CAGE questionnaire (CAGE-AID): primarily used for brief screening for alcohol abuse but has been adapted to include drugs. Ask your patients these four questions and use the scoring method described below to determine if substance abuse exists and needs to be addressed. Item 3 is asked first and classifies over half of respondents as either nonhazardous or hazardous drinkers. 2008. Sigvardsson S, Bohman M, Cloninger CR. Accessed: March 4, 2016. Arch Gen Psychiatry. Bergström JP, Helander A. By itself, the CAGE questionnaire is not an adequate screening for alcohol problems.The CAGE questionnaire is less reliable when given after asking questions on frequency. Saitz R, O'Malley SS. Without a lead in question, the CAGE does not distinguish between current and past drinking problems. 2004. It can be self-administered or be provided by a family doctor or other health care providers.The CAGE questionnaire is utilized to test for AUD or alcohol use disorder in adults. Dobie DJ, Kivlahan DR, Maynard C, Bush KR, Davis TM, Bradley KA. Replication of the Stockholm Adoption Study of alcoholism. November 2007. 337(24):1705-14. 2010. 1992 Nov. 49(11):876-80. New York, NY: McGraw-Hill; 1992. Available at http://www.medscape.com/viewarticle/817472. 2004 Aug. 113(3):440-50. [25] and men younger than 65 years should consume no more than 4 drinks on any one occasion and no more than 13 standards drinks per week. Please confirm that you would like to log out of Medscape. N Engl J Med. Ruidavets JB, Ducimetiere P, Evans A, Montaye M, Haas B, Bingham A. 65(3):441-8. Finally, it is less effective when attempting to detect less severe AUD and its discriminate ability to determine less severe from more serious AUDs is problematic. [Medline]. [Medline]. As with other instruments, any positive response to the CAGE should prompt further alcohol use discussion and assessment (Mayfield et al., 1974; Kitchens, 1994). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 28: Substance Abuse and Mental Health Services Administration (SAMHSA). J Clin Psychiatry. Baer JS, Sampson PD, Barr HM, et al. [Medline]. [Medline]. for: Medscape. Schuckit MA, Smith TL. Rosner S, Hackl-Herrwerth A, Leucht S, Vecchi S, Srisurapanont M, Soyka M. Opioid antagonists for alcohol dependence. It … 2005 Nov. 37(11):10-2, 14, 16-7; quiz 18-9. Ethnic and sex bias in primary care screening tests for alcohol use disorders. CDC. Consequently, a direct series of questions answered truthfully may fail to distinguish those who drink heavily from those who drink moderately because the responses from both groups may tend to be the same. Ann Intern Med. Comparison of the combined marker GGT-CDT and the conventional laboratory markers of alcohol abuse in heavy drinkers, moderate drinkers and abstainers. 352(6):596-607. Biol Res Nurs. Centers for Disease Control and Prevention. Alcohol and public health. Confirmatory cross-fostering analysis. Medical Diagnosis and Treatment of Alcoholism. JAMA Intern Med. Moreover, since four out of every five patients tend to screen negative for hazardous and harmful drinking, clinicians need an efficient detection method of identifying relevant patients needing alcohol intervention. Nursing Care Plans. 2001 Jan-Feb. 36(1):2-10. Ault, A. Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse: U.S. Preventive Services Task Force Recommendation Statement. Alcohol Research & Health. The American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder. Anderson P. WHO Reports 3 Million Alcohol-Related Deaths in 2016. JAMA. Medscape Medical News. Alcohol use disorders identification test (AUDIT). 2002 Dec. 26(12):1823-32. NAZNIN ESPHANI MD, EDUARDO BRUERA MD, in Cancer Pain, 2006. Brief physician advice for problem alcohol drinkers: A randomized controlled trial in community-based primary care practices. [Medline]. Ask about previous alcohol problems, prior treatment for detoxification, or participation in a rehabilitation program. Available at http://www.medscape.com/viewarticle/813817. “Yes” answers to two or more questions indicate a clinically significant alcohol problem (sensitivity has been measured at 0.78 to 0.81, specificity at 0.76 to 0.96), and positive screening suggests the need for further evaluation. Washington, DC: Society of General Internal Medicine; 1993. 1999 Nov. 156(11):1758-64. Medication treatment of different types of alcoholism. Perhaps this lack of an in-depth history is why Backer and Walton-Moss (2001) found that fully 20–25% of all patients with alcohol-related problems were treated medically for the symptoms of alcoholism rather than for the condition itself, and that a diagnosis of alcohol abuse was never made in almost one-fourth of all alcoholics seen for medical treatment. J Gen Intern Med. [Medline]. Sommers MS, Savage C, Wray J, Dyehouse JM. [Medline]. Arch Gen Psychiatry. Drug harms in the UK: a multicriteria decision analysis. Medscape Medical News. Council on Scientific Affairs, American Medical Association. Biomarkers of alcoholism: an updated review. This website also contains material copyrighted by 3rd parties. It does not provide information about quantity, frequency, or pattern of drinking. National Strategy for Suicide Prevention 2012: Overview. Elizabeth G. Baxley MD, ... Kathryn J. Trotter RN, MSN, CNM, FNP, in Family Medicine Obstetrics (Third Edition), 2008. Substance use disorders in patients with posttraumatic stress disorder: a review of the literature. MLO Med Lab Obs. University of North Carolina at Cahpel Hill, CAGE is an internationally used assessment instrument for identifying alcoholics. Accessed: January 10, 2012. Thus, a pragmatic approach for primary care clinicians may be to use AUDIT-C as a prescreening tool to quickly filter out negative cases, and then administer the remaining seven AUDIT questions to the smaller pool of positive cases to provide an accurate and differential assessment of alcohol-related risk or harm. BMJ. MacKillop J, Few LR, Stojek MK, Murphy CM, Malutinok SF, Johnson FT, et al. If the patient answers questions on the CAGE questionnaire or AUDIT affirmatively, following up with additional questions about circumstances and reasons is important (see Additional questions). BMJ. CAGE Substance Abuse Screening Tool Directions: Ask your patients these four questions and use the scoring method described below to determine if substance abuse exists and needs to be addressed. Search. Mohammed Issa, ... Ajay D. Wasan, in Practical Management of Pain (Fifth Edition), 2014, CAGE questionnaire (CAGE-AID): primarily used for brief screening for alcohol abuse but has been adapted to include drugs.72, Short Michigan Alcoholism Screening Test (SMAST-AID): also adapted to include drugs.72, Prescription Opioid Abuse Checklist: based on DSM-III-R parameters.54, Prescription Drug Use Questionnaire (PDUQ): developed by Miotto and colleagues and includes 42 items to be administered by trained clinicians.73, Substance Use Questionnaire: capable of differentiating between chronic pain patients and heroin street abusers.58, Opioid Risk Tool (ORT): categorizes patients into low (score of 3 or lower), moderate (score of 4 to 7), or high (score of 8 or higher) risk for aberrant drug-related behavior.74, Screening Tool for Addiction Risk (STAR) questionnaire: developed by specialists in both pain and addiction medicine. Med Clin North Am. A score of 5+ indicates hazardous or harmful drinking. [Medline]. Alcohol Alcohol. Volpicelli JR, Alterman AI, Hayashida M, O'Brien CP. Psychosomatics. ), Annoyed (Have people annoyed you by criticizing your drinking? US Department of Health and Human Services. Nevertheless, a recent review of AUDIT and its shorter variants reported that the shorter tools have relatively good psychometric properties and that AUDIT-C in particular was nearly as accurate as the full AUDIT. Because of its longevity of use and brief, easy to remember questions, the applicability of the CAGE to identify alcohol abuse and dependence has been studied alone compared to other screening instruments (Buchsbaum et al., 1991, 1992b; Fleming and Barry, 1991a; Chan et al., 1994; Brown and Rounds, 1995; Morton et al., 1996; Volk et al., 1997a; Cherpitel, 1998; Rumpf et al., 1998; Steinbauer et al., 1998). The CAGE does have limitations as a sole screening assessment of alcohol abuse and dependence. Lancet. AJ Gordon, ... DA Fiellin, in Comprehensive Handbook of Alcohol Related Pathology, 2005. Pharmacological management of alcohol withdrawal: A meta-analysis and evidence-based practice guideline. JAMA. Curr Med Res Opin. Heinz A, Reimold M, Wrase J, et al. [Medline]. Regard one or more positive responses to the CAGE-AID as a positive screen. Unhealthy alcohol use. Have people annoyed you by criticizing your drinking? World Health Organization. Efficacy of the alcohol use disorders identification test as a screening tool for hazardous alcohol intake and related disorders in primary care: a validity study. Gender, age, frequency of obesity, cigarette use, diabetes, and number of levels fused were compared between the 2 cohorts using χ 2 test. SAFE-T Pocket Card: Suicide Assessment Five-Step Evaluation and Triage for Clinicians. Alcohol Alcohol. Pescosolido BA, Martin JK, Long JS, Medina TR, Phelan JC, Link BG. Spitzer RL, Kroenke K, Williams JB. September 27, 2018; Accessed: October 2, 2018. Biochemical markers of alcoholism. [Medline]. Contribution of excessive alcohol consumption to deaths and years of potential life lost in the United States. JAMA. Deaths while intoxicated. [Medline]. 167(6):630-9. [Medline]. Niemelä O. Biomarkers in alcoholism. Arria AM, Caldeira KM, Kasperski SJ, Vincent KB, Griffiths RR, O'Grady KE. The CAGE Questionnaire (Table 8-3)23 is a brief, clinician-administered tool used to screen for alcohol problems in many clinical settings. Hietala J, Koivisto H, Anttila P, Niemelä O. Sinclair JD. 338(9):592-602. 2018 Nov 13. He served as the founding director of the Bowles Center for Alcohol Studies, where he developed the CAGE questionnaire. Women should consume no more than 3 standard alcohol drinks on any one occasion and no more than 7 drinks per week Alcohol consumption, binge drinking, and early coronary calcification: findings from the Coronary Artery Risk Development in Young Adults (CARDIA) Study. For instance, one study found a 53% sensitivity of the CAGE to screen for combined diagnoses harmful drinking, alcohol abuse, and alcohol dependence (Rumpf et al., 1997). Th e CAGE is the briefest of all the instruments used for assessment, with each letter of "CAGE" representing one item. Available at http://www.who.int/substance_abuse/publications/global_alcohol_report/msb_gsr_2014_1.pdf?ua=1. 1996 Mar. [Medline]. CAGE questionnaire (Table 5-6): The CAGE questionnaire was developed in 1970 and remains one of the most reliable and easy screening instruments for the detection of alcoholism.35 A single affirmative answer on this screening should alert the provider to the possibility of alcohol abuse, although most studies using the CAGE survey have used two positive answers as the threshold for further evaluation.30 The validity of this instrument has not been determined within a prenatal population. Laboratory measures of alcohol (ethanol) consumption: strategies to assess drinking patterns with biochemical measures. 1996 Mar. [Medline]. O'Malley SS, Rounsaville BJ, Farren C, et al. Brooks M. Alcohol remains a leading cause of premature death. Bisson et al. Stewart and Richards (2000) write, “A patient who answers yes to two or more of these questions probably abuses alcohol; a patient who answers yes to one question should be screened further” (p. 56). 1997 Jul. 2003 Dec. 98 Suppl 2:81-91. The CAGE test is a straightforward alcoholism screening test, used by many professionals in the alcohol addiction field. Browse. 2014 Jun 26. 1997. Alcohol Clin Exp Res. 365(9458):519-30. 292(12):1433-9. Fast alcohol screening test – a two-stage screening procedure based on four of the original AUDIT items. 1997 Dec 11. CAGE has been translated into several languages. 4. National Institute on Alcohol Abuse and Alcoholism. If opiates seem the appropriate treatment, only a sufficient quantity should be supplied to allow the patient pain relief for the period until the history can be verified—normally one or two days worth of medication only. [Medline]. [Medline]. 163(14):1695-704. Have you ever felt bad or guilty about your drinking? N Engl J Med. CAGE is an acronym for Cut, Annoyed, Guilty, and Eye-Opener (see the questions below). 2013 Nov 4. [Medline]. 1997. 60(4):377-85. prenatal use, based on … CAGE is an easy to use, international screening test for identifying patients who are experiencing drinking and potential alcohol problems. The instrument includes consequences related to drug abuse (without being specific about the drug); it is most useful in settings where drug-related problems are not the patient's chief complaint. [Medline]. Miller (2001) reports that two simple questions asked of substance abusers have an 80% chance of diagnosing substance abuse: “In the past year, have you ever drunk or used drugs more than you meant to?” and, “Have you felt you wanted or needed to cut down on your drinking or drug abuse in the past year?” Miller reports that this simple approach has been found to be an effective diagnostic tool in three controlled studies using random samples and laboratory tests for alcohol and drugs in the blood stream following interviews. Dr. Hayeri is a former Research Fellow, Division of MSK Imaging at University of California, Irvine Medical Center, Orange, CA, and Dr. Tehranzadeh is Chief of Radiology at Long Beach VA and Professor Emeritus and Vice Chair of Radiology, Department of Radiological Sciences, University of California, Irvine Medical Center, Orange, CA. Catherine A. Haighton, ... Eileen F.S. Questions on the instrument are all geared to life situations among older adults that may have acted as catalysts for excessive alcohol use. This finding supports the concern that short questions may not be accurate in diagnosing substance abuse and that diagnosis requires an in-depth social, emotional, and medical history in which the guidelines of the DSM-IV provide direction for the types of historical and medical issues one might look for. [Full Text]. [Medline]. Thun MJ, Peto R, Lopez AD, Monaco JH, Henley SJ, Heath CW Jr. Alcohol consumption and mortality among middle-aged and elderly U.S. adults. Cases that utilized structural allograft and synthetic cages were identified via CPT codes. Nery FG, Stanley JA, Chen HH, Hatch JP, Nicoletti MA, Serap Monkul E, et al. Accessed: December 16, 2013. [Medline]. 1998 Feb 26. [Medline]. Sood B, Delaney-Black V, Covington C, et al. Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (eye opener)? History of treatment in a drug or alcohol rehabilitation facility is a significant predictor of ongoing addiction with a positive predictive value of 93% and a negative predictive value of 5.9%.75. A decade of change in public reactions to schizophrenia, depression, and alcohol dependence. [Medline]. In other studies, with two positive answers, the CAGE increases its sensitivity from 21 to 94% (with specificities of 77–97%) (Bush et al., 1987; Buchsbaum et al., 1991; Fleming and Barry, 1991a; Chan et al., 1994; Brown and Rounds, 1995; Steinbauer et al., 1998). Accessed: November 13, 2013. The CAGE questionnaire, named after its four questions, is one such example that may be used to screen patients quickly in a clinical encounter. de Beaurepaire R, Lukasiewicz M, Beauverie P, Castéra S, Dagorne O, Espaze R, et al. Cassels C. Anticonvulsant Promising for Alcohol Dependence. We use cookies to help provide and enhance our service and tailor content and ads. At a score of 8 or more out of a possible 40, the ability of AUDIT to detect genuine excessive drinkers (sensitivity) and to exclude false cases (specificity) is 92 and 94%, respectively. Stewart and Richards (2000) suggest that four questions from the CAGE questionnaire are predictive of alcohol abuse. 2010 Nov 12. From 1970 to 1984, 17 reports had already been published using the CAGE questionnaire, but it was the JAMA article 1 that called it to wide attention. The T-ACE is scored by assigning two points to an affirmative response on the tolerance (T) question and one point each to the others. 2000 Sep. 2(3 Pt 1):191-5. Am Fam Physician. Alcohol Clin Exp Res. Mar 3 2014. [Full Text]. [Medline]. The CAGE questionnaire is best used in a clinical setting as part of a general clinical history taking and should not be preceded by any questions about alcohol intake because its sensitivity is dramatically enhanced by an open-ended introduction. 129(5):353-62. 2018 Jan 1. Accessed: December 12, 2014. Medscape Medical News. September 2006. 2015 Nov. 49 (5):e73-9. [Medline]. Nunes EV. 19(3):200-4. Item responses on the CAGE are scored 0 or 1, with a higher score an indication of alcohol problems. For this reason, several shorter versions of the AUDIT have been developed including the following: AUDIT-C – the first three (consumption) items of the full AUDIT. Other drinking considered hazardous is any use of alcohol by children, teens, by those with a personal or family history of alcohol dependence, women who are pregnant or breastfeeding, and use before or during situations requiring attention or skill (e.g., driving). 314(7078):420-4. Washington, DC: American Psychiatric Association; 2013. Addict Behav. A 21-year longitudinal analysis of the effects of prenatal alcohol exposure on young adult drinking. Vaillant GE. Enoch MA, Goldman D. Problem drinking and alcoholism: diagnosis and treatment. Epidemiology of DSM-5 Alcohol Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions III. 278:144-151. 2002 Feb 1. 2013 Nov 4. 161(5):423-33. J Abnorm Psychol. 45(8):953-61. Malone SM, Iacono WG, McGue M. Drinks of the father: father's maximum number of drinks consumed predicts externalizing disorders, substance use, and substance use disorders in preadolescent and adolescent offspring. 2014 Jun 26. Create. If the subject answers “yes” to five or more questions, a drug abuse disorder is likely. Naltrexone in the treatment of alcohol dependence. [Medline]. Reus VI, Fochtmann LJ, Bukstein O, Eyler AE, Hilty DM, Horvitz-Lennon M, et al. Have you ever felt you should cut down on your drinking? 2015 Aug. 72 (8):757-66. Correlation of stable elevations in striatal {micro}-opioid receptor availability in detoxified alcoholic patients with alcohol craving: a positron emission tomography study using carbon 11-labeled carfentanil. Medscape Medical News. Pectus carinatum, sometimes called pigeon chest, is a non-life-threatening condition. [Medline]. Eye-opener: Have you ever had a drink first thing in the morning (Eye-opener) to steady your nerves or get rid of a hangover? This report presents an overview of a national strategy designed to guide suicide prevention activities over the next decade. Family transmission and heritability of externalizing disorders: a twin-family study. Arch Gen Psychiatry. Garbutt JC, Kranzler HR, O'Malley SS. 2010 Nov 6. [Medline]. The name CAGE is an acronym formed by taking the first letter of key words (cut down, annoyed, guilty, eye opener) from each of the four screening questions: Have you ever felt you should cut down on your drinking? In addition, they do not clearly differentiate between hazardous, harmful, and dependent drinking. On physical examination, look for “stigmata” of drug or alcohol abuse, or both: icterus, track marks, spider angioma, hepatomegaly, tremor, or mild peripheral neuropathy. 5:e544. The CAGE Framework identifies the Cultural, Administrative, Geographic, and Economic differences between the various countries that companies should address and take care of whilst working on and crafting international strategies. JAMA Intern Med. Alcohol Involvement in Accidental Death, Homicide, and Suicide. Neumann T, Spies C. Use of biomarkers for alcohol use disorders in clinical practice.

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