Screen by asking women two questions:
- "Have you ever had a drinking problem?"
- "When was your last drink?"
(Perceived history of drinking problem and/or last drink within 24
hrs has 91.5% sensitivity, 89.7% specificity and a positive predictive
value of 69.4%27)
Screen with CAGE
CAGE is a four-item questionnaire
representing the terms: Cut back,
and Eye-opener. For women, one or
more positive responses may indicate a problem with alcohol.
Ask the following:
- Have you ever felt the need to reduce the level of your alcohol consumption?
- Have people ever annoyed you with their criticisms of your drinking
- Have you ever felt guilty while you were drinking?
- Have you ever started the day with a drink either to wake yourself
up, in order to relax, or to cure a hangover?
From: Ewing, J.A.(1984) Detecting alcoholism: the
CAGE questionnaire. JAMA, 252:1905-1907.
DSM IV Diagnostic Criteria for Alcoholism
Alcoholism may be defined if at least three of these seven symptoms occur
during one year:
- Neglect of other activities: social, occupational or recreational
activities are given up or reduced because of alcohol use.
- Excessive use: Alcohol is consumed in larger amounts over a longer
period than intended.
- Impaired control: Ongoing or unsuccessful attempts to cut down or
control alcohol consumption.
- Persistence of use: Alcohol consumption is continued despite knowledge
of having a persistent or recurrent physical or psychological problem
that is likely caused or exacerbated by alcohol.
- Large amounts of time spent in alcohol related activities: A great
deal of time is spent in activities necessary to obtain, use or recover
from the effects of alcohol.
- Withdrawal: Withdrawal symptoms, such as nausea, sweating, shakiness,
and anxiety when alcohol use is stopped after a period of heavy drinking.
- Tolerance: The need for increasing amounts of alcohol to feel its
Interventions in Clinical Settings
Women are more likely than men to seek help for drinking and alcohol-related
problems from medical and mental health clinics than alcohol treatment
Do assessment of every patient for risk factors as well as drinking habits.
Ask about desire to change current drinking pattern in any patient who
is at risk. Women are more likely to respond positively to interventions
from providers than men are.
Evaluate stage in self-change process:
- Pre-contemplator (no desire to quit, denies problem)
- Contemplator (thinking about)
- Action (making behavior change)
- Maintenance (maintaining positive change)
Link intervention with appropriate stage of change:
- Pre-contemplator: Plant the seed-crises related to drinking
may be used as windows of opportunity to motivate positive behavior
- Contemplator: Provide education about adverse impact of drinking,
and resources for support. Assist with goal setting. List pros and cons
of drinking and not drinking to determine readiness to act.
University of Washington Medical Center
Women's Health Care Center