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How to Use CAGE for Substance Abuse

Though many people are well acquainted with common signs of drug use, physicians, psychologists, and addiction specialists have the tools they use to determine whether or not a person’s drug use is a problem.

One of these methods is CAGE.

This simple questionnaire involves asking questions and tallying up a person’s answers. This lets specialists know whether or not someone needs help.

CAGE is a simple method that can let addiction specialists know if a person requires further assessments. But the National Institute on Drug Abuse says various screening tools are available to help people gain further insight into their drug or alcohol use.

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How CAGE Is Used to Diagnose Drug Abuse

As Healthline mentions, CAGE consists of four questions that can help doctors see if you are dependent on alcohol. The purpose of the questions is to be gentle with the person being questioned instead of being too direct about possible signs of alcohol misuse.

The acronym CAGE comes from the questions that should be asked of someone who may have an alcohol dependency. The questions are:

CAGE

  • Have you ever felt you should cut down on your drinking?
  • Have people annoyed you by criticizing your drinking?
  • Have you ever felt bad or guilty about your drinking?
  • Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (as an eye-opener)?

Doctors require you to answer CAGE questions with a yes or no. They then tally your answers. The general rule is that answering yes to two or more questions may point to possible alcohol dependency.

Some doctors also find the last question to be most important because it may show that you are experiencing withdrawal symptoms as a result of your alcohol use.

The point of CAGE is to allow people to discuss their alcohol misuse without feeling as if they have done something wrong. With the stigma of drug and alcohol dependence today, it is good to have methods that allow people to discuss their alcohol dependency without feeling judged.

When CAGE Is Most Useful

In an August 2014 case study, Occupational Medicine mentioned that it is best not to ask questions related to alcohol use before asking any questions from the CAGE questionnaire. This creates an environment that allows patients to feel less sensitive about CAGE questions once they hear them.

Doctors can feel free to ask follow-up questions after they have finished CAGE. Occupational Medicine says that CAGE has been compared to physical tests that look for signs of problem drinking or alcohol misuse.

In these comparisons, CAGE has been shown to accurately detect alcohol issues in men at rates between 68 and 93 percent. This is compared to tests that measure blood parameters and carbohydrate-deficient transferring (CDT).

CAGE is a great tool to help doctors discuss alcohol use in a way that does not make patients get defensive. However, it is limited to only one substance. Healthline mentions that the questionnaire has been adapted for drugs as well. In this iteration, it is referred to as CAGE-AID (adapted to include drugs).

CAGE vs. CAGE-AID and Other Adaptations

In a June 2016 publication, the Indian Journal of Medicine mentions that CAGE-AID also has been adapted for families and is called Family CAGE-AID.

The study mentions that using this test is important because:

  • If alcohol or drug misuse is caught early, less drastic measures such as an intervention can be effective.
  • Using a family version of CAGE-AID may be more useful in collectivist cultures, such as India, where family members can help an individual recognize a problem that is invisible to them.
  • Family CAGE-AID can also screen family members who do not use substances and check their stress levels or assist in diagnosis.
  • Family CAGE-AID may also assist in diagnosing a person who misuses alcohol but is not available for conversation.

When Other Methods Might Help

CAGE has great success in identifying problem drinking patterns in men, but Occupational Medicine mentions that it does not seem to be as effective for women.

It was not originally designed to detect the misuse of substances. It may also not be of use in situations where patients are getting primary care. Other tests may also be better at detecting people with dangerous drinking patterns. These include:

  • FAST. Known by its acronym, this is the Fast Alcohol Screening Test. This four-question screening is meant to detect drinking that could cause a person to experience physical or psychological damage.
  • AUDIT. The Alcohol Use Disorders Identification Test consists of 10 questions designed to screen for hazardous drinking patterns and dependence. The test is a bit more complicated and involves multiple choice questions that must be tallied. Men who take the test are reevaluated for problem drinking if they score 4 or higher, and women are further assessed if they score 3 or above. Higher scores generally mean that a person’s alcohol use is negatively impacting their life.

TWEAK. This test was created to identify problem or hazard drinking in pregnant women. It consists of five questions and addresses instances of blacking out.

Still, these methods address drinking. Similar methods exist for the misuse of other substances. The National Institute on Drug Abuse mentions various tools that can be used for adults, teens, and other substances, such as:

  • The Opioid Risk Tool. This is a self-administered test to detect drug use in adults.
  • TAPS. The Tobacco, Alcohol, Prescription medication, and other Substance use test can be used to ask questions about a variety of substances. It is meant for adults.
  • S2BI. Screening to Brief Intervention was designed for teens. It asks questions about both drugs and alcohol.
  • NIDA-Modified (NMASSIST). This is the NIDA Drug Use Screening Tool: Quick Screen. In its original form, it was created to detect troubling drug and alcohol use in adults and to be administered by a professional. However, forms have been adapted for teens or people who want to administer it themselves.
  • BSTAD. The Brief Screener for Alcohol, Tobacco, and other Drugs screens for drug and alcohol use. It was also created to be used in teens and can be administered by a clinician or self-administered by the patient.

The Substance Abuse and Mental Health Services Administration (SAMHSA) also provides a list of screening tools that can assist you if CAGE does not adequately address hazardous drinking or use of substances.

Still, the importance of CAGE is that it creates an environment where patients can discuss their alcohol use without feeling as if someone is accusing them of something.

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