university students in Ireland and the United Kingdom from 2002 to 2014: a systematic review

Background

Alcohol is a leading cause of global suffering. Europe reports the uppermost volume of alcohol consumption in the world, with Ireland and the United Kingdom reporting the highest levels of binge drinking and drunkenness. Levels of consumption are elevated among university students. Thus, this literature review aims to summarise the current research on alcohol consumption among university students in the Republic of Ireland and the United Kingdom.

Methods

MEDLINE, CINAHL, EMBASE and PsychInfo were systematically searched for literature from January 2002 until December 2014. Each database was searched using the following search pillars: alcohol, university student, Ireland or the United Kingdom and prevalence studies.

Results

Two thousand one hundred twenty eight articles were retrieved from electronic database searching. These were title searched for relevance. 113 full texts were retrieved and assessed for eligibility. Of these, 29 articles were deemed to meet inclusion criteria for the review. Almost two thirds of students reported a hazardous alcohol consumption score on the AUDIT scale. Over 20 % reported alcohol problems over their lifetime using CAGE while over 20 % exceed sensible limits each week. Noteworthy is the narrowing of the gender gap throughout the past decade.

Conclusion

This is the first review to investigate consumption patterns of university students in Ireland and the United Kingdom. A range of sampling strategies and screening tools are employed in alcohol research which preclude comparability. The current review provides an overview of consumption patterns to guide policy development.

Associations between alcohol use and alcohol-related negative consequences among black and white college men and women

OBJECTIVE

The gender gap in alcohol use has been narrowing among young adults, while race differences in alcohol problems change throughout the life course, with Whites experiencing more problems before middle adulthood and Blacks experiencing more after. Yet, there is a paucity of research on the intricate relationship among gender, race, alcohol use, and alcohol problems in emerging adults. The present study addressed this gap in the literature.

METHOD

The sample included White (n = 14,772) and Black (n = 458) college students from multiple colleges across the United States (59% female; 51% freshmen; Mage = 20 years).

RESULTS

With alcohol use levels adjusted for, women were more likely to report consequences related to damage to self and dependence-like symptoms than men. There were no significant race differences in either the type or the number of alcohol problems. Further, there was no Race × Alcohol Use interaction in relation to alcohol problems. We found a statistically significant interaction between gender and alcohol use in predicting alcohol problems, suggesting that, at higher levels of drinking, the risk for women to experience alcohol problems was significantly greater than that for men.

CONCLUSIONS

The reverse race gap in alcohol use and problems may not surface until young adulthood or may not be relevant for those who attend college. College interventions should help both Black and White students reduce problems associated with drinking and focus on limiting harm among female students.

Alcohol Consumption, Dating Relationships, and Preliminary Sexual Outcomes in Collegiate Natural Drinking Groups

This study tested the effects of committed relationships and presence of dates on alcohol consumption and preliminary sexual outcomes in natural drinking groups (NDGs). Undergraduate drinkers (N = 302) answered an online questionnaire on their most recent participation in a NDG. The interaction between relationship commitment and presence of a date on alcohol consumption was significant. Among students not in committed relationships, those dating within their NDG reported heavier drinking than those not dating. Students in committed relationships drank less than those who were not committed only when their partners were present. The positive correlation between drinking and sexual contact was significant only for those who were not in committed relationships. Implications for future research and interventions are discussed.

Gender differences in the validity of the substance abuse subtle screening inventory--3 (SASSI-3) with a criminal justice population

The Substance Abuse Subtle Screening Inventory-3 is a brief, self-administered screening tool designed to measure the probability of having a substance dependence disorder. The present study assessed the validity of this instrument with an inmate population using a DSM-IV diagnosis of substance dependence as the criterion measure. The study also examined instrument validity by gender. Findings revealed differences in the prediction of dependence between male and female inmates. The advantages and shortcomings of the instrument are discussed in light of these findings, and suggestions for future research are advanced.

Concurrent validity of the CAGE questionnaire. The Nord-Trøndelag Health Study

The aim of this study was to examine the psychometric properties of the CAGE questionnaire, and the questionnaire's concurrent validity with current and previous alcohol consumption. This study employed data from the Nord-Trøndelag Health Survey wave 1 (HUNT-1 in 1984-86: N=24,900) and wave 2 (HUNT-2 in 1995-97: N=36,350). The concurrent validity of the CAGE questionnaire was examined both as a dichotomous variable with the recommended cut-off (≥2 affirmative answers) for alcohol problems, and as a categorical scale. The categorical scale was constructed by counting responses from 0 to 4, and a separate category for current abstainers in HUNT-2. Current self-reported consumption above the gender specific 80th percentile was defined as "current excessive consumption". "Previous excessive consumers" were defined by meeting at least one of the two following criteria at the time of HUNT-1: reporting drinking too much alcohol in any period of their life, or reporting a high level of alcohol consumption. The internal reliability of CAGE was adequate, and in relation to alcohol consumption, there was a linear relationship between the CAGE score and both the current and previous excessive consumption. In conclusion, this study indicates good concurrent validity and adequate psychometric properties of the CAGE questionnaire. The dose-response pattern seen between the CAGE score and alcohol consumption, suggests that it can be used as an ordinal measure, rather than with a cut-off of two or more. The concurrent validity of the CAGE is better in women than in men.

Lifestyle, health characteristics and alcohol abuse in young adults who are non-daily smokers

CONTEXT AND OBJECTIVES

Despite the decline in the prevalence of tobacco use in many countries, including Brazil, there are growing numbers of smokers who continue to smoke at a low daily rate, or less frequently (non-daily smokers). This group needs to be better characterized in order to direct preventive actions and public health policies. The aim here was to compare lifestyle, health characteristics and alcoholism problems among young adult smokers, non-daily smokers and non-smokers.

DESIGN AND SETTING

This was a cross-sectional study in which volunteers from the university community and its surrounds in Santa Maria, State of Rio Grande do Sul, Brazil, were included between October 2007 and January 2008.

METHODS

Out of 1240 volunteers initially contacted in a university cafeteria, a total of 728 participants of mean age 22.45 ± 3.32 years were selected for final analysis. Data were collected using structured questionnaires.

RESULTS

In general, it was observed that the non-daily smokers showed intermediate characteristics in relation to the smokers and non-smokers. However, there was a significant association between non-daily smoking and alcohol abuse. The non-daily smokers presented an odds ratio of 2.4 (95% confidence interval: 1.10-5.48) in relation to the daily smokers and an odds ratio of 3.3 (confidence interval: 1.7-6.5) in relation to the non-smokers, with regard to presenting a positive CAGE test, thereby indicating alcohol abuse or dependence.

CONCLUSION

The study suggested that non-daily smoking and alcohol consumption were concomitant behaviors.

Screening for substance abuse among adolescents validity of the CAGE-AID in youth mental health care

OBJECTIVE

To examine the diagnostic accuracy of the four-item self-report and parent-report versions of the CAGE-AID as a screen for substance-use disorders (SUD) among adolescents in mental health care.

METHOD

Patients were 190 Dutch treatment-seeking adolescents (12-18 years old, mean age 15.5 years, 53% boys) and their parents who completed the CAGE-AID questionnaire during intake. DSM-IV clinical diagnoses were used as gold standard in receiver operating characteristic analyses to determine psychometric properties.

RESULTS

Psychometric properties for both the self-report and the parent-report versions showed the CAGE-AID's excellent diagnostic accuracy in predicting SUD.

CONCLUSIONS

The CAGE-AID seems to be a brief and valid instrument for detecting SUD among adolescents in mental health care. However, denial may play a role in both the CAGE-AID and the clinical interviews. More research is needed to further establish the CAGE-AID's usefulness in other settings. The study's limitations have been noted.

Paradoxical increase of positive answers to the Cut-down, Annoyed, Guilt, Eye-opener (CAGE) questionnaire during a period of decreasing alcohol consumption: results from two population-based surveys in Ile-de-France, 1991 and 2005

AIMS

To describe trends of responses to the Cut-down, Annoyed, Guilt, Eye-opener (CAGE) questionnaire during a period of declining alcohol consumption, in a country with no temperance history.

DESIGN

Two random-sample surveys, conducted in 1991 and 2005, respectively.

SETTING

The adult population of Ile-de-France.

PARTICIPANTS

A total of 1183 subjects in 1991 and 5382 subjects in 2005.

MEASUREMENTS

Responses to CAGE questions, obtained by face-to-face interviews in 1991 and by telephone in 2005.

RESULTS

were standardized on the 2005 population structure.

FINDINGS

The proportion of subjects giving at least two positive answers has increased by 4.2 times; the biggest increase was observed for the Guilt question (4.8 times) and the smallest for the Eye-opener question (2.6 times). Several increases were higher for women than for men: 12.9 times versus 3.3 times for two or more positive answers, 9.8 times versus 3.8 times for the Guilt question. Increases did not vary consistently by age.

CONCLUSION

These paradoxical trends do not support the use of CAGE in general population surveys. They confirm previous reports suggesting that CAGE was sensitive to community temperance level. They might reflect the emergence of a temperance movement in France, with stronger impact among women. This movement might be responsible for the fall in alcohol consumption.

Simultaneous and concurrent polydrug use of alcohol and prescription drugs: prevalence, correlates, and consequences

OBJECTIVE

In this study, we sought to examine the prevalence, correlates, and consequences associated with simultaneous polydrug use and concurrent polydrug use of alcohol and prescription drugs. For purposes of this investigation, simultaneous polydrug use referred to the co-ingestion of different drugs at the same time, and concurrent polydrug use referred to the use of different drugs on separate occasions within the past 12 months.

METHOD

Undergraduate students attending a large public midwestern university in the United States were randomly selected to self-administer a Web survey. The sample consisted of 4,580 undergraduate students, with a mean (SD) age of 19.9 (2.0) years; the sample consisted of 50% women, and the racial breakdown was 65% white, 13% Asian, 7% black, 5% Hispanic, and 10% other race/ethnicity. The survey assessed simultaneous polydrug use and concurrent polydrug use of alcohol and four classes of prescription drugs: (1) pain medication, (2) stimulant medication, (3) sedative medication, and (4) sleeping medication.

RESULTS

The 12-month prevalence for polydrug use involving alcohol and abusable prescription drugs was 12.1% (including 6.9% simultaneous polydrug use). The majority of polydrug use involving alcohol and each class of prescription drugs was simultaneous polydrug use, with the exception of sleeping medication. Simultaneous polydrug use was more prevalent among undergraduate students who were male, were white, and reported early initiation of alcohol use. Simultaneous polydrug use was associated with more alcohol-related and other drug use-related problems than concurrent polydrug use.

CONCLUSIONS

Based on the high prevalence and increased risk for consequences associated with simultaneous polydrug use of alcohol and prescription drugs, collegiate prevention efforts aimed at reducing substance abuse should clearly focus on co-ingestion of alcohol and prescription drugs.

A modified version of the Drug Abuse Screening Test among undergraduate students

The present study assesses the prevalence of items from a modified version of the Drug Abuse Screening Test, Short Form (DAST-10) for substances other than alcohol among undergraduate students. More than 4,500 undergraduate students at a large Midwestern research university completed a web-based survey in 2005. Nearly 1 every 10 undergraduate students experienced three or more DAST-10 items in the past 12 months. Although the prevalence of illicit drug use did not differ by gender, undergraduate men were significantly more likely than women to report DAST-10 items. Less than 6% of individuals who reported three or more drug DAST-10 items had ever used treatment services for substance use. As a brief screening instrument, the DAST-10 offers promise for detecting possible drug abuse among college students. Based on the prevalence of drug use, colleges and universities are encouraged to provide screening opportunities to identify and to provide services for students at high risk for drug abuse.

Alcohol Use Disorders Among Emergency Department-Treated Older Adolescents: A New Brief Screen (RUFT-Cut) Using the AUDIT, CAGE, CRAFFT, and RAPS-QF

BACKGROUND

Early identification of alcohol use disorders (AUD) among emergency department (ED)-treated patients is important for facilitating intervention and further evaluation outside EDs. A number of brief screening instruments have been developed for identifying patients with AUD, but it is not clear whether they are practical and perform well with older adolescents in an ED setting. This study contrasted four brief screening instruments for detecting DSM-IV-defined AUD and tested a newly developed brief screen for use among ED-treated older adolescents.

METHODS

The Alcohol Use Disorders Identification Test (AUDIT), the CAGE, the CRAFFT, and a modified RAPS-QF were given to 93 alcohol-using older adolescents (55% men; aged 18-20 years) in an ED. Receiver operator characteristic analyses were used to evaluate the performance of brief screens against the criterion of a lifetime DSM-IV alcohol abuse or dependence diagnosis.

RESULTS

Of existing instruments, the AUDIT had the best overall performance in identifying AUD (sensitivity, 82%; specificity, 78%). A new, shorter screening instrument composed of two AUDIT items, two CRAFFT items, and one CAGE item (RUFT-Cut) performed as well as the AUDIT (sensitivity, 82%; specificity, 78%).

CONCLUSIONS

Among existing alcohol screening instruments, the AUDIT performed best for identifying ED-treated older adolescents with alcohol use disorders. The RUFT-Cut is a brief screening instrument for AUD that shows promise for identifying ED-treated older adolescents who are in need of intervention or further evaluation. Future research should focus on use of the RUFT-Cut in other settings with larger, more diverse samples of adolescents.

Prevalence and trends of alcohol use and misuse among adolescents and young adults in the Netherlands from 1993 to 2000

This study presents an overview of Dutch studies on prevalence of alcohol use and adds findings from our own study on prevalence of drinking among adolescents and young adults aged 12-30 years in the Netherlands. Data were collected as part of a longitudinal study by the Netherlands Twin Register in 1993 (n=3885), 1995 (n=4814), 1997 (n=3772) and 2000 (n=4090). Measures included lifetime alcohol use, frequency of drinking, quantity of drinking, lifetime drunkenness, frequency of drunkenness and problem drinking. The main findings are: (a) alcohol use increased with age until the age of 25, after which it decreased; (b) males exceeded females on all aspects of alcohol use, with exception of the youngest age group and lifetime alcohol use; (c) time trends indicated an increase in frequency and quantity of drinking among 12-15-year-old adolescents during the 1990s; and moreover, (d) 21-25-year-old females drank more frequently, consumed more drinks a week, had more experience with lifetime drunkenness and were drunk more often in 2000 than in 1993. Among 21-25-year-old males, an increase of drunkenness and problem drinking was displayed during the 1990s.

Alcohol screening in young persons attending a sexually transmitted disease clinic. Comparison of AUDIT, CRAFFT, and CAGE instruments

OBJECTIVE

To compare the ability of 3 brief alcohol screens (Alcohol Use Disorders Identification Test [AUDIT], CRAFFT, and CAGE) to identify adolescents and young adults with a current alcohol use disorder (AUD) and to determine whether there are gender-based or race-based differences in screening performance.

DESIGN, PARTICIPANTS, AND SETTING

Cross-sectional study of 358 young persons (55% males; 49% blacks; age range, 15-24 years; mean age, 20.6 years) who were attending an urban clinic for sexually transmitted diseases and reported alcohol use during the past year.

MEASUREMENTS

Receiver operating characteristic (ROC) curve analysis was used to determine the ability of the 3 screens to discriminate between participants with and without AUDs detected in the Structured Clinical Interview for DSM-IV (SCID).

RESULTS

One third (33%) of participants met Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for a current AUD (24% with alcohol abuse and 9% with alcohol dependence). The AUDIT performed best at a cut score of 9 (sensitivity, 0.76; specificity, 0.79), CRAFFT at a cut score of 2 (sensitivity, 0.94; specificity, 0.33), and CAGE at a cut score of 1 (sensitivity, 0.69; specificity, 0.63). The AUDIT had the best overall performance (area under the curve [AUC], 0.84), followed closely by CRAFFT (AUC, 0.79) and then CAGE (AUC, 0.70). Performance of screens did not differ by gender. The AUDIT performed slightly better in whites than blacks, but no race-based differences were observed for the CAGE or CRAFFT.

CONCLUSIONS

Clinicians should use the AUDIT or CRAFFT, rather than the CAGE, to screen young persons for AUDs. The AUDIT performs best, but its length may limit its utility in this setting. The CRAFFT is a suitable alternative, with excellent sensitivity and no gender-based or race-based differences.

CUGE: A SCREENING INSTRUMENT FOR ALCOHOL ABUSE AND DEPENDENCE IN STUDENTS

OBJECTIVES

The prevalence of alcohol abuse on college campuses ranges from 7 to 17%. Frequent heavy drinkers place themselves and others at risk for a variety of adverse consequences and frequently remain undetected. Brief individual interventions result in a significant reduction on the number of drinks. Therefore, detection of students at risk is useful and desirable. The CUGE has been elsewhere described as a promising screening device for problem drinking in students. In order to determine the diagnostic value of this new questionnaire, we set up a validation study in a new and independent population of freshmen.

METHODS

A cross-sectional diagnostic study. Participants were college freshmen of the Katholieke Universiteit Leuven. All students received a questionnaire, containing the CUGE, being the test of interest, and the CIDI as the reference test.

RESULTS

The CUGE combines a very high sensitivity of 91% with a reasonable specificity of 76.3% in this validation group.

CONCLUSIONS

The CUGE is an excellent screening device in this population of students. In addition, it is a short questionnaire with only yes or no questions. This makes the CUGE easily applicable as a part of broad routine questionnaires.

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

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.

Concurrent validity of the Personality Assessment Inventory Alcohol Problems (ALC) Scale in a college student sample

The concurrent validity of the Alcohol Problems scale (ALC) was investigated in a college student sample (N = 200). The relationships between the ALC and associated features of alcohol problems (e.g., consumption patterns, expectancies, maladaptive coping, and stress) were examined. The validity of the ALC for identifying clinically significant alcohol problems (assessed with the Structured Clinical Interview for the fourth edition ofthe Diagnostic and Statistical Manual of Mental Disorders) was also examined. The ALC was related to the associated features and was a valid indicator of alcohol problems. T scores of 80, 85, and 90 had superior hit rates for alcohol abuse; and scores of 80, 85, and 90 had superior hit rates for alcohol dependence.

Comparison of the Rost and the CAGE alcohol screening instruments in young adults

The Rost and CAGE alcohol screening instruments were compared in a random sample of 103 of 3609 young adults participating in a longitudinal panel. Rost (t = 6.01, df = 101, p<.001) and CAGE (t = 7.27, df = 97, p<.001) scores were significantly higher for those classified as having alcohol dependence than for those without dependence according to the short-form of the Composite International Diagnostic Inventory (SF-CIDI). The areas under the curve for the CAGE (0.840) and the Rost (0.783) were not statistically different (z = 1.30, p>.05).

The Drinking Context Scale. A confirmatory factor analysis

The current article examines the development and validation of the Drinking Context Scale through the use of confirmatory factor analysis. The scale measures the self-reported likelihood of excessive drinking across a number of specific social-cognitive drinking contexts. Five-hundred-and-five college students adjudicated for breaking university drinking rules filled out the anonymous questionnaire. Three factors including convivial, intimate, and negative coping contexts were confirmed, and these factors demonstrated good reliability and evidence of concurrent validity with other substance abuse indices, including the Alcohol Use Disorders Identification Test and the College Alcohol Problem Scale. Implications for the DCS as an assessment tool for prevention and early intervention with young people are discussed.

Validating the Alcohol Use Disorder Identification Test with college first-offenders

Although the Alcohol Use Disorders Identification Test (AUDIT) has been shown to have good validity and reliability with clinical samples, little data has been examined with respect to youthful problem drinkers, particularly college students. Data collected with 312 students cited their first time for breaking university drinking rules was examined to evaluate the factorial validity and internal consistency of the 10-item scale, and also to test the validity of the AUDIT against two scales designed with a previous cohort specifically to measure hazardous (The Drinking Context Scale) and harmful drinking (the College Alcohol Problem Scale) in college students. Overall, results suggest that the AUDIT is a valid and reliable screening device for college students, and could play an important role in assessing youthful problem drinkers for early intervention programming.

Psychophysiological reactivity to alcohol advertising in light and moderate social drinkers

Psychophysiological responses to alcohol and nonalcohol advertising slides were compared in light and moderate social drinkers. Each slide presentation was interspersed with a rest period. Before viewing the slides, participants completed a questionnaire to estimate their quantity and frequency of alcohol consumption. Participants were divided into two groups using a median split of alcohol consumption scores. Light social drinkers showed a significant decrease in heart rate response to both alcohol-related and nonalcohol advertisements. Moderate social drinkers showed a significant increase in skin conductance to both alcohol-related and nonalcohol advertisements. The findings of this study have implications for understanding both the influence of alcohol advertisements on behavior and the psychophysiological correlates of cue reactivity.

Women's mental health in primary care. Depression, anxiety, somatization, eating disorders, and substance abuse

Primary care physicians can improve the care of women patients by applying new concepts of women's physiology and psychosocial development. New developmental models that emphasize the importance of relationships in women's self-concept and well-being have led to effective psychotherapies for depression, eating disorders, anxiety and substance abuse. Many of these therapies can be offered in brief formats suitable to primary care settings. New biological treatments including the use of estrogen, thyroid hormone and bright light for depression and refeeding to increase metabolic rate in eating disorders also promise to expand the range of mental health problems that generalist physicians can treat successfully.

Measuring problem drinking in first time offenders. Development and validation of the College Alcohol Problem Scale (CAPS)

Research on college drinking continues to justify serious concerns for the psychological, social, and physical well-being of young persons who abuse alcohol. However, despite considerable interest and research in this regard, there are few valid, reliable and clinically useful brief screening instruments available to measure youthful drinking problems. The current study of 315 college students cited their first time for breaking university drinking rules describes the development and validation of the College Alcohol Problem Scale (CAPS) for measuring different psychosocial dimensions of problem drinking in college students. Two related but distinct factors emerged defining Socio-Emotional and Community Problems. These two factors explained almost two thirds of the variance, and showed very good internal reliabilities. MANOVA analysis demonstrated concurrent validity for the CAPS with both a measure of heavy drinking derived from the QFI and a modified version of the MAST. Implications for using the CAPS for identifying potential drinking problems in young persons are emphasized.