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Screening tests to identify problem drinkers

OCT 2011

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Several screening tests have been developed to assess whether a person might have a drinking problem. Among these are the CAGE and AUDIT tests, as well as a questionnaire from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).

If either of these test results suggests that you have an alcohol problem, contact your doctor, a psychotherapist, a substance abuse rehabilitation program, or a self-help group.

The CAGE test

The simplest is the CAGE test, so named because the first letters of a key word in each question spell "cage."

  1. Have you ever felt you should Cut down on your drinking?

  2. Have people Annoyed you by criticizing your drinking?

  3. Have you ever felt Guilty or bad about your drinking?

  4. Have you ever had a drink first thing in the morning to steady your nerves, get rid of a hangover, or as an Eye-opener?

If you responded "yes" to any one of these questions, you may have a drinking problem. If you responded "yes" to more than one question, it's highly likely that a problem exists.

AUDIT

The World Health Organization developed the Alcohol Use Disorders Identification Test (AUDIT) to help physicians identify harmful or hazardous drinking patterns in their patients.

How often do you have a drink containing alcohol?

0 = never
1 = monthly or less
2 = 2–4 times a month
3 = 2–3 times a week
4 = 4 or more times a week

How many drinks containing alcohol do you have on a typical day when you are drinking?

0 = none
1 = 1–2
2 = 3–4
3 = 5–6
4 = 7–9
5 = 10 or more

How often do you have six or more drinks on one occasion?

0 = never
1 = less than monthly
2 = monthly
3 = weekly
4 = daily or almost daily

How often during the past year have you found that you were unable to stop drinking once you had started?

0 = never
1 = less than monthly
2 = monthly
3 = weekly
4 = daily or almost daily

How often during the past year have you failed to do what was normally expected of you because of drinking?

0 = never
1 = less than monthly
2 = monthly
3 = weekly
4 = daily or almost daily

How often during the past year have you needed a first drink in the morning to get going after a heavy drinking session?

0 = never
1 = less than monthly
2 = monthly
3 = weekly
4 = daily or almost daily

How often during the past year have you had a feeling of guilt or remorse after drinking?

0 = never
1 = less than monthly
2 = monthly
3 = weekly
4 = daily or almost daily

How often during the past year have you been unable to remember the night before because you had been drinking?

0 = never
1 = less than monthly
2 = monthly
3 = weekly
4 = daily or almost daily

Have you or someone else been injured as the result of your drinking?

0 = never
2 = yes, but not in the past year
4 = yes, in the past year

Has a relative, doctor, friend, or health professional been concerned about your drinking or suggested you cut down?

0 = never
2 = yes, but not in the past year
4 = yes, in the past year

Scoring

Add up the numbers for each response to get your total score. A score of 8 or more suggests that you may have a drinking problem and indicates the need for more in-depth assessment.

What are symptoms of an alcohol use disorder?

(from Rethinking Drinking, a publication of the National Institute on Alcohol Abuse and Alcoholism)

See if you recognize any of these symptoms in yourself. In the past year, have you

  • had times when you ended up drinking more, or longer, than you intended?

  • more than once wanted to cut down or stop drinking, or tried to, but couldn't?

  • more than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?

  • had to drink much more than you once did to get the effect you want? or found that your usual number of drinks had much less effect than before?

  • continued to drink even though it was making you feel depressed or anxious or adding to another health problem? or after having had a memory blackout?

  • spent a lot of time drinking? or being sick or getting over other aftereffects?

  • continued to drink even though it was causing trouble with your family or friends?

  • found that drinking — or being sick from drinking — often interfered with taking care of your home or family? or caused job troubles? or school problems?

  • given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?

  • more than once gotten arrested, been held at a police station, or had other legal problems because of your drinking?

  • found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure? or sensed things that were not there?

If you don't have any of the symptoms above, then staying within low-risk drinking limits will reduce your chances of having problems in the future. If you do have one or more of these symptoms, then alcohol may already be a cause for concern. The more symptoms you have, the more urgent the need for change. A health professional can look at the number, pattern, and severity of symptoms to see whether an alcohol use disorder is present and help you decide the best course of action.