Screening for Drinking Disorders in the Elderly Using the CAGE Questionnaire

Buchsbaum, David G.; Buchanan, R; Welsh, Josephine A.; Centor, Robert M.; Schnoll, Sidney H.

doi:10.1111/j.1532-5415.1992.tb01956.x

Cited by 174 publications

(107 citation statements)

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“…A score of 2 or higher (CAGE X 2) is usually considered to be a positive screen for moderateto-severe alcohol abuse and/or dependence. 14 The participants also answered about use of tobacco and illicit substances (marijuana, cocaine, and crack).…”

Section: Methodsmentioning

confidence: 99%

Mood disorder, anxiety, and suicide risk among subjects with alcohol abuse and/or dependence: a population-based study

Wiener

Moreira

Zago

et al. 2017

Rev. Bras. Psiquiatr.

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Objective: To evaluate the prevalence of alcohol abuse and/or dependence in a population-based sample of young adults and assess the prevalence of comorbid mood disorders, anxiety, and suicide risk in this population. Methods: This cross-sectional, population-based study enrolled 1,953 young adults aged 18-35 years. The CAGE questionnaire was used to screen for alcohol abuse and/or dependence, with CAGE scores X 2 considered positive. Psychiatric disorders were investigated through the structured Mini International Neuropsychiatric Interview (MINI). Results: Alcohol abuse and/or dependence was identified in 187 (9.60%) individuals (5.10% among women and 15.20% among men). Alcohol abuse and/or dependence were more prevalent among men than women, as well as among those who used tobacco, illicit drugs or presented with anxiety disorder, mood disorder, and suicide risk. Conclusion: These findings suggest that alcohol abuse and/or dependence are consistently associated with a higher prevalence of psychiatric comorbidities, could be considered important predictors of other psychiatric disorders, and deserve greater public heath attention, pointing to the need for alcohol abuse prevention programs.Keywords: Alcohol abuse and/or dependence; anxiety; mood disorder; depression; suicide risk IntroductionAlcohol consumption is highly prevalent worldwide and has numerous negative consequences for health and quality of life, especially in the young population. 1 Alcohol use disorders (AUDs) are among the most frequently diagnosed disorders, with a 12-month prevalence rate of 8.5%. 2 In the United States alone, according to the 2013 National Survey on Drug Use and Health, 37.9% of young adults reported binge drinking (four or more drinks for women and five or more drinks for men on an occasion) at least once in the past 30 days. 3 Moreover, studies have shown a higher prevalence of cigarette smoking or drug abuse among subjects who engage in heavy or frequent binge drinking. [3][4][5] AUDs are highly comorbid with mood and anxiety disorders in adults and are associated with substantial societal and personal costs. In a study conducted by Grant et al., among adults seeking treatment for an AUD, 40.69% and 33.3% were diagnosed with at least one current comorbid mood disorder and anxiety disorder, respectively. 6 The diagnosis of current mood or anxiety disorders among individuals with AUD is challenging, because many symptoms of intoxication, for example, resemble those of mood and anxiety disorders. 7 In addition to mood disorders and anxiety, other serious problems that can develop in people with AUDs include violent behavior and suicide attempts. 8 Alcoholics are 60 to 120 times more likely to attempt suicide compared to the general population. 9 Furthermore, studies demonstrate that 85 out of every 100 individuals who complete suicide had comorbid depression and/or alcoholism. 10 Individuals with AUDs should be evaluated for the risk of suicide whenever they present with depressive symptoms, 11 Psiquiatria. 2018;40:1-5 Br...

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Section: Methodsmentioning

confidence: 99%

Mood disorder, anxiety, and suicide risk among subjects with alcohol abuse and/or dependence: a population-based study

Wiener

Moreira

Zago

et al. 2017

Rev. Bras. Psiquiatr.

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“…Most previous studies of the AUDIT and CAGE have evaluated these instruments as intervieweradministered questionnaires. 1,[4][5][6][7][8][9][10][11][12][13]30,36 Three studies of interviewer-administered CAGE questionnaires in elderly VA populations similar to ours found the sensitivity of the CAGE (Ն2) for DSM-III-R lifetime alcohol abuse or depen- dence to be 78% to 82%. [10][11][12] Our sensitivity for the selfadministered CAGE (Ն2) compared with the same comparison standard was 53% (95% confidence interval [CI] 44%, 61%).…”

Section: Discussionmentioning

confidence: 99%

“…27 After questions about alcohol consumption, interviewers administered the alcohol module of a computerized version of the Diagnostic Interview Schedule (C-DISR, Interview Manager, version 2.0). 28 This standardized instrument, used in previous studies of alcohol screening questionnaires, 1,4,6,29,30 provides a lifetime diagnosis of DSM-III-R alcohol abuse or dependence, as well as the time of the most recent alcohol-related symptom and the number of symptoms in the past year. The entire interview usually lasted 10 to 20 minutes (range, 5 to 40 minutes).…”

Section: Interview Measuresmentioning

confidence: 99%

“…2 The 4-item CAGE questionnaire is a brief, effective screening questionnaire for alcohol abuse and dependence. 1,[3][4][5][6][7][8][9][10][11][12][13] However, the CAGE asks about alcohol problems "ever" experienced, so many patients who respond "yes" to the CAGE questions may have had alcohol problems only in the distant past. A more useful questionnaire screen would predominantly identify patients with "active" alcohol abuse or dependence, who meet diagnostic criteria, and have had at least one alcohol-related symptom in the past year.…”

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confidence: 99%

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Screening for problem drinking

et al. 1998

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OBJECTIVE:To compare self-administered versions of three questionnaires for detecting heavy and problem drinking: the CAGE, the Alcohol Use Disorders Identification Test (AUDIT), and an augmented version of the CAGE. DESIGN:Cross-sectional surveys. SETTING: Three Department of Veterans Affairs general medical clinics.PATIENTS: Random sample of consenting male outpatients who consumed at least 5 drinks over the past year ("drinkers"). Heavy drinkers were oversampled. MEASUREMENTS:An augmented version of the CAGE was included in a questionnaire mailed to all patients. The AUDIT was subsequently mailed to "drinkers." Comparison standards, based on the tri-level World Health Organization alcohol consumption interview and the Diagnostic Interview Schedule, included heavy drinking ( Ͼ 14 drinks per week typically or Ն 5 drinks per day at least monthly) and active DSM-IIIR alcohol abuse or dependence (positive diagnosis and at least one alcohol-related symptom in the past year). Areas under receiver operating characteristic curves (AUROCs) were used to compare screening questionnaires. MAIN RESULTS:Of 393 eligible patients, 261 (66%) returned the AUDIT and completed interviews. For detection of active alcohol abuse or dependence, the CAGE augmented with three more questions (AUROC 0.871) performed better than either the CAGE alone or AUDIT (AUROCs 0.820 and 0.777, respectively). For identification of heavy-drinking patients, however, the AUDIT performed best (AUROC 0.870). To identify both heavy drinking and active alcohol abuse or dependence, the augmented CAGE and AUDIT both performed well, but the AUDIT was superior (AUROC 0.861). CONCLUSIONS:For identification of patients with heavy drinking or active alcohol abuse or dependence, the self-administered AUDIT was superior to the CAGE in this population.

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“…Then, Bush subsequently studied the CAGE using medical inpatients (4). Consequently, Buchsbaum applied the CAGE on elderly General Medicine outpatients (5). Up-to-date, CAGE has been administered to a variety of other patient groups such as college students and general populations for measuring the dimensions of their alcohol problems (6,7).…”

Section: Methodsmentioning

confidence: 99%

Analysis of cut-off points for the CAGE Questionnaire for alcohol abuse

Taner

Güveniş

2001 Conference Proceedings of the 23rd Annual International Conference of the IEEE Engineering in Medicine and Biology Society

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Abstract--Physicians are in a key position to diagnose and treat patients with alcohol-related problems. Early interventions before the onset of these problems may decrease the costly health care as well as the psychological and social burden of alcoholism on the patient as well as the society. At this stage, the need for physicians to screen alcohol users systematically with a simple, effective and accurate instrument is becoming more critical. Being an easy-to-administer, low-cost, sensitive and specific screening tool, CAGE Questionnaire meets these criteria and offers the promise of raising the identification rate of alcoholic patients substantially. However, CAGE has still been reported to miss nearly half of risk-drinkers because of the incorrect setting of the high likelihood criterion for the presence of alcoholism. Therefore, there is a need to determine a clinically significant cut-off point above which CAGE will be diagnostic. This article aims to identify these optimal work-points for three different clinical settings by employing a step-wise application of statistical indices such as the area under the ROC curve, leveling factor and Youden index. This method will enable health care providers to determine the optimal CAGE scores for different treatment settings and significantly decrease the number of unrecognised at-risk drinkers.Keywords -Alcoholism, CAGE Questionnaire, cut-off, leveling factor, Youden index I. INTRODUCTIONAlcoholism is a chronic, progressive and potentially fatal disease characterized by continued use of alcohol resulting in emotional, social, physical, or legal problems. These problems take an enormous emotional toll on individuals as well as their families, and are a great financial expense to health care systems and society in purely economic terms (1).Early detection and identification of alcohol-related problems may alleviate ongoing medical and social problems due to drinking and reduce the future risks and costs from excessive alcohol use. This can only be possible by using a powerful screening test that coverts drinking problems and discriminates between at-risk and risk-negative alcohol users with high diagnostic accuracy. With proper screening for these conditions, physicians can identify individuals in a patient population who have begun to develop or who are atrisk for developing alcoholism.Once they are diagnosed, patients can be treated as outpatient or inpatient depending on the complication of their alcohol-related problems. Those patients with mild-tomoderate withdrawal symptoms for uncomplicated problems and psychological stability are usually treated as 'outpatients' and assigned to support groups, counseling, or both. On the otherhand, patients with a coexisting medical or psychiatric disorder and those who may harm themselves or others, who have not responded to conservative treatments, or who have a disruptive home environment receive an 'inpatient' treatment in a general or psychiatric hospital or in a center dedicated to treatment of alcohol abuse. Since in...

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Screening for Drinking Disorders in the Elderly Using the CAGE Questionnaire

Abstract: The CAGE can effectively discriminate elderly patients with a history of drinking problems from those without such a history. The chosen cut-off score should consider the prevalence of drinking problems in the population being tested.

Cited by 174 publications

References 17 publications

Mood disorder, anxiety, and suicide risk among subjects with alcohol abuse and/or dependence: a population-based study

Mood disorder, anxiety, and suicide risk among subjects with alcohol abuse and/or dependence: a population-based study

Screening for problem drinking

Analysis of cut-off points for the CAGE Questionnaire for alcohol abuse

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