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Alcohol and Women:
Diagnostic Tools and Interventions

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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, Annoyed, Guilty, and Eye-opener. For women, one or more positive responses may indicate a problem with alcohol.

Ask the following:

  1. Have you ever felt the need to reduce the level of your alcohol consumption?
  2. Have people ever annoyed you with their criticisms of your drinking habits?
  3. Have you ever felt guilty while you were drinking?
  4. 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 effects.


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 settings.

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 change.

  • 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.

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