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Old 06-26-2010
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Poison The Validity of CAGE questionnaire in identifying alcohol abuse

The CAGE type of questions are used to identify alcohol abuse in a patient, however, when I notice these questions are somehow confusing for me.
For example, if a person is an active alcoholic and this habit is egosyntonic for him he will be happy with this habit and would probably answer No to the first three question and possibly Yes to the last question which is " Have u taken an eye opener during the morning ?" and even a person may be abusing alcohol and not necessarily take an eye opener during the morning. So as amongst the CAGE questions a Yes answer to two or more of them lead a physician to suspect alcohol abuse, what if a person is abusing alcohol and answers No to all question.

Don't u think that simply asking about the frequency and amount of alcohol intake is a good way to identify alcohol abuse?
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Old 06-26-2010
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I disagree I think it's good

You asked me the type, frequency, amount, and duration. I told you that I drink 3-5 glasses of Wine on most of the days since 10 years. Now, what do you get from that, am I alcoholic? Does alcohol affect my life?

The CAGE questionnaire is an attempt to find out the effect of alcohol on patient's life (hence trying to find chronic alcoholism). If I am drinking everyday yet I have no social, interpersonal, job, family, ..etc problems then am not alcoholic.

Regarding the C and the G;
No matter how adamant alcoholics are with their drinking habits they must at some point thought to Cut down or feel Guilty about it. This is specially true if alcohol is affecting their life.

Regarding the A;
It's not about if the patient is Annoyed by his/her drinking habit. It's about being Annoyed when other people talk to them about too much drinking. Think of it, when you were a child weren't you annoyed when your mother ask you to stop staying up late or stop playing video games too much. I bet you were.

Regarding the E;
Yes, I agree with you. The Eye Opener is perhaps the most sensitive of all four questions.

The CAGE is trying to avoid a categorical "NO" if you ask directly the patient "Is alcohol affecting your life?". We are trying to ask indirect questions trying to gauge the situation. It was found to have 71% sensitivity in one of the meta analysis done by the BMJ, here's the link
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Old 06-28-2010
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Arrow DSM IV Criteria of Alcoholism

The DSM IV states that there should three out of the following eight points before we can diagnose alcoholism.

  1. Continued drinking despite physical or psychological consequences caused or exacerbated by alcohol.
  2. Neglect of other activities.
  3. Inordinate time spent drinking and recovering.
  4. Drinking more or over longer period than intended.
  5. Inability to control drinking.
  6. Tolerance (more drinking needed to achieve the same effects).
  7. Withdrawal symptoms upon cessation of alcohol.
  8. Drinking to avoid or relieve withdrawal symptoms.
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