A COMPARISON OF CARBOHYDRATE DEFICIENT TRANSFERRIN WITH OTHER MARKERS OF ALCOHOL MISUSE IN MALE SOLDIERS UNDER THE AGE OF THIRTY

The paper describes a study of 58 consecutive male soldiersunder 30 years old admitted to an alcohol treatment unit inLondon, and 51 age- and gender-matched controls to compare theefficacy of isoelectric focusing, a non-quantitative measureof carbohydrate deficient transferrin (CDT), with other markersof alcohol misuse. The Severity of Alcohol Dependence Questionnaire,the Michigan Alcohol Screening Test and the CAGE questions wereall more sensitive in detecting alcohol misusers than the laboratorymarkers measured. At standard cut-off levels, the laboratorymarkers yielded low sensitivities even in those subjects whoadmitted to drinking over 80 g alcohol daily for at least 3weeks immediately prior to the study. CDT was the most sensitive(31%), followed by mean cell volume (14%) and gamma glutamyltransferase (11%). The questionnaires and laboratory markershad good specificities.     

Screening for alcohol use by pregnant women of public health care in Rio de Janeiro, Brazil

OBJECTIVE: To assess the prevalence of suspected cases of alcohol use during pregnancy in women seeking care in public health services. METHODS: Cross-sectional study comprising 537 women randomly selected in public maternity hospitals in Rio de Janeiro, Southeastern Brazil, from March to October 2000. A well-trained team of female interviewers used the instruments Cut-down, Annoyed, Guilty, Eye-opener (CAGE), Tolerance Cut-down, Annoyed, Eye-opener (T-ACE) and Tolerance Worry Eye-opener Annoyed Cut-down (TWEAK) to assess suspect cases of alcohol misuse. The Chi-square test was used in the analysis according to socioeconomic and demographic variables. RESULTS: About 40% of women informed having used any type of alcoholic beverage during pregnancy. Beer was the most frequently used drink (83.9%). Depending on the measurement instrument used, estimates of alcohol misuse varied from 7.3% to 26.1%. Suspected cases of alcohol abuse were more common among non-white, older and less educated women; those not living with a partner; those reporting use of tobacco and illicit drugs either by one or both partners in a couple; and those with little social support. CONCLUSIONS: High prevalence of suspected alcohol misuse and its overlapping with several risk factors for adverse pregnancy outcomes indicate this is an important issue of public health concern requiring continuous screening during prenatal care.     

Typologies of alcohol consumption in adolescence: predictors and adult outcomes

AIMS: Data from the 1970 British Cohort Study were used to examine the effects of alcohol expectancies, norms, and openness of communication with parents on typologies of adolescent alcohol use and the subsequent risk of adult alcohol misuse from adolescent use. METHODS: Of a population originally defined as all children born in the UK in 1 week of April 1970, 69.4% were interviewed at age 16 and 70.1% at age 30. Missing information was imputed using the multivariate imputation by chained equation (MICE) method, yielding a sample size of 7023 for men and 6896 for women. Four adolescent drinking typologies were defined by frequency and quantity of alcohol consumption at age 16. RESULTS: Positive alcohol expectancies predicted all types of adolescent alcohol use in young men and women. Norms affected frequency of alcohol use over quantity, while openness of communication with parents affected quantity of alcohol use. All men who drank alcohol in adolescence were at risk of alcohol misuse (defined by the CAGE questionnaire) in adulthood, whereas the risk for women was limited to frequent drinkers. CONCLUSIONS: Drinking typologies were useful for understanding the mechanisms of adolescent alcohol use. Early prevention may be required to reduce alcohol related problems in later life.     

The detection of alcohol problems in a primary care clinic

The CAGE is a four item questionnaire which is used to help clinicians identify alcohol problems. Charts of 433 primary care patients who were given a medical health form containing the CAGE questions (experimental patients) were compared with charts of 451 patients given a similar form that did not contain the CAGE questions (control patients). Alcohol problems were detected more frequently in the experimental patients (10.6%) than in the control patients (6.7%) (p<0.05). This difference in detection tended to be most evident for persons with milder alcohol problems (problem drinking) as opposed to more well developed alcohol abuse. Experimental patients (3.7%) also tended to be more likely than control patients (2.9%) to receive active alcohol treatment during their initial medical visit. Medical health screening forms which include the CAGE questions may promote the identification of alcohol problems in primary care.Mark Olfson is Assistant Professor of Psychiatry and Robert L. Braham is Associate Professor of Medicine, both at the Cornell University Medical College.This research project was supported by a Reader's Digest Research Psychiatrist Fellowship to Dr. Olfson.     

Association between depressive symptoms and alcohol abuse among students from Bucaramanga, Colombia

Various studies have reported an important association between depressive symptoms and alcohol abuse. However, the topic had not been investigated in Colombian students. This study focused on the association between depressive symptoms and alcohol abuse among high school students in Bucaramanga, Colombia. A self-reported anonymous questionnaire was answered by 560 15-19-year-olds. The survey included the Zung Self-Reported Depression Scale, CAGE Questionnaire for Alcohol Use, and VESPA questionnaire (Epidemiological Surveillance of Psychoactive Drugs). Logistic regression was used to establish associations. Prevalence was 5.7% for alcohol dependence and 39.5% for depressive symptoms. Associations were found between alcohol abuse and depressive symptoms (PR = 3.33; 95%CI: 1.41-7.83), poor self-perceived academic achievement (PR = 2.59; 95%CI: 1.16-5.37), and smoking (PR = 2.47; 95%CI: 1.13-5.40). The authors conclude that there is a strong association between depressive symptoms and alcohol abuse in Colombian high school students. Preventive programs are needed to identify early depressive disorders and alcohol abuse.     

Social inequalities in alcohol use and misuse in the german general population

This paper investigates social inequalities in drinking behaviour in a sample of the German general population aged 25 to 59 years. The prevalence of several indicators of alcohol use and misuse were examined by socio-economic status (SES). Odds ratios were calculated to examine the relative effect of socio-economic status on the various alcohol misuse indicators. Abstinence showed a clear negative gradient with social status. When age was controlled, no differences were found in the prevalence of hazardous drinking. In comparison with men of high SES, men of middle SES had increased odds of consuming five or more drinks per day at least weekly and of a positive score on the AUDIT hazardous use measure, while men of lower SES had higher odds for dependence symptoms. Women of middle SES had significantly lower odds for reporting items of the CAGE alcohol screening instrument and DSM-IV alcohol abuse criteria in comparison to women of high SES. Thus, women of lower and higher SES resemble each other in drinking behaviour. For men, no identifiable pattern was found. The lack of clear social inequalities among the consuming German general population may be due to the widespread integration of alcohol drinking in everyday life.     

Efficacy of an alcoholism self-report questionnaire in a residency clinic

The efficacy of the CAGE alcoholism screening test, when used as a part of a much larger health and social history questionnaire, was assessed in a family medicine residency clinic by retrospectively studying 155 charts of randomly selected adult patients. The rate of problem drinking, as determined by the CAGE, was then compared with the rate found in other studies using the CAGE questionnaire. The CAGE responses were also compared with other information in the patients' charts to assess how frequently this screening test might support a diagnosis of problem drinking. The incidence of problem drinking identified by the CAGE was 3.2 percent, compared with the expected 9.8 percent level (P = .0039). The CAGE questionnaire proved to be no better than a simple self-report of alcohol consumption (which demonstrated an incidence of 4 percent), and failed to identify two patients with histories of alcohol abuse as noted in their charts. CAGE, when used as a part of a larger health questionnaire, thus failed to identify the anticipated number of patients with drinking problems.     

Determining positivity of alcohol abuse by Taguchi methods

PURPOSE: Aims to establish the critical score and screening accuracy of the CAGE Questionnaire in three treatment settings--primary health care, walk-in (triage) clinic and the emergency room. DESIGN/METHODOLOGY/APPROACH: Taguchi methods are applied to three screens of the CAGE questionnaire. FINDINGS: Analysis of the sensitivity and specificity data of three CAGE screens by leveling factor (p'), signal-to-noise ratios (S/N, SS/N) and their dependent relation resulted in critical CAGE scores of 1, 1 and 2; and high screening accuracy levels of 98.44, 97.20 and 94.92 percent, respectively. The illustrated method yielded excellent (> or = 95 percent) screening accuracy values for primary health care, emergency room and walk-in clinic patients. ORIGINALITY/VALUE: To reduce misclassification rates of alcohol abuse, screening systems should concentrate first on developing ways to standardize protocols. Further work is needed to establish high screening accuracy in other clinical settings, and particularly in those at risk of alcohol abuse in the general population.     

Alcohol misuse,depressive symptoms,and HIV/STI risks of US Hispanic women

Objectives: Alcohol misuse and depressive symptoms have been linked to HIV/STI risk, but studies have rarely included Hispanic women, who have over four times greater HIV incidence than white, non-Hispanic women. Understanding the connections among alcohol misuse, depressive symptoms, and HIV/STI risks may suggest ways to meet specific needs of Hispanic women. This study’s objective is to examine the relationships among alcohol misuse, depressive symptoms, and seven HIV/STI risk factors.

Design: Five hundred forty-eight US Hispanic women with intake data from a randomized trial were assessed for alcohol misuse (CAGE) and depressive symptoms (CES-D). GZLM and path analyses tested relationships between alcohol misuse or depressive symptoms and HIV/STI risk factors.

Results: Self-efficacy and condom use were not related to alcohol misuse or depressive symptoms, but only 15% of women reported consistent condom use. After controlling for demographics, women with alcohol misuse had significantly more perceived HIV/STI risk (OR?=?2.15) and better HIV/STI knowledge (β?=??.54); and women with depressive symptoms had significantly more perceived HIV/STI risk (OR?=?1.76) and worse HIV/STI knowledge (β?=?.37).

Conclusions: Interventions to increase condom use for Hispanic women are needed, regardless of mental disorders. Working with Hispanic women with alcohol misuse or depressive symptoms presents a need (and opportunity) to address issues directly related to HIV/STI risk. Women’s health practitioners have an excellent opportunity to reach women by implementing regular screening programs in clinics that serve Hispanic women. For women with high depressive symptoms, poor HIV/STI knowledge should also be addressed. Future studies should test whether integrated and tailored risk reduction interventions affect these factors and lower HIV/STI risk for Hispanic women.     

Detecting excessive drinking among admissions to a general hospital

A questionnaire combining items on alcohol consumption with the four CAGE questions was used by 27 housemen to detect abnormal drinking among 520 patients of all specialties admitted to a general hospital. 15.6--23.2% of patients were classified as abnormal drinkers with the largest proportions occurring among the emergency surgical, orthopaedic, psychiatric and medical patients. 95% of the abnormal drinkers were detected by the questions on consumption alone, while 22 of the 28 patients who were identified by both the consumption and CAGE questions had been admitted as a direct result of alcohol abuse. With the aid of simple questionnaire and some encouragement, junior medical staff can become quite adept at detecting abnormal drinkers in the course of their routine practice.     

PHYSICIAN KNOWLEDGE OF THE CAGE ALCOHOL SCREENING QUESTIONS AND ITS IMPACT ON PRACTICE

A cross-sectional survey of physicians (n=301) and patients(n=321) at a universitybased department of medicine was completedto determine physician's ability to list CAGE alcohol screeningquestions and how this knowledge is associated with practicepatterns. Forty-five percent of the physicians had heard ofthe CAGE, but only 14% could list all four of the questionscorrectly. Physicians who knew the CAGE were more likely toreport counseling and referral of their patients who abuse alcohol.However, as assessed by patient interview and chart review,patients with an alcohol abuse problem were no more likely tohave been recognized by or to have received more aggressivecare from residents who knew the CAGE than patients cared forby residents who did not know the CAGE. Knowledge of an alcoholscreening test is not sufficient to change physician practicerelated to care of patients with an alcohol abuse problem. Moreattention must be directed towards the development of effectivestrategies which integrate into clinical practice screeningand initial treatment of patients who abuse alcohol.     

Alcohol questionnaires and HDL: Screening scores as scaled markers of alcohol consumption

Improving the quality of alcohol-related care requires practical approaches to assessing alcohol consumption to guide management and monitor outcomes. Given the increasing use of alcohol screening questionnaires to identify alcohol misuse it would be ideal if scores on screening questionnaires were also indicators of average alcohol consumption. However, the questionnaires were not designed for this purpose and include dimensions of drinking that may not reflect average consumption (e.g. heavy episodic drinking, alcohol-related problems). In a general population sample, scores on the AUDIT-C screen correlated with reports of alcohol consumption in detailed interviews, but the relationship is unknown for clinical populations and other questionnaires. Serum high-density lipoprotein cholesterol (HDL) is a biomarker routinely obtained in clinical care and is known to rise with average alcohol consumption. This cross-sectional study of 11,175 male U.S. Veterans Affairs patients enrolled in a primary care study used HDL as an objective biomarker to evaluate whether average alcohol consumption increased as scores increased on 3 brief alcohol screens – the AUDIT-C, AUDIT Question #3 (a single-item screen), and the CAGE questionnaire. Mean HDL progressively increased as screening scores increased for the AUDIT-C and AUDIT Question #3: about 12 mg/dL from the lowest to the highest scores. The association was much weaker for the CAGE questionnaire. Results were minimally affected by adjustment for covariates (e.g. age, race, medical comorbidity, smoking, medication count, and depression) but the association was modified (p = 0.008) and mildly attenuated by adherent use of lipid-lowering medications. This study using HDL as a biomarker of average alcohol consumption adds to evidence that some alcohol screening scores may also serve as scaled markers of average alcohol consumption.     

Alcohol use disorders, and at-risk drinking in patients affected by a mood disorder, in Cagliari, Italy: sensitivity and specificity of different questionnaires

AIMS: (i) To evaluate the prevalence of alcohol use disorders, and at risk-drinking among outpatients admitted to the Division of Psychiatry, University of Cagliari, Italy, for mood disorders, and (ii) to compare the sensitivity and specificity of the questionnaires used. METHODS: Fifty-six patients affected by mood disorders answered to the questions of (i) The NIAAA Guide for identification of at-risk drinking, (ii) AUDIT questionnaire, (iii) The CAGE questionnaire and, (iv) SCID-I application forms for mood and alcohol use disorders. RESULTS: Fourteen subjects (25%) met the criteria for alcohol use disorders according to SCID-I; 17 (30.4%) achieved a score > or = 1 in CAGE questionnaire; 12 (21.4%) reached AUDIT scores of > or =8 and 4 for men and women, respectively; 12 (21.4%) provided positive answers to NIAAA Guide. Despite these prevalence rates, no diagnosis of alcohol use disorders had previously been registered in their medical records. The CAGE questionnaire achieved the highest values of sensitivity and specificity in detecting alcohol use disorders tested against that of the SCID-I. CONCLUSIONS: Alcohol use disorders and at-risk drinking are frequent in patients affected by mood disorders, although often underestimated; this underestimation was virtually absolute in the sample of patients investigated. Combination of the CAGE questionnaire plus the first questions in the NIAAA Guide may be an effective tool for use in the identification of psychiatric patients with possible alcohol use disorders or at-risk drinking.     

Features of excessive alcohol drinking in older adults distinctively captured by behavioral and biological screening instruments. An epidemiological study.

The entire > or =65-year-old population living in a small Italian town, where alcohol use is almost ubiquitous, was assessed with a frequency-quantity questionnaire for alcohol intake and with two screening instruments for alcohol problems, the CAGE questionnaire and the MCV-gammaGT test. Aim of the study was to assess whether these instruments identify different subsets of subjects with alcohol problems. Of the 649 participants, 19.1% were at-risk drinkers (average intake > 40 g/day in men and > 20 g/day in women). Both the screening instruments were positive in only a minority of participants. Of the 377 drinkers, 53 gave > or =1 affirmative response to the CAGE questionnaire, whereas 24 had a positive MCV-gammaGT test. The concordance between positive CAGE questionnaire and MCV-gammaGT test was limited to seven subjects (kappa = 0.10), and these tests identified subjects who differed for several health and psychosocial characteristics. Participants aged > or =75 years drank less, but had similar prevalence of CAGE and MCV-gammaGT positive markers as compared to younger participants. In conclusion, excessive drinking is common in the elderly. Screening tests based on behavioral and biological markers identify two different sets of subjects with possible alcohol problems. This might indicate the opportunity to use these instruments in conjunction.     

The prevalence of alcohol misuse among acute admissions: current experience and historical comparisons

BACKGROUND: Over the last 25 years there has been a large increase in alcohol related deaths in Scotland. Medical patients who misuse alcohol may have overt alcohol related disease, but may also present with other unrelated illness. AIM: We examined alcohol misuse amongst acute medical admissions to compare this with other similar studies at the same hospital since 1974. PATIENTS AND METHODS: 850 consecutive admissions to the medical receiving unit of Victoria Infirmary were assessed. They were assessed using the modified Michigan Alcohol Screening Test (MAST) and also by a medical consultant. 414 patients also had their blood ethanol levels measured on admission. RESULTS: 18.6% admissions had a MAST greater than 5 and were considered to misuse alcohol (24.8% male and 12.2% female; p < 0.0001). Patients from socio-economic group V and patients presenting with gastro-intestinal haemorrhage or self-poisoning were more likely to misuse alcohol. The sensitivity and specificity of consultant opinion regarding alcohol misuse were 0.55 and 0.97 compared with the MAST. There was an increase in the alcohol misuse amongst women admitted (12.2%) compared to 1977 (5.5%; p = 0.0026) and 1981/2 (6.3%; p = 0.004). CONCLUSION: Alcohol misuse is common amongst acute medical admissions. Since 1979, there has been a particular increase in female medical admissions who misuse alcohol. Medical opinion regarding alcohol misuse lacks sensitivity in identifying at risk individuals compared with a validated.     

Alcohol abuse: prevalence and detection in a general hospital

Despite a high prevalence of alcohol-related disabilities and the availability of cost-effective interventions, alcohol abuse and dependence commonly go undetected in hospital inpatients. In a university teaching hospital we compared three well validated screening methods for sensitivity and specificity-the Alcohol Use Disorders Identification Test (AUDIT, with various cut-off scores), CAGE (a four-question screening tool), and a 10-question version of the Michigan Alcoholism Screening Test (BMAST). A subset of patients also completed the DSM IV structured clinical interview for diagnosis. 1133 adult patients were randomly selected from all hospital admissions, with exclusion of day cases and patients too ill to be interviewed. Two-thirds of the patients were interviewed, most of the remainder being unavailable at the time. 30% of the men and 8% of the women met the DSM IV criteria for alcohol abuse or dependence. Sensitivities and specificities of the screening tools were as follows: AUDIT (with cut-off score >8) 89% and 91%; CAGE 77% and 99%; BMAST 37% and 100%. 255 case records of patients scoring above the cut-off on one or more questionnaires were subsequently reviewed. The admitting team recognized an alcohol problem in only 46, of whom 17 were referred for appropriate follow up. As in previous hospital surveys, alcohol abuse and dependence was not receiving proper attention. The most efficient screening tool was the CAGE questionnaire.     

Reassessment of the CAGE questionnaire by ROC/Taguchi methods

OBJECTIVES: The clinical assessment efficiency of the CAGE questionnaire for alcohol abuse based on diagnostic accuracy has not been fully established to date because of the varied and inconclusive gold standards used as diagnostic criteria. CAGE has also been highlighted to miss almost half of the risk-drinkers due to the use of inadequetly set criteria for the positive recognition of alcohol abuse. This study aims to establish the diagnostic accuracy of CAGE at different treatment settings. METHODS: A hybrid of the receiver operating characteristic (ROC) and the Taguchi method was used, as this approach proved to evaluate the diagnostic performance and accuracy in hypothetical clinical settings. Data were used from three cross-clinical treatment settings, i.e., general medicine outpatients, medical inpatients, and psychiatric inpatients, and analyzed by means of a step-wise application of managable number of statistical indices such as the area under the ROC curve (AUC), leveling factor (p'), and signal-to-noise ratios (S/N; standardized S/N [SS/N]). RESULTS: The selected settings yielded similar AUCs but portrayed different trade-offs on the ROC curves signaling the presence of different critical CAGE scores. Analysis of the sensitivity and specificity data of i, ii, iii by p', S/N, SS/N and their dependent relation resulted in the critical CAGE scores of 1,1, and 2; and high diagnostic accuracy levels of 76.84 percent, 86 percent, and 76.84 percent, respectively. CONCLUSIONS: By setting these critical CAGE scores as the minimum detection levels of alcohol abuse, early intervention before the onset of serious alcohol-related problems is possible. This will decrease the health-care costs of the patient and, in addition, reduce the psychological and social burdens inherent to alcohol abuse both on the patient and society. Having its critical scores reliably identified and diagnostic accuracy fully determined, CAGE can now improve the detection rate of problem drinking individuals substantially.     

Personality and alcohol/substance-use disorder patient relapse and attendance at self-help group meetings.

This study evaluated the role of personality in the short-term outcome of alcohol/substance-use disorder patients. Detoxifying alcohol/substance-use disorder patients were administered the Myers-Briggs Type Indicator (MBTI), the Tridimensional Personality Questionnaire (TPQ), the Michigan Alcohol Screening Test (MAST), the CAGE Questionnaire, and the Beck Depression Inventory (BDI). These patients were subsequently evaluated over a 1-month period for relapse and attendance at self-help group meetings. High TPQ Persistence scale scores predicted abstinence. When the Thinking and Feeling groups were considered separately, and when these two groups were combined into a single group, high scores for the individual groups and the combined group (i.e. Thinking and Feeling types together) predicted abstinence. High TPQ Persistence scale scores and low Shyness with Strangers and Fear of Uncertainty subscale scores predicted attendance at self-help group meetings. High MBTI Extroversion and high MBTI Thinking scores also predicted attendance at self-help group meetings. When the Extroverted and Introverted types and the Thinking and Feeling types respectively were combined, as with abstinence, high scores predicted attendance at self-help group meetings. Age, gender, CAGE, MAST, and BDI scores did not predict outcome. The above information suggests that specific personality variables may predict abstinence and attendance at self-help group meetings in recently detoxified alcoholics, and this may have prognostic and therapeutic significance.     

The domestic violence against the elderly within the Family Health Program of Niterói (RJ, Brazil)

This article investigates the magnitude and characteristics of violence against the elderly by trusted people at Ilha da Concei??o, Niterói--RJ registered at the Family Health Program. A domestic survey interviewed 343 individuals with 60 years or more, selected by a simple random sample. To identify the violence it was used the Conflict Tactics Scales. Information about identification, demographics and socio-economics characteristics were obtained using the National Health Interview Survey. The Mini-Mental State Examination was used to evaluate mental health. In order to evaluate the functional capacity, the Health Assessment Questionnaire was used. In cases of alcohol suspicion among men, it was used the instrument CAGE. To female elder or caregivers, the TWEAK instrument was used. 43% reported at least one episode of psychological violence. Physical violence was reported by 9.6% of the interviewed, 6.1% reported serious physical violence in this period. The prevalence of different modalities of violence was higher among the youngest individuals, with higher scholarity, among those who have one of the pathologies that characterize the elderly as having a vulnerability (depression and/or urinary incontinence/fecal and/or diabetes and/or rheumatism) and those living with the greatest number of individuals.     

Joint use of clinical parameters,biological markers and CAGE questionnaire for the identification of heavy drinkers in a large population-based sample

AIMS: Alcohol consumption in France is one of the highest in the world. Factors associated with excessive alcohol drinking are numerous. However, taken separately, none of the existing clinical or biological markers of excessive alcohol intake enables an adequate identification of heavy drinkers. The aim of this cross-sectional survey was to identify socio-demographic, clinical and biological factors associated with excessive alcohol drinking, to develop a model and to assess its reliability, thus enabling the detection of heavy drinkers. METHODS: Subjects were 1619 men and 1559 women, aged 35-64 years, living in three French areas (Lille, Strasbourg and Toulouse) and randomly selected from polling lists. Socio-demographic status, lifestyle, reported alcohol intake and answers to the CAGE questionnaire (alcohol dependence) were obtained by questionnaire. A blood sample was taken for quantification of biological parameters. Men who drank 60 g of ethanol a day (g/day) or above and women who drank 30 g/day or above were classified as heavy drinkers. The reference class (RC) gathered non-drinkers and moderate drinkers together. The sample was divided into two sub-samples: the first was used to estimate the parameters of a logistic regression model (heavy drinkers vs others), and the second to assess the accuracy of this model for the identification of heavy drinkers, using receiver operating characteristic (ROC) curves. A specific analysis was performed for each gender. RESULTS: Fourteen per cent of men and 40.8% of women were non-drinkers. Nine per cent of women and 14.4% of men were heavy drinkers. Wine was the most consumed alcoholic beverage. In the univariate analyses, differences were observed between the two groups of alcohol consumers for most of the socio-demographic, clinical and biological variables considered. In the multivariate analyses, low educational level, smoking, apoprotein B, high density lipoprotein cholesterol, mean corpuscular volume (MCV), gamma-glutamyl-transferase (GGT) and the CAGE score for men, and living area, age, MCV, GGT and the CAGE score for women remained independently and significantly associated with heavy drinking. In the validation sub-sample, these models combining different types of markers enabled a good discrimination between heavy drinkers and the RC, with an area under the ROC curve of 82% for men and of 79% for women. CONCLUSIONS: In this study, socio-demographic, clinical and biological factors and the CAGE score were independently related to excessive alcohol drinking and their joint utilization in a screening model enabled a good recognition of heavy drinkers.