Validated Clinical Scales
Validated Bedside Screening Instruments Directory
Psychometric sensitivity, specificity, and exact scoring thresholds for primary care adult, adolescent, and co-occurring mental health screening.
Instrument Selection
AUDIT-C outperforms the older CAGE questionnaire for detecting non-dependent hazardous drinking in primary care. Pair AUDIT-C with DAST-10 for adult drug screening, CRAFFT 2.1+N for adolescents aged 12 to 21, and PHQ-4 to detect co-occurring depression or anxiety requiring immediate warm handoff.
Evidence basis: USPSTF Evidence Synthesis and NIAAA / NIDA primary care validation studies.
1. Sensitivity, Specificity & Cutoff Reference Table
| Instrument | Target Population | Items & Score Range | Positive Cutoff | Sensitivity / Specificity |
|---|---|---|---|---|
| AUDIT-C | Adults 18+ | 3 items (0-12) | >=3 F / >=4 M | 73-86% / 89-91% (unhealthy drinking) |
| Full AUDIT-10 | Adults 18+ | 10 items (0-40) | >=8 (AUD likely >=20) | 84-92% / 85-94% |
| DAST-10 | Adults (Non-medical drugs) | 10 Yes/No (0-10) | >=3 Moderate | 82-90% / 77-86% |
| CAGE | Lifetime Dependence | 4 Yes/No (0-4) | >=2 | ~71% / ~90% (misses binge/hazardous use) |
| CRAFFT 2.1+N | Adolescents 12-21 | 6 Yes/No + frequency (0-6) | >=2 | 80-92% / 76-94% |
| PHQ-4 | Co-occurring Mood/Anxiety | 4 items (0-12) | >=6 Moderate | 83% / 88% (composite distress) |
2. Secondary Scale Threshold Checker
CAGE, CRAFFT 2.1+N & PHQ-4 Quick Scorer
Positive
Select Secondary Scale
Adjust Observed Score
2 / 4
CAGE
3. Domain Usage Notes
Why Avoid CAGE as Standalone Primary Screen?
CAGE queries lifetime alcohol dependence symptoms rather than current drinking quantity. A patient binge drinking 6 drinks every weekend often scores 0 on CAGE despite scoring 5+ on AUDIT-C.
Integrating PHQ-4 Co-Screening
Depression and panic symptoms frequently co-occur with hazardous alcohol or cannabis self-medication. Screen both together and route elevated PHQ-4 scores to a same-day warm handoff.