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Alcohol:
Alcohol Screening and Brief Intervention with the CAGE

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Adapted from The Physicians Guide to Helping Patients with Alcohol Problems.


Step. I:  Ask About Alcohol Use

  1. How much alcohol do you drink?

    If the patient does not drink, stop here. If the patient does drink, go to Step II.



Step II:  Assess consumption level

  1. What is the number of drinks per week, per occasion?

    1 drink = 1½ oz liquor, 4 oz table wine, one regular beer, 1 wine cooler


  2. Perform CAGE questionnaire

    Have you ever tried to Cut back?
    Do others Annoy you when they talk to you about your drinking?
    Does your drinking ever make you feel Guilty?
    Do you ever need an Eye-opener when you wake up?


  3. Assessment

    If consumption is:
          Men: >10 drinks per week or >2 per occasion
          Women: >6 drinks per week or > 1 per occasion
    OR
          Score 1 or more on CAGE

    then go to Step III



Step III.  Assess level of severity of alcohol-related problems

  1. At-risk drinking

    Drinking at levels above the limits noted above

    Drinking in high risk situations; drinking to cope with depression, stress, insomnia, personal problems

    Go to Step IV


  2. Problem drinking

    1-2 responses on CAGE in past year

    Evidence of alcohol-related medical or behavioral problems

    Go to Step IV


  3. Dependence

    3-4 positive responses on CAGE in past year

    One or more symptoms: Compulsion to drink, impaired control, relief drinking, withdrawal symptoms, increased tolerance

    Go to Step IV



Step IV.  Advise Appropriate Action

  1. Action for alcohol dependence / Action for at-risk drinking

    Advise that abstinence should be goal; advise to cut down or quit.

    If patient is not willing to accept referral, suggest a second opinion from a substance abuse professional.

    Brochure: How to Cut Back on Your Drinking

    Go to Step V


  2. Action for problem drinking

    Advise to cut down or quit.

    Set a drinking goal.

    Brochure: How to Cut Back on Your Drinking

    Refer to DrinkWise Program 1-800-222-5145, Employee Assistance Program (if appropriate), or Alcoholics Anonymous.



    3. Step V.  Monitor Patient Progress

    1. At-risk and problem drinkers:

      Offer continued support at each visit.

      Refer to DrinkWise Program 1-800-222-5145, Employee Assistance Program (if appropriate), or Alcoholics Anonymous.

    2. Alcohol dependent patients:

      Communicate with treatment specialist.

      Monitor and treat alcohol-related physical problems.

      Monitor lab tests.

      If patient is not willing to accept referral, suggest second opinion from a substance abuse professional.


    These protocols are provided by DrinkWise of the University of Michigan Health System. Preparation of these guidelines was funded by a grant from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) through its Center for Substance Abuse Prevention (CSAP).

    References:
    1. Medical Consequences, Tenth Special Report to the U.S. Congress on Alcohol and Health, National Institute for Alcohol Abuse and Alcoholism (NIAAA), Washington, DC, pp. 197-282, 2000.


    2. Fleming, M, Cotter, F, and Talboy, E. Training Physicians in Techniques for Alcohol Screening and Brief Intervention, U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, Washington, DC, 1997.


    3. Alcohol and Crime: An analysis of National Data on the Prevalence of Alcohol Involvement in Crime. Report prepared for Assistance Attorney Generals National Symposium on Alcohol Abuse and Crime, Washington, DC: U.S. Department of Justice, 1998.


    4. Vitiello, MV. "Sleep, Alcohol and Alcohol Abuse." Addict Biol (2):151-158, 1997.


    5. Piette, JD, Barnett, PG, and Moos, RH. "First-time Admissions with Alcohol-related Medical Problems: A 10-year Follow-up of a National Sample of Alcoholic Patients." Journal of Studies on Alcohol 59(1):89-96, January 1998.


    6. Gerke, P, Hapke, U, and Rumpf, HJ. "Alcohol-related Diseases in General Hospital Patients." Alcohol & Alcoholism 32(2):179-84, March-April 1997.


    7. Missed Opportunity: The National Survey of Primary Care Physicians and Patients on Substance Abuse. The National Center on Addiction and Substance Abuse at Columbia University (CASA), New York, 2000.


    8. Bethell, Christina. Development of Measures of Health System Performance in the Early Identification and Reduction of Alcohol-Related Problems. FACCT, Inc., Portland, OR. February 2000.
  
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