The CAGE Questionaire

        The CAGE Questionaire is one of the most sensitive tests for alcohol dependence available, and can be administered in less than 3 minutes.  It consists of 4 questions:

        1.    C)ut back or C)ontrol:  "Have you ever attempted to cut back or control your drinking?"  Note that making attempts at complete abstinence or spending an inordinate amount of time and energy controlling one's intake of alcohol is indicative of a problem.
        2.    A)ngry or A)nnoyed:  "Have you ever been angry or annoyed by anything anyone said about your drinking?"
        3.    G)uilt:    "Have you ever felt guilty about your drinking?"
        4.    E)ye opener:  "Have you ever needed an eye opener?"  An eye opener is a drink taken usually early in the morning following a binge to avoid withdrawal.  (Many patients will give you a blank look when you ask them this question, so be prepared to put it into terms they can understand.  I count any tremulousness ("have you ever gotten `the shakes'?") as a positive "E.")  This is usually a sign of physiological dependence.

Scoring:    3/4 = highly likely patient has alcohol dependence; 4/4 = virtually guaranteed.
    The sensitivity of the test (ability to detect true alcoholism given a certain number of positive responses) DECLINES as the number of positive responses increases.  The specificity, on the other hand, declines.
    For example, if someone answers 1 question positively, the test has a sensitivity of 85% for alcoholism.
    However, if one answers all 4 questions negatively, the probability of that person NOT being an alcoholic is 89%.  In other words, the specificity of the CAGE is about 89%.

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