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Primary care physicians are well situated to identify patients with substance abuse problems and motivate them to seek appropriate assistance, but active programs are the exception. A study in a community setting was undertaken to assess the CAGE (the first letters of key words in a series of four questions about drinking: cut down; annoyed; guilty; and eye-opener), instrument in the routine screening for alcohol problems in both new and established patients. The screening process identified subjects for a pilot evaluation of a motivational interview designed to encourage problem-solving behavior. This article focuses on the screening results and the use of the CAGE instrument. During June and July of 1990, 687 patients of two primary care physicians belonging to a large group practice were asked to complete a health questionnaire that included the CAGE. Those who responded affirmatively to at least two of the four CAGE questions were requested to participate in follow-up assessment of problems associated with alcohol and health. The type and severity of alcohol problems experienced by patients who scored positive on the CAGE are described. Prevalence of a positive score on the CAGE was 8.6 percent with males, smokers, and blue collar and unemployed persons being more likely to score positive. The positive predictive value was .68. Primarily, persons with moderate alcohol problems were identified. Results show that the CAGE instrument is a useful screening device for identifying those with mild to moderate substance abuse problems, increasing the opportunity for intervention prior to serious medical complications. The instrument is easily administered, and has demonstrated relatively high levels of sensitivity and specificity. When combined with assessment and motivational interviews, the CAGE shows promise in the secondary prevention of substance abuse and related health problems.
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PMID:Screening for patients with alcohol problems: severity of patients identified by the CAGE. 148 31

The US Preventive Services Task Force recommended that physicians use the CAGE questions to screen patients for alcohol abuse. A similarly brief screening instrument for abuse of other drugs is needed. Two conjoint screening questionnaires for alcohol and other drug abuse were adapted from the CAGE questions and the Short Michigan Alcoholism Screening Test (SMAST). For 124 patients of an academic, community family practice, the conjoint questionnaires and their forerunners were compared with DSM-III-R diagnoses of substance use disorders as measured by the Diagnostic Interview Schedule-Revised (DIS-R). The SMAST and its conjoint analog exhibited low sensitivity. The CAGE Adapted to Include Drugs (CAGE-AID) was more sensitive but less specific for substance abuse than the CAGE, especially when a reduced criterion score was employed. The CAGE-AID was more sensitive than the CAGE for subjects of varying sex, income, and level of education, as well as most patterns of substance use disorders. The diminished specificity of the CAGE-AID may have been, at least in part, artifactual. The CAGE-AID holds promise for identifying primary care patients with alcohol and drug disorders.
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PMID:Conjoint screening questionnaires for alcohol and other drug abuse: criterion validity in a primary care practice. 777 30

In our study, 616 primary care physicians of eastern North Carolina were surveyed for screening practices for detection of alcoholism in their patient population. We defined primary care as Family Medicine, Internal Medicine, Obstetrics and Gynecology, Pediatrics and Psychiatry. We defined eastern North Carolina as the 29 counties that Pitt County Memorial Hospital serves. In our survey we found that eastern North Carolina is medically underserved as well as having less resources for referral and consultation. In response to the questionnaire, we found that most physicians agreed on some numerical value for drinks per day, social drinks, and drinks per week while pregnant. Values for drinks per week and weekend binges generally reflected significant tolerance for heavy drinking behavior. We also found that physicians of the same specialty commonly agreed on answers but when compared to other specialties they differed. Physicians preferred personal and clinical screening methods to questionnaires such as CAGE. Most physicians did not prescribe Antabuse but did suggest to their patients to cut down on drinking. Physicians felt that their patients needed more education and support from the community as well as intervention at an early age. We conclude that physicians should receive more education concerning alcoholism and substance abuse.
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PMID:Alcohol screening practices of primary care physicians in eastern North Carolina. 786 49

Substance abuse frequently accompanies and complicates serious traumatic brain injury (TBI). An important prerequisite to providing assistance to TBI patients is the ability to identify substance abuse accurately. The authors prospectively evaluated 10 consecutive admissions to a TBI program using four substance abuse screening tools: the CAGE questions, the Brief Michigan Alcohol Screening Test (BMAST), the Substance Abuse Subtle Screening Inventory, and the Addiction Severity Index. The CAGE questions and the BMAST were found to be easy to administer and very sensitive as well as specific for substance abuse in this population. The authors conclude that all patients with traumatic brain injuries should be screened for substance abuse by using either the CAGE questions or the BMAST.
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PMID:Screening patients with traumatic brain injuries for substance abuse. 804 35

The current study assessed whether perceived quality of life differed between alcoholics and non-alcoholics. Patients attending an urban-based hospital were screened for alcoholism using the CAGE questionnaire. Patients were recruited from an out-patient clinic setting as well as from an in-patient substance abuse unit. Quality of life scores were based on Chubon's (1987) Life Situation Survey. Results indicated that alcoholics experience a lower quality of life than their non-alcoholic counterparts regardless of setting; however, all patients reported experiencing poor life quality. The impact of alcoholism treatment programmes on patients already experiencing low quality of life is questioned.
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PMID:Quality of life of alcoholics and non-alcoholics: does excessive drinking make a difference in the urban setting? 813 98

In a large inner-city teaching hospital, only 28 percent of over 1000 consecutive hospital admissions received proper screening for diseases of substance abuse. Although the CAGE questions are currently considered the best screening test for quickly assessing an alcohol abuse history, not a single CAGE question was documented during our 23 day study. Of the 1010 patients in the study, 160 or 16% were found to be substance abusers. Of these, 57 (37%) were properly screened by the physician team and 8 (5%) received adequate follow-up treatment for their substance abuse by way of social service or psychiatric consultation, or documented counselling by their physician. Physicians are not adequately screening for the diseases of substance abuse, and are not appropriately evaluating and referring patients who are known to be substance abusers. Meaningful training of medical students and physicians is necessary to increase awareness and produce positive behavior change.
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PMID:The adequacy of screening, documenting, and treating the diseases of substance abuse. 820 77

Elderly people do use substances to alter mood and states of awareness. Detection is difficult because presenting symptoms are often those that are commonly associated with aging itself. All patients who present with symptoms of self-neglect, falls, cognitive and affective impairment, and social withdrawal should be screened for substance abuse. The CAGE and MAST, although not perfect, can be used. When abuse is found, the elderly should be treated as aggressively as their younger counterparts, with slow, careful detoxification and the use of some form of group therapy, such as AA.
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PMID:Recognition and treatment of substance abuse in the elderly. 846 37

Adolescents and young adults are among the highest users of alcohol and other drugs in the United States. One of the tools most commonly employed in screening for problem drinking and alcohol dependence is the CAGE questionnaire. Research has indicated, however, that not only may the CAGE be a poor detection device for identifying youthful substance abuse, but it may particularly lack strength in the detection of alcohol abuse by young women. The current study examined the predictive power of the CAGE relative to other common assessment indicators of youthful substance abuse in a sample of college students. It focused on the relative predictive power of the CAGE in detecting a high level of drinking-related problems. In addition, the interaction of gender and a positive CAGE score was included in the logistic regression analysis to test the hypothesis that the CAGE is predictive for men but not for women. Results suggest that the CAGE is a relatively weak predictor of alcohol-related problems in this sample of college students, and it lacks predictive power for detecting, problems in college women. Issues concerning substance-abuse assessment in young people are discussed, with special consideration given to gender differences.
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PMID:Predicting problem drinking in college students: gender differences and the CAGE questionnaire. 902 68

The Transtheoretical Stages of Change model hypothesizes that disadvantages of substance abuse must outweigh advantages before change occurs. This study examined whether substance-related sequelae predicted readiness to change scores. A total of 150 dually diagnosed patients were administered the CAGE questionnaire (CAGE is an acronym for questions about substance use: Cutting down, Annoyed by criticism, feel Guilty, Early morning usage), which was scored for mood and behavior symptoms; a checklist of 12 physical, intrapersonal, and environmental symptoms; and the Brief Readiness to Change questionnaire (RTC). Regression analyses suggested that more physical and mood symptoms were predictive of higher total RTC (R2 = .11); physical, mood, and behavioral symptoms were predictive of higher contemplation scores (R2 = .17), whereas fewer physical symptoms were predictive of higher precontemplation scores (R2 = .05). The results suggest that the relative severity of physical, mood, and behavior symptoms may be important factors related to the contemplation of change among dually diagnosed patients.
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PMID:Specific classes of symptoms predict readiness to change scores among dually diagnosed patients. 934 64

The objective of this study was to assess the perceptions and reported practices of osteopathic physicians in the diagnosis and treatment of addiction. Copies of survey questions were sent to the 344 members of the West Virginia Osteopathic Society. A total of 176 (51.2%) physicians responded; of these responses, 166 surveys were used for analysis. Respondents included 130 practicing physicians and 36 physicians in internship or residency training programs. Of those responding, 133 were men and 33 were women, and ages ranged from 24 to 81 years with a mean of 41.6 years. Respondents who were graduates of the West Virginia School of Osteopathic Medicine numbered 132 (79.5%), and 99 (59.6%) were in family practice. Characteristics most commonly attributed to addiction were a chronic nature and psychological or physical dependence. More than half of the test subjects did not consider addiction to be a primary disease independent of other factors or psychiatric conditions. Respondents reported a mean addiction prevalence of 20.4%, with the most common substances reported as tobacco, alcohol, and benzodiazapines, respectively. Individual prevalence reports varied from 0% to 95% (SD +/- 20.4%). The most commonly used diagnostic tools were the CAGE (Cut down, Annoyed, Guilty, and Eye-opener) test, DSM III-R (Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, revised) or DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) criteria, and quantity and frequency questions. Medical sequelae such as jaundice or emphysema were the most likely reasons for the respondents to address a substance abuse problem. For referral resources, respondents were most likely to use inpatient or outpatient treatment. A mean success rate of 27.7% was reported by the 133 physicians responding. The wide variance in reported prevalence and the low success rate reported in comparison to that demonstrated in published treatment studies indicate that there is a need for further education of both physicians in training and those presently in practice. Medical sequelae are frequently irreversible signs of late-stage addiction, and physicians should be urged to include such tools as the CAGE test in each regular physical to facilitate earlier intervention.
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PMID:Perceptions and reported practices of osteopathic physicians in diagnosing and treating addiction. 1052 83


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