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Director's Comments Transcript: Alcoholism Screening 12/15/2008

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Greetings from the National Library of Medicine and

Regards to all our listeners!

I'm Rob Logan, Ph.D. senior staff National Library of Medicine substituting this week for Donald Lindberg, M.D, the Director of the U.S. National of Medicine.

Here is what's new this week in MedlinePlus.

To listen to Dr. Lindberg's comments, click herelisten

A simple, four question survey -- that could help physicians screen for alcoholism -- is underutilized nationally, according to a commentary recently published in the Journal of the American Medical Association.

The CAGE questionnaire, first published in JAMA 25 years ago, asks four questions:

  • Have you ever felt the need to cut down your drinking?
  • Have you ever felt annoyed by criticism of your drinking?
  • Have you ever had guilty feelings about drinking?
  • Have you ever taken a morning eye opener?

If a person answers 'yes' to two or three of the questions, this suggests a high probability of alcoholism and if a person answers 'yes' to all four questions, then, alcoholism is strongly suggested.

The letters 'C'….'A'….'G'….'E'.. are to help physicians remember the questions so they can be used easily in patient screening. 'C' stands for 'cut down,' 'A' stands for 'annoyed,' 'G' stands for 'guilty' and 'E' stands for 'eye opener.'

Dr. Charles O'Brien, the author of the recent JAMA commentary about CAGE, notes the test, which was developed in North Carolina, was validated by 17 studies published between 1970 and 1984. The test works even though it does not provide any information about the frequency, quantity, or patterns of drinking, explains Dr. O'Brien, who is from the University of Pennsylvania. The JAMA study, published in 1984, reviewed the evidence and reported the test's ease of use in clinical settings.

Dr. O'Brien provides some context; the CAGE test is designed to screen, not diagnose, alcoholism. There have been other screening tests developed since CAGE, but Dr. O'Brien notes some contain more than 20 questions and are less likely to be used by physicians in routine patient visits.

To backup for a moment: the short time physicians have to meet with patients means screening instruments need to be brief, simple for the patient to understand, and easy for a physician to administer.

Given this background and the CAGE test's simplicity, Dr. O'Brien asks why only a little more than half of the 30 percent of primary care physicians, who say they screen for substance abuse, use CAGE.

To Dr. O'Brien, this and other findings suggest that most primary care physicians are ignoring a simple, helpful, widely available test. Worse yet, he adds many primary care physicians fail to screen for alcoholism, and sometimes overlook it altogether.

Dr. O'Brien describes a study that found primary care physicians were prone to substitute diagnoses, such as ulcers, or irritable bowel syndrome, even when there was pressing evidence of alcoholism. He notes another study where a cataract disease that is linked to alcoholism was rarely diagnosed as alcoholism by primary care physicians.

Dr. O'Brien writes and we quote: 'abuse of alcohol or other drugs is frequently the underlying cause of other diseases about which physicians find less discomforting to inquire' (end of quote).

Dr. O'Brien adds the underlying tragedy of this pattern of oversight is alcoholics can obtain help from widely available therapy, medications, and self help programs that help patients curb drinking, improve their quality of life, and sometimes save a marriage and a family.

Dr. O'Brien concludes physicians need better education about alcoholism plus other addictions and need to be more confident about their ability to screen for substance abuse problems. He hopes reminding physicians about the underused CAGE test is a step in the right direction.

Meanwhile, there is comprehensive information about alcoholism on that provides background information and an array of other, helpful resources.

If the CAGE survey is less helpful to you,'s alcoholism health topic page provides two websites that offer additional screening tools for alcoholism. There are surveys provided by the Substance Abuse and Mental Health Services Administration and by the Mayo Foundation for Medical Education and Research. Both are in the 'health check tools' section of MedlinePlus'gov's alcoholism health topic page.'s alcoholism health topic page also contains information about treatment, coping, specific conditions (such as withdrawal and workplace substance abuse problems), related issues (such as alcoholism and liver disease, and characteristics of adult children of alcoholics), and specific information for: men, women, seniors, and teens.

The latest research findings, directories of helpful organizations, among other resources, additionally are provided on MedlinePlus' alcoholism health topic page. To find it, type 'alcoholism' in the search box on's home page, then, click on 'alcoholism (National Library of Medicine).'

Finally, contains other home pages devoted to alcoholism related issues. These include: alcohol and youth, alcohol consumption, cirrhosis, fetal alcohol syndrome, and substance abuse problems.

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