CAGE questionnaire

CAGE questionnaire
· The CAGE Questionnaire was developed in 1970 by Dr John A Ewing. It is a combination of 4 simple questions that can be used for the screening of patients for alcoholism.
· The questions focus on Cutting down, Annoyance by criticism, Guilty feeling, and Eye-openers. The acronym "CAGE" helps the physician to recall the questions.
· The 4 questions are "Have you ever:
(1) felt the need to cut down your drinking;
(2) felt annoyed by criticism of your drinking;
(3) had guilty feelings about drinking; and
(4) taken a morning eye opener?
· A positive response to the CAGE interview is not a diagnostic of alcoholism. A positive response should, however, alert the interviewer to the high likelihood of the presence of alcoholism.
· A total of two or more positive answers indicate a positive history of alcoholism.
· Studies have shown that many physicians miss the diagnosis of alcoholism.
· This questionnaire has to be completed as part of the patient’s medical history, so that the patient is not feel defensive.
· The questions refer to the whole life of the patient and not for this month or for the past year.
· It does not provide information about quantity, frequency, or pattern of drinking. These questions should be asked after the CAGE questions for the assessment to be valid.
· There are other tests such as the Michigan Alcohol Screening Test(MAST), which consists of 25 questions that inquire about drinking behaviour or adverse consequences of alcohol drinking. Another is the Alcohol Use Disorders Identification Test, which was designed to be sensitive to signs of hazardous and harmful drinking as well as alcohol dependence. However, but given the reluctance of busy primary care physicians to use the brief CAGE questions, the longer instruments are not likely to achieve broad acceptance
· One option adopted by some clinicians is to use the CAGE as a portable memorized instrument along with standard questions about quantity and frequency of drinking. The clinicians can then administer the Alcohol Use Disorders Identification Test or the Michigan Alcohol Screening Test, which can be self-administered for patients who require further investigation and possible referral to specialized treatment.
· The CAGE questions move the discussion toward the behavioural effects of the drinking rather than toward an isolated number of drinks per day.

References:

http://jama.ama-assn.org/cgi/content/full/300/17/2054

http://jama.ama-assn.org/cgi/data/300/17/2054/DC1/1

http://www.palliative.org/PC/ClinicalInfo/AssessmentTools/CAGE.PDF

Michigan Alcohol Screening Test (MAST) questions

http://www1.alcoholcme.com/?id=1776:8953

Alcohol Use Disorders Identification Test(AUDIT) questions

http://www.mentalneurologicalprimarycare.org/downloads/primary_care/11-2_audit_questionnaire.pdf