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Military Combat Deployment and Alcohol Use—Reply

Military Combat Deployment and Alcohol Use—Reply In Reply: We agree with Drs Dervaux and Laqueille that using a score of 2 or more for the CAGE questionnaire increases specificity while decreasing sensitivity when screening patients for alcohol abuse or dependence.1,2 In a study of alcohol dependence, higher specificity may be more desirable. However, the purpose of our study was to investigate changes in alcohol use behaviors and alcohol-related problems before and after combat deployment, using the metrics of heavy weekly drinking, binge drinking, and alcohol-related problems defined by the Patient Health Questionnaire.3 The CAGE screening questions in our study were used to adjust for confounding related to the existence of potential alcohol-related problems prior to the baseline questionnaire. We elected to use a more sensitive definition of 1 or more affirmative responses on the CAGE, which was the cutoff established when the questions were first developed and has been deemed useful in other studies,4,5 to improve our ability to identify individuals possibly at increased risk for the 3 primary outcomes studied. Thus, we were careful to use the term potential alcohol dependence because of the sensitive criteria involved in using a tool for screening (rather than a thorough clinical evaluation). Although it is not directly related to the primary goals of this study, we agree that it is of interest to examine the robustness of our findings using a more specific definition with the CAGE items. We compared the results in our article (using ≥1 affirmative responses to the 4-item CAGE questionnaire) with the results when we defined CAGE as positive after only 2 or more affirmative responses. Although redefining our measure did reduce the number of positive individuals identified in the follow-up population (n = 48 481) from 8836 (18.2%) to 7490 (15.5%), the overall study findings were unchanged. For both active duty and Reserve or National Guard personnel, when using 2 or more as the cutoff, the adjusted measures of association for combat deployment changed by less than 1% across all outcomes. Moreover, the odds ratios for potential alcohol dependence using the score of 2 or more changed by less than 3% for both populations across all outcomes. Back to top Article Information Financial Disclosures: None reported. References 1. Mayfield D, McLeod G, Hall P. The CAGE questionnaire: validation of a new alcoholism screening instrument. Am J Psychiatry. 1974;131(10):1121-11234416585PubMedGoogle Scholar 2. Dervaux A, Bayle FJ, Laqueille X, et al. Validity of the CAGE questionnaire in schizophrenic patients with alcohol abuse and dependence. Schizophr Res. 2006;81(2-3):151-15516314077PubMedGoogle ScholarCrossref 3. Spitzer RL, Kroenke K, Williams JB.Patient Health Questionnaire Primary Care Study Group. Validation and utility of a self-report version of PRIME-MD: the PHQ Primary Care Study. JAMA. 1999;282(18):1737-174410568646PubMedGoogle ScholarCrossref 4. Ewing JA. Detecting alcoholism: the CAGE questionnaire. JAMA. 1984;252(14):1905-19076471323PubMedGoogle ScholarCrossref 5. Cherpitel CJ. Analysis of cut points for screening instruments for alcohol problems in the emergency room. J Stud Alcohol. 1995;56(6):695-7008558901PubMedGoogle Scholar http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Military Combat Deployment and Alcohol Use—Reply

JAMA , Volume 300 (22) – Dec 10, 2008

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References (6)

Publisher
American Medical Association
Copyright
Copyright © 2008 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.2008.765
Publisher site
See Article on Publisher Site

Abstract

In Reply: We agree with Drs Dervaux and Laqueille that using a score of 2 or more for the CAGE questionnaire increases specificity while decreasing sensitivity when screening patients for alcohol abuse or dependence.1,2 In a study of alcohol dependence, higher specificity may be more desirable. However, the purpose of our study was to investigate changes in alcohol use behaviors and alcohol-related problems before and after combat deployment, using the metrics of heavy weekly drinking, binge drinking, and alcohol-related problems defined by the Patient Health Questionnaire.3 The CAGE screening questions in our study were used to adjust for confounding related to the existence of potential alcohol-related problems prior to the baseline questionnaire. We elected to use a more sensitive definition of 1 or more affirmative responses on the CAGE, which was the cutoff established when the questions were first developed and has been deemed useful in other studies,4,5 to improve our ability to identify individuals possibly at increased risk for the 3 primary outcomes studied. Thus, we were careful to use the term potential alcohol dependence because of the sensitive criteria involved in using a tool for screening (rather than a thorough clinical evaluation). Although it is not directly related to the primary goals of this study, we agree that it is of interest to examine the robustness of our findings using a more specific definition with the CAGE items. We compared the results in our article (using ≥1 affirmative responses to the 4-item CAGE questionnaire) with the results when we defined CAGE as positive after only 2 or more affirmative responses. Although redefining our measure did reduce the number of positive individuals identified in the follow-up population (n = 48 481) from 8836 (18.2%) to 7490 (15.5%), the overall study findings were unchanged. For both active duty and Reserve or National Guard personnel, when using 2 or more as the cutoff, the adjusted measures of association for combat deployment changed by less than 1% across all outcomes. Moreover, the odds ratios for potential alcohol dependence using the score of 2 or more changed by less than 3% for both populations across all outcomes. Back to top Article Information Financial Disclosures: None reported. References 1. Mayfield D, McLeod G, Hall P. The CAGE questionnaire: validation of a new alcoholism screening instrument. Am J Psychiatry. 1974;131(10):1121-11234416585PubMedGoogle Scholar 2. Dervaux A, Bayle FJ, Laqueille X, et al. Validity of the CAGE questionnaire in schizophrenic patients with alcohol abuse and dependence. Schizophr Res. 2006;81(2-3):151-15516314077PubMedGoogle ScholarCrossref 3. Spitzer RL, Kroenke K, Williams JB.Patient Health Questionnaire Primary Care Study Group. Validation and utility of a self-report version of PRIME-MD: the PHQ Primary Care Study. JAMA. 1999;282(18):1737-174410568646PubMedGoogle ScholarCrossref 4. Ewing JA. Detecting alcoholism: the CAGE questionnaire. JAMA. 1984;252(14):1905-19076471323PubMedGoogle ScholarCrossref 5. Cherpitel CJ. Analysis of cut points for screening instruments for alcohol problems in the emergency room. J Stud Alcohol. 1995;56(6):695-7008558901PubMedGoogle Scholar

Journal

JAMAAmerican Medical Association

Published: Dec 10, 2008

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