4 question screening for alcohol problems
The CAGE questionnaire was developed in 1968 at North Carolina Memorial Hospital to combat the paucity of screening measures to detect problem drinking behaviors. The original study, conducted in a general hospital population where 130 patients were randomly selected to partake in an in-depth interview, successfully isolated four questions that make up the questionnaire.
The CAGE questionnaire, the name of which is an acronym of its four questions, is a widely used screening test for problem drinking and potential alcohol problems. The questionnaire takes less than one minute to administer, and is often used in primary care or other general settings as a quick screening tool. It’s free, has a extensive research base, and been studied in multiple populations. The CAGE questionnaire does not have a specific intended population, and is meant to find those who drink excessively and need treatment. It is insufficient to make a diagnosis of Alcohol Use Disorder, as it lacks a question about clinically significant functional impairment or distress.
The recommendation of the National Institute of Alcohol Abuse and Alcoholism is that all patients who drink alcohol should be screened with the CAGE questionnaire. The population were screening without indication, have a high prevalence or significant risk of Alcoholism, is generally pregnant women, college students, arrested and incarcerated persons especially those with DWI and domestic violence offenses.
Scores of two or higher is the typical cut-off for a positive screening, however some clinicians also consider the “eye opener” question as highly concerning for unhealthy drinking behavior, even if all other questions are answered negatively, as this can suggest physiologic dependence. An abnormal or positive screening may raise suspicion about the presence of an alcohol use problem, while a normal or negative result should suggest a low probability of an alcohol use problem. A positive screening should be followed up with a in depth clinical interview or a additional questionnaires such as the Alcohol Use Disorders Identification Test (AUDIT).
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Journal of Drug Education 1992, 22 (4): 337-52
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