Young Il Ryou, et al: Alcohol-screening Instruments in Elderly Male Drinkers small bottle of beer, a bowl of Makgeolli, a glass of wine, or a shot of hard liquor. To categorize alcohol use disorders into alcohol abuse and dependence, a structured interview was used based on the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV TR).4) 2) Questionnaire survey Upon completing the family physician-led diagnostic interview, subjects were asked to fill out the questionnaires, which included items on socio-demographic characteristics as well as the Alcohol Use Disorder Identification Test (AUDIT), Short Michigan Alcoholism Screening Test-geriatric version (SMAST-G), and acronym referring to four questions (cut down, annoyed, guilty, eye-opener; CAGE) questionnaires. Socio- demographic data included patient’s age, religion, residential status, occupation, medical history, smoking status, family history of alcoholism, and age at onset of drinking. 3) Screening instruments (1) Alcohol Use Disorder Identification Test The AUDIT was developed in 1989 by the World Health Organization11) and consists of a total of 10 items. Each item is rated on a 4-point scale, for a total of 40 points possible. Of the 10 items, three are related to the frequency of drinking, the amount of alcohol consumption, and the frequency of binge drinking. The AUDIT tool differs from other conventional tools in that it measures heavy drinking and binge drinking, and it does not include any items on withdrawal symptoms. Therefore, the AUDIT is useful to screen for problem drinkers rather than alcohol dependence and thus is suitable for primary care settings. Regarding the validity of the AUDIT in Korea, it was recommended that ≥ 12 points is suggestive of problem drinking, ≥ 15 points is considered ‘alcohol use disorders’, and ≥ 26 points is indicative of alcohol dependence; with sensitivity and specificity were 85.7% to 96.9% and 79.5% to 100.0%, respectively.12) (2) Cut down, annoyed, guilty, eye-opener The CAGE is a questionnaire developed in 1970 that is composed of 4 questions: 1) Have you ever felt that you should cut down on your drinking?, 2) Have people annoyed you by criticizing your drinking?, 3) Have you ever felt bad or guilty 128 | Vol. 33, No. 3 May 2012 about your drinking?, and 4) Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (eye opener)?13) According to a Korean study that assessed the sensitivity and specificity of the questionnaire, a total of two or more positive responses on the questions is indicative of an alcohol use disorder.14) (3) Short Michigan Alcoholism Screening Test-geriatric version The SMAST-G consists of 10 questions and was developed by Blow et al.15) based on the 24-item Michigan Alcoholism Screening Test scale to assess drinking problems in the elderly. It is suggested that a score of ≥ 2 indicates problem drinking in an elderly individual. The present study used the SMAST-G as translated by Kim.16) 3. Data Analyses Descriptive analysis was applied to subjects’ socio- demographic characteristics including age, religion, smoking status, and medical history. In identifying the at-risk drinking and alcohol use disorders, receiver operating characteristic (ROC) curve and area under the ROC (AUROC) curve analyses for each screening tool were investigated. The differences between areas among the three screening tools were evaluated using comparisons of paired ROC curves. The sensitivity, specificity, positive predictive value, and negative predictive value of each screening tool were investigated for at-risk drinking and alcohol use disorders. SPSS ver. 13.0 (SPSS Inc., Chicago, IL, USA) and MedCalc Statistical Software ver. 10.0 (MedCalc Software, Mariakerke, Belgium) were used for statistical analysis. A P-value < 0.05 was deemed statistically significant. RESULTS 1. Socio-Demographic Characteristics and Drinking History of the Subjects The mean age ± SD of the subjects was 71.8 ± 5.5 years. Of the subjects, 151 (62.4%) practiced a religion, 161 (66.5%) were living with guardians, 54 (22.3%) were employed, 73 (30.2%) had a smoking habit, and 115 (47.5%) were on medication due to chronic illness. Regarding educational background of the subjects, Korean J Fam Med