Young Il Ryou, et al: Alcohol-screening Instruments in Elderly Male Drinkers Table 3. Cutoff points and performance of screening instruments for identifying alcohol use disorder. % (n) Cutoff points Sensitivity Speciﬁcity PPV NPV AUDIT ≥ 10 95.7 (44/46) 83.2 (163/196) 57.1 (44/77) 98.8 (163/165) ≥ 11 91.3 (42/46) 90.8 (178/196) 70.0 (42/60) 97.8 (178/182) ≥ 12 87.0 (40/46) 92.9 (182/196) 74.1 (40/54) 96.8 (182/188) SMAST-G ≥ 3 78.3 (36/46) 57.7 (113/196) 30.3 (36/119) 91.9 (113/123) ≥ 4 73.9 (34/46) 76.5 (150/196) 42.5 (34/80) 92.6 (150/162) ≥ 5 58.7 (27/46) 89.3 (175/196) 56.3 (27/48) 90.2 (175/194) CAGE ≥ 1 100.0 (46/46) 31.6 (62/196) 25.6 (46/180) 100.0 (62/62) ≥ 2 87.0 (40/46) 63.3 (124/196) 35.7 (40/112) 95.4 (124/130) ≥ 3 58.7 (27/46) 86.7 (170/196) 50.9 (27/53) 89.9 (170/189) PPV: positive predictive value, NPV: negative predictive value, AUDIT: Alcohol Use Disorder Identiﬁcation Test, SMAST-G: Short Michigan Alcoholism Screening Test-geriatric version, CAGE: cut down, annoyed, guilty, eye-opener. The optimal cut-off score of the AUDIT in screening for alcohol use disorders was 11 points (where the sum of sensitivity and specificity values was maximal) with sensitivity of 91.3%, specificity of 90.8%, positive predictive value of 70.0%, and negative predictive value of 97.8%. The optimal cut-off value of the SMAST-G in screening for alcohol use disorders was 4 points, with sensitivity of 73.9%, specificity of 76.5%, positive predictive value of 42.5%, and negative predictive value of 92.6%. The cut- off score of the CAGE in screening for alcohol-use disorders was 2 points, with sensitivity of 87.0%, specificity of 63.3%, positive predictive value of 35.7%, and negative predictive value of 95.4% (Table 3). DISCUSSION It is important to identify patients with alcoholism in primary care settings so that they can receive proper treatment. However, it would be better to screen problem-drinking patients at earlier stages to foster prevention. As at-risk drinking in the form of continuous drinking rather than developed alcoholism is often found in elderly people, screening tools that effectively identify drinking problems are required.17) The present study chose the AUDIT, CAGE, and SMAST-G questionnaires as screening tools for at-risk drinking and alcohol use disorders and investigated each tool’s AUROC and optimal cut-off score. Korean J Fam Med In the present study, the AUDIT showed the greatest AUROC value in screening for at-risk drinking in the elderly. This may be attributed to the fact that, in contrast to the SMAST-G and CAGE questionnaires, the AUDIT contains items assessing the frequency of drinking and the amount of alcohol consumed as a means of assessing heavy drinking or binge drinking. Based on the results of this study, the cut-off score for the AUDIT for screening at-risk drinking in males aged ≥ 65 years, was 7 points and higher. This score differs from 12 points, the cut-off point identified by Kim et al.12) and presented in their study on adult Korean males. The difference in cut-off scores likely reflects the drinking habits of elderly problem drinkers, who tend to consume a certain amount of alcohol on a continuing basis rather than engaging in occasional binge drinking.17) Additionally, the difference in cut-off scores may have been resulted from the modified AUDIT questions used in the current study. More specifically, due to the changes in the concentration of Soju, consuming a bottle of Soju was scored as 3 points (7 standard drinks) for AUDIT question number 2 in the previous study, whereas it was scored as 1 point (4 standard drinks) in the current study. Similarly, consuming a bottle of Soju (7 units in Soju cups) was considered to be binge drinking on question number 3 in the previous study but not in the current study, resulting in an overall decrease in respondents’ drinking scores. Also, regarding the cut- off score of the AUDIT in screening for alcohol use disorders, the present study found 11 points to be an optimal cut-off score in Vol. 33, No. 3 May 2012 | 131