CAGE Questionnaire Research Articles

Alcohol: use and related problems - prevalence among foreigners and the natives in Belarus

Materials and methods A total of 1517 respondents (172 foreigners and 1345 native Belarusians) from all major cities in Belarus enrolled for the survey. Standardized AUDIT, CAGE and MAST questionnaire including other alcohol-related questions were used as a measure. All three questionnaires were administered since it has been suggested that the CAGE might show less sensitivity, compared to the results of the MAST and AUDIT in some population [1,2]. The Student’s t and Pearson, c2 tests were employed for analysis of results.

The effect of alcohol use on academic performance of university students

Materials and methods Students (n = 46, mean age 21 yrs) from three major universities (Belarusian State Medical University, Belarusian State Agro-Technical University and Belarusian State National Technical University) in Minsk, Belarus agreed to participate in the randomized anonymous study. All participants received questionnaire containing the AUDIT, MAST, CAGE and other alcohol related questions. Examination scores of each participant were filled into the questionnaire on “Academic Performance” from their examination booklets and were controlled by our researcher, Dr. MO Welcome. Academic performances (the Grade Point Average and the effectiveness to sit for examinations) of all participants from the 1st to 6th semesters of university education were used as objective criteria for problems related with alcohol use. The Pearson c2 and Student’s t-tests were employed for analysis of results. The probability value for significance was set at p < 0.05.

Prevalence of Alcohol‐Related Problems in an Elderly Population and Their Association With Cognitive Impairment and Dementia

Studies investigating the association between alcohol use and cognitive disorders in the elderly population have produced divergent results. Moreover, the role of alcohol in cognitive dysfunction is not clear. The aims of this study were to estimate the prevalence of alcohol-related problems in an elderly population from Brazil and to investigate their association with cognitive and functional impairment (CFI) and dementia. A community-based cross-sectional study was performed. A sample of 1,145 elderly people was examined in 2 phases. Several instruments were utilized in the first phase: the CAGE questionnaire was used to identify potential cases of alcohol-related problems, and a screening test for dementia was used to estimate CFI. The CAMDEX interview (Cambridge Examination) and DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) criteria were used for the clinical diagnosis of dementia in the second phase. "Heavy alcohol use" (CAGE > or = 2) was found in 92 subjects (prevalence: 8.2%). It was associated with gender (males, p < 0.001), low education (only in females, p = 0.002), and low socioeconomic level (p = 0.001, in females; p = 0.002, in males). The Mini Mental State Examination exhibited a nonlinear relationship with alcohol-related problems in females; "mild-moderate alcohol use" (CAGE < 2) presented the highest score. A significant association between alcohol-related problems and cognitive dysfunction was found only in females. "Heavy alcohol use" was associated with higher CFI and dementia rates compared to "mild-moderate alcohol use" (p = 0.003 and p < 0.001, respectively). "Mild-moderate alcohol use" had a tendency of association with lower CFI and dementia rates when compared to "no alcohol use" (p = 0.063 and 0.050, respectively). Our findings suggest that alcohol use does not have a linear relationship with cognitive decline.

Continuing Medical Education Questions: January 2010

QUESTIONS: 1. Which of the following is true about alcoholic liver disease? A. It is an uncommon cause of liver disease. B. The spectrum of liver injury varies from simple steatosis to cirrhosis. C. Simple fatty liver disease due to alcohol is usually irreversible despite abstinence. D. Alcoholic hepatitis is never a life-threatening condition. 2. Which of the following best describes the use of questionnaires in screening for alcohol abuse/dependence? A. Questionnaires have less sensitivity then biochemical test in screening for alcohol abuse. B. The CAGE questionnaire was developed for outpatients and focuses on short-term drinking behaviors. C. The AUDIT screen has a higher sensitivity and specificity than shorter screening instruments. D. Screening for alcohol abuse/dependence is not important in the clinical setting. 3. Which one of the following statements is true regarding the treatment of alcoholic liver disease? A. In patients with severe disease with MDF score of ≥ 32, treatment with steroids or pentoxifylline is indicated. B. Abstinence does not play a significant role in the treatment of alcoholic liver disease because the injury is already done. C. Patients in acute alcoholic hepatitis should not be fed because nutrition during acute liver injury increases mortality. D. TNF inhibitors, such as infliximab and etanercept, in combination with steroids, have been shown to provide a significant mortality advantage compared to steroids alone.

Problem alcohol drinking in rural women of Telangana region, Andhra Pradesh

Background:This is the first ever study conducted to assess the prevalence of problem alcohol use in the rural women of Telangana region of Andhra Pradesh.Aims:To evaluate the prevalence of dependence and problem drinking, observe the factors that led to it and to monitor the effect of intervention in the form of psycho-education on their treatment seeking attitude.Materials and Methods:Cases were referred by the registrar from the Medicine Out-Patient Department using a three-item questionnaire for history of alcohol intake. Consecutive consenting female patients fulfilling the inclusion–exclusion criteria formed the sample. ICD-10 criteria and CAGE Questionnaire were used to assess dependence, problem drinking and co-morbid psychiatric illnesses. The socio-demographic data and the details regarding the nature and pattern of drinking and its complications were recorded using a semi-structured proforma. All patients were instructed to report at the end of 1 and 3 weeks for follow-up after a brief psycho-education regarding the problems of alcohol use.Results:Dependence was seen in 4.1% and problem drinking in 1%. Physical complications possibly due to alcohol were seen in 4.1% and psychiatric co-morbidity in 1%. Pregnancy drinking was recorded in 4.4%. Only 0.2% came for follow-up.Conclusion:To conclude, there is a perceptible degree of problematic use of alcohol in the rural women of this region. Yet, none of them were seeking psychiatric help. The soaring number of pregnancy drinking needs further exploration. The poor psychiatric follow-up leads us to conclude that in this sample the perception of alcohol problem is very low.

P01-335 - Interconfessional analysis of alcohol use and related problems: the Christians and Muslims

ObjectivesThe influence of religion on the rate of alcohol use can not be overemphasized. In recent times, some studies have suggested that the inter-religion differences in alcohol use might be fading away. And that closer relationship might exist between the Christian and Muslim societies, especially in a population where alcohol use has become part of the life of people. We analyzed the prevalence of alcohol use and related problems among Muslims and Christians in Minsk, Belarus.MethodsAfter the aims and objectives had been explained, 65 Christians and 70 Muslims agreed to participate in the anonymous and randomized study which was conducted among students at major four universities in Minsk, Belarus. All respondents were administered the AUDIT, CAGE and MAST questionnaire. Statistical analysis was performed using SPSS 16.0 version for Windows and the Pearson χ2.ResultsThe present study revealed that no differences in both the number of alcohol users and problem drinkers exist (according to the results of all three screening instruments) among the Christians and Muslims. Alcohol users were 67.7% Christians and 57.1% Muslims. Problem drinkers were 27.7 Christians and 34.3% Muslims.ConclusionThis study is an exceptional one where for both Christians and Muslims, the percentages (as well as the average scores) of alcohol users and problem drinkers were the same on the AUDIT, CAGE and MAST.

P01-333 - Alcohol problems among foreigners and the natives: a prevalence study in Belarus

BackgroundAlcohol use is a major public health problem and contributes to the burden of disease world-wide. The problem of alcohol use might defer among the natives and foreigners in a given cultural milieu.AimTo screen for the prevalence of alcohol use among the native Belarusians and foreigners.Materials and methods1517 respondents (172 foreigners and the rest native Belarusians) from different cities in Belarus enrolled for the study. Standardized questionnaire containing the AUDIT, CAGE, MAST and other alcohol-related questions were administered to all respondents. The Student's t and Pearson, χ2 tests were employed for analysis of results.ResultsAlcohol users were 90% native Belarusians and 62% foreigners. Problem drinkers were 16% native Belarusians and 30% foreigners. A significant increase (in approximately 2 times) in the rate of alcohol use after a 2-4 years stay in Belarus was noted among the foreigners (p&lt; 0.05).ConclusionThere is a significant difference in the pattern of alcohol use among the foreigners and native Belarusians. The rate of alcohol use and related problems is higher among foreigners, compared to the native Belarusians.

Estimating risk of alcohol dependence using alcohol screening scores

Brief alcohol counseling interventions can reduce alcohol consumption and related morbidity among non-dependent risky drinkers, but more intensive alcohol treatment is recommended for persons with alcohol dependence. This study evaluated whether scores on common alcohol screening tests could identify patients likely to have current alcohol dependence so that more appropriate follow-up assessment and/or intervention could be offered. This cross-sectional study used secondary data from 392 male and 927 female adult family medicine outpatients (1993-1994). Likelihood ratios were used to empirically identify and evaluate ranges of scores of the AUDIT, the AUDIT-C, two single-item questions about frequency of binge drinking, and the CAGE questionnaire for detecting DSM-IV past-year alcohol dependence. Based on the prevalence of past-year alcohol dependence in this sample (men: 12.2%; women: 5.8%), zones of the AUDIT and AUDIT-C identified wide variability in the post-screening risk of alcohol dependence in men and women, even among those who screened positive for alcohol misuse. Among men, AUDIT zones 5-10, 11-14 and 15-40 were associated with post-screening probabilities of past-year alcohol dependence ranging from 18 to 87%, and AUDIT-C zones 5-6, 7-9 and 10-12 were associated with probabilities ranging from 22 to 75%. Among women, AUDIT zones 3-4, 5-8, 9-12 and 13-40 were associated with post-screening probabilities of past-year alcohol dependence ranging from 6 to 94%, and AUDIT-C zones 3, 4-6, 7-9 and 10-12 were associated with probabilities ranging from 9 to 88%. AUDIT or AUDIT-C scores could be used to estimate the probability of past-year alcohol dependence among patients who screen positive for alcohol misuse and inform clinical decision-making.

Self-injurious behavior among Greek male prisoners: Prevalence and risk factors

Background Self-harm among prisoners is a common phenomenon. This study aims to estimate the prevalence of self-injurious behavior (SIB) among Greek male prisoners, record their motives and determine independent risk factors. Methods A self-administered, anonymous questionnaire was administered to 173 male prisoners in the Chalkida prison, Greece. The questionnaire included items on self-harm/SIB, demographic parameters, childhood history, family history, physical and mental disease, lifestyle and smoking habits, alcohol dependence (CAGE questionnaire), illicit substance use, aggression (Buss–Perry Aggression Questionnaire [BPAQ] and Lifetime History of Aggression [LTHA]), impulsivity (Barrat Impulsivity Scale-11) and suicidal ideation (Spectrum of Suicidal Behavior Scale). Univariate nonparametric statistics and multivariate ordinal logistic regression were performed. Results Of all the participants, 49.4% (95% CI: 41.5–57.3%) disclosed self-harm (direct or indirect). The prevalence of SIB was equal to 34.8% (95% CI: 27.5–42.6%). Most frequently, SIB coexisted with indirect self-harm (80.7%). The most common underlying motives were to obtain emotional release (31.6%) and to release anger (21.1%). At the univariate analysis, SIB was positively associated with a host of closely related factors: low education, physical/sexual abuse in childhood, parental neglect, parental divorce, alcoholism in family, psychiatric condition in family, recidivism, age, sentence already served, impulsivity, aggression, alcohol dependence, self-reported diagnosed psychiatric condition and illicit substance use. Childhood variables were particularly associated with the presence of diagnosed psychiatric condition. At the multivariate analysis, however, only three parameters were proven independent risk factors: self-reported diagnosed psychiatric condition, illicit substance use and aggression (BPAQ scale). Conclusion The prevalence of SIB is particularly high. Psychiatric condition, illicit substance use and aggression seem to be the most meaningful risk factors; childhood events seem only to act indirectly.

Psychoactive substances consumption in French fishermen and merchant seamen

The aim of this study is to assess tobacco consumption, nicotine dependence as diagnosed by Fagerström test, alcohol consumption, alcohol dependence as diagnosed by CAGE questionnaire and drug consumption in French seamen. Results are presented according to job category: fishermen and merchant seamen. French seamen were recruited from a stratified survey of 19 ports in France. Subjects completed a questionnaire during their annual medical check-up. The questionnaire covered demographic and professional items, tobacco, alcohol and drug consumption behaviour. Nicotine and alcohol dependence were, respectively, assessed by the Fagerström Test for Nicotine Dependence (FTND) and a French version of the CAGE questionnaire. A urine test was used to detect cannabis derivatives. Prevalence rates for current smoking and daily alcohol consumption were higher in fishermen than merchant seamen. The prevalence of nicotine dependence on FTND was likewise higher in fisherman smokers, who also showed more intense smoking behaviour. The category of seamen did not correlate with alcohol addiction, but differences in alcohol-related behaviour emerged between fishermen and merchant seamen. Prevalence of cannabis and other drug use was higher in merchant seamen, although the two categories of seaman did not differ with respect to recent use of cannabis. Demographic factors cannot fully explain these differences, as multivariate analysis showed significantly greater risks in marine fisheries. Alcohol and tobacco consumption are a major public health problem for seafarers. Fishermen seem to be more liable to high consumption. Working conditions may explain these differences.

Posttraumatic Stress Disorder and Male-Perpetrated Intimate Partner Violence

ALTHOUGH THE RELATIONSHIP BETWEEN POSTTRAUmatic stress disorder (PTSD) and aggression is generally well established within the literature, research investigating the relationship between PTSD and male-perpetrated intimate partner violence (IPV) has only begun to emerge. Preliminary findings suggest a link between trauma exposure, PTSD symptomatology, and maleperpetrated IPV, which may have important clinical implications for batterer intervention programs. To the extent that IPV associated with PTSD has an etiology distinct from non–PTSD-related IPV, prevention and intervention programs may need to be tailored to address the potentially unique IPV risk factors among men with PTSD. Because of the lack of research on the association of PTSD and IPV perpetrated by women, this Commentary will focus on male-perpetrated IPV. Most US studies examining the relationship between PTSD and male-perpetrated IPV have been conducted with male veterans. Findings from these studies indicate that male veterans with greater PTSD symptomatology often self-report higher levels of anger, hostility, aggressiveness, anger reactivity, and IPV perpetration than veterans without significant PTSD symptomatology. The association between PTSD and IPV perpetration has also been found among civilian men. Rosenbaum and Leisring found that civilian male batterers referred to a group batterers treatment program who met diagnostic criteria for PTSD based on the PTSD Checklist-Civilian Version self-reported greater generalized aggressivity and significantly higher rates of IPV perpetration on the Conflict Tactics Scale than civilian male batterers without PTSD. In a study examining IPV rates within a nonclinical civilian male sample recruited from a college campus, Jakupcak and Tull reported similar findings, with higher self-reported rates of IPV perpetration, trait and internal anger, and hostility found among civilian men with PTSD symptomatology compared with civilian men without PTSD symptoms. Prior research investigating the relationship between PTSD and aggression has often included PTSD as a single construct. However, findings from a 3-wave longitudinal study examining the course of PTSD symptoms over a 12-month period in young adults who experienced community violence highlight the importance of considering how the 3 PTSD symptom clusters differentially change over time, influence other PTSD symptoms, and affect behavior, including aggression. Although debate exists as to the nature and number of factors, PTSD is currently characterized by 3 distinct symptom clusters consisting of (1) reexperiencing symptoms (eg, nightmares, flashbacks); (2) avoidance symptoms (eg, avoidance of trauma-related stimuli); and (3) hyperarousal symptoms (eg, hypervigilance, exaggerated startle response). These 3 symptom clusters have been examined as they relate to aggressive behavior. Overall, hyperarousal symptoms appear to play an especially prominent role in the initiation of aggressive behavior. For example, in a study examining the association between aggression and each of the 3 PTSD symptom clusters among male Vietnam veterans participating in a larger multisite psychophysiological project on PTSD, Taft et al found hyperarousal symptoms to have the strongest positive relationship with aggressive behavior in comparison with the other 2 PTSD symptom clusters. Additionally, the authors found that hyperarousal symptoms were both directly related to aggression and indirectly associated with aggression through alcohol problems, as measured by the CAGE questionnaire for assessing alcoholism. Conversely, findings from the same study show that reexperiencing symptoms may not directly influence aggressive behavior, but may indirectly affect aggression via their positive relationship on physiological reactivity (ie, heart rate and skin conductance) to trauma cues and negative affect on alcohol problems. Mixed findings exist regarding the role of PTSD avoidance symptoms and subsequent aggressive behavior. A study comparing male Vietnam veterans seeking inpatient PTSD treatment with a mixed diagnostic group of male inpatient Vietnam veterans without PTSD found a positive relationship between avoidance/numbing symptoms and aggression when assessing PTSD symptom clusters using the brief Mississippi Scale for Combat-Related PTSD. However, additional evidence from the study by Taft et al suggests a potential negative association between avoidance/numbing

The Perceptions and Habits of Alcohol Consumption and Smoking Among Canadian Medical Students

The authors aim to quantify the extent, and to assess student perception, of alcohol and tobacco use among medical students at the University of Calgary, and the relationship of these attitudes to problem drinking (according to the CAGE questionnaire). A questionnaire was distributed to first-, second-, and third-year medical students attending the University of Calgary medical school. Of the 327 students enrolled, 175 of students responded to the questionnaire. Six percent of the students currently smoke while 24% of students reported cigarette smoking at some point in their life. Eighty-six percent of students currently drink, with a majority drinking fewer than 11 drinks per week. Fifteen percent of students were at an increased risk for problem drinking according to the CAGE questionnaire. An increased risk for problem drinking was significantly related to believing more strongly that getting drunk is acceptable on occasion and less strongly that increased alcohol has many negative health consequences, as well as feeling less in control of alcohol consumption. Medical students at the University of Calgary consume less alcohol and cigarettes than a comparable population. However, a high proportion of students are at risk for alcohol abuse according to the CAGE questionnaire. The results of this study suggest that although the quantity of alcohol consumed is not a substantial concern at this time, students might be at risk for future alcohol abuse.

Poor sleep quality and alcohol use problems among elderly Taiwanese aboriginal women

Little is known about sleep quality and alcohol use problems in the elderly minority population. This study aimed to identify a one-month prevalence of poor sleep quality and alcohol use problems among elderly Taiwanese aboriginal women and to examine the association between them. A cross-sectional survey with stratified random sampling was conducted in eight aboriginal communities in Taiwan. The 1261 elderly aboriginal women (response rate 84%) completed all assessments. Sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI), while the CAGE questionnaire was used to evaluate alcohol use problems. Of the study participants, 20.54% and 25.59% had poor sleep quality and alcohol use problems, respectively. Controlling for confounding factors, alcohol use problems were a risk factor for poor sleep quality (AOR = 1.44, p = 0.0433). Alcohol use problems were associated with three components of PSQI: sleep disturbances, subjective sleep quality, and daytime dysfunction. The elderly Taiwanese aboriginal women with problematic alcohol drinking experienced poorer sleep quality. Development of a program to reduce alcohol use problems might improve sleep quality among elderly Taiwanese aboriginal women.

Problem drinkng among patients attending primary healthcare units in Kampala, Ugana

Previous studies have shown that a large a number of primary health care patients have alcohol related problems and very few are detected and treated. Few studies have been done in developing countries on this topic. This study sought to determine the prevalence and detection of alcohol related problems in a Primary Health Care setting (PHC). in Kampala Uganda. 768 consecutive PHC patients in two PHC centers in Kampala, Uganda, were screened in a two stage procedure. After being asked if they drink alcohol they were interviewed by means of the CAGE questionnaire and a quantity/frequency questionnaire. Those who scored positive on the CAGE were further diagnosed for alcohol dependence using the DSM- IV diagnostic criteria. Of all patients, 17.4% scored above cut-off on the CAGE, 28.5% had a high risk drinking pattern and 9.5% had alcohol dependence. Among drinkers, drinking beyond safe limit was more common among men. Males and those aged between 35 to 44 years, were more likely to be CAGE positive and to be diagnosed with alcohol dependence. Only 27 out of 366 drinkers were asked about alcohol by the PHC professional. Males and high risk drinkers were more likely to be asked. Prevalence of alcohol problems was high and detection rate of alcohol related problems was low in this Ugandan setting. Training of PHC professionals in diagnosing and treating alcohol related problems is required.

α-Synuclein, alcohol use disorders, and Parkinson disease: A case–control study

Collaborative pooled analyses demonstrated that allele length variability of the dinucleotide repeat sequence within the α-synuclein gene promoter ( SNCA REP1) is associated with Parkinson disease (PD) worldwide. Other studies demonstrated that variability in the SNCA promoter is also associated with alcohol use disorders, but not consistently. Yet other studies demonstrated that alcohol use disorders are inversely associated with PD, but not consistently. The aim of this study was to clarify the patterns of association between REP1 genotype, alcohol use disorders, and PD. Cases were recruited from the Department of Neurology of the Mayo Clinic in Rochester, MN. The controls included unaffected siblings and unrelated controls. We assessed alcohol use via a structured telephone interview and screened for alcohol use disorders using the CAGE questionnaire. REP1 genotyping was performed using an ABI 3730XL platform. Odds ratios (ORs) and 95% confidence intervals (CIs) were determined using conditional logistic regression models. We recruited 893 case–control pairs. There was an increasing risk of PD with increasing SNCA REP1 allele length (OR 1.18 for each REP1 genotype score unit, 95% CI 1.02–1.35; p = 0.02). There was a decreasing risk of PD with increasing CAGE score ( p = 0.01). The association of REP1 score with PD remained significant after adjusting for CAGE score, and the association of CAGE score with PD remained significant after adjusting for REP1 score. There were no pairwise interactions. Our findings suggest that SNCA REP1 genotype and alcohol use disorders are independently associated with PD.

Alcohol problems and all-cause mortality in men and women: Predictive capacity of a clinical screening tool in a 21-year follow-up of a large, UK-wide, general population-based survey

Objective While the relation between alcohol consumption and mortality has been well explored, little is known about the link between alcohol problems and mortality in general population-based studies, particularly among women. This was the objective of the present study Methods In this prospective cohort study, 5333 non-abstaining individuals (2539 women) from the UK-wide Health and Lifestyle Survey (aged 42.9 years at study induction) completed the CAGE questionnaire of alcohol problems and participated in a medical examination in 1984/1985; they were then followed up for mortality experience until 2005. Results Alcohol problems at baseline were less common in women (2.4%) than in men (7.8%). A total of 21 years of follow-up gave rise to 1201 deaths. Elevated rates of mortality were evident in persons reporting symptoms of alcohol problems in comparison to those who did not. In gender-stratified analyses, alcohol problems were more strongly associated with mortality risk in women (age-adjusted hazards ratio: 2.25; 95% confidence interval: 1.22–4.12) than in men (1.49; 1.12–1.99), although this effect modification was not statistically significant ( P value for interaction=0.125). Controlling for a range of covariates—including socioeconomic position, co-morbidity (somatic and psychiatric), and alcohol intake—had essentially no impact on these associations. Conclusion The CAGE questionnaire may have some utility in routine health assessments in the general population.

The CAGE Questionnaire for Detection of Alcoholism

Four clinical interview questions, the CAGE questions, have proved useful in helping to make a diagnosis of alcoholism. The questions focus on Cutting down, Annoyance by criticism, Guilty feeling, and Eye-openers. The acronym “CAGE” helps the physician to recall the questions.How these questions were identified and their use in clinical and research studies are described.See PDF for full text of the original JAMA article.

Factors Affecting Hospital Length of Stay: Is Substance Use Disorder One of Them? A Study in a Greek Public Psychiatric Hospital

Comorbidity of psychiatric disorder and substance use disorder (SUD) is very common. Clinical experience says that comorbidity increases inpatient length of stay. We aimed to discover which factors affect length of stay for inpatients at a psychiatric department in a specialized mental hospital in a Greek urban area, and specifically whether SUD is one of them. All patients admitted over a 12-month period were given the CAGE questionnaire and that part of the EUROPASI questionnaire dealing with substance use. This was followed by a diagnostic interview to establish the final diagnosis in accordance with the DSM-IV criteria. Following this, the patients' characteristics in conjunction with their average length of stay were all evaluated statistically. A total of 313 patients were assessed. Present substance use disorder was identified in 102 individuals (32.6%). The principal substances involved in addiction or abuse were alcohol, cannabis, benzodiazepines, and opiates. Patients differed as to their cooperation with the medication regime. On the other hand, there was no statistical difference regarding the number of hospitalisations. Psychopathology was not found to play a direct role, as no one diagnosis correlated with length of stay. The factors found to affect length of stay in this psychiatric department were the length of time they had been mentally ill and cooperation in taking medication. It appears that SUD is not one of the factors affecting length of stay.

Alcoholism screening in patients with advanced cancer: impact on symptom burden and opioid use.

Alcoholism is a devastating disease that can cause patient and family suffering and is frequently underdiagnosed. Preliminary studies suggest that it is associated with increased symptom expression and opioid dose escalation. The CAGE questionnaire is a widely used tool for alcoholism screening. The purpose of this study was to determine the frequency and characteristics of patients who screen positive for alcoholism in a palliative care outpatient clinic (PCOC). We reviewed 665 consecutive charts of patients referred to the PCOC and collected data regarding age, gender, and type of cancer. For the first 100 consecutive CAGE positive (CAGE+) and 100 consecutive CAGE negative (CAGE-) patients, time from advanced cancer diagnosis (AC) to PCOC was calculated, and symptoms (Edmonton Symptom Assessment Scale, ESAS) and Morphine Equivalent Daily Dose (MEDD) were collected. CAGE was available for 598 of 665 (90%) patients. Of 598 patients, 100 (17%) were CAGE+. CAGE+ patients were younger (58 versus 60 years, p < 0.05), predominantly male (68% versus 47%, p < 0.0001), and with head/neck malignancies (24% versus 9%, p < 0.05). CAGE+ patients were referred earlier (5 +/- 27 months after AC, p < 0.0001). At baseline, pain, sleep, dyspnea, well-being, and total symptom distress were significantly worse among CAGE+ patients. Both groups showed similar improvement in symptoms. CAGE+ patients were more frequently on opioids upon referral (47/100 versus 29/100, p < 0.05) and follow-up (27/65 versus 16/68, p < 0.05). At follow-up, opioid doses did not show significant changes. Seventeen percent of the patients were CAGE+. These patients were referred earlier to palliative care, had more symptom expression, and were more frequently on opioids. The palliative care team successfully improved symptom control in both groups without opioid dose escalation.

Problem drinking and exceeding guidelines for 'sensible' alcohol consumption in Scottish men: associations with life course socioeconomic disadvantage in a population-based cohort study.

BackgroundWith surveys suggesting that exceeding guidelines for 'sensible' alcohol intake is commonplace, the health and social impact of modifying intake on a population level is potentially considerable. If public health interventions are to be successfully implemented, it is first important to identify correlates of such behaviours, including socioeconomic disadvantage. This was the aim of the present study.MethodsPopulation-representative cohort study of 576 men from the West of Scotland. Data on life course socioeconomic position were collected in 1988 (at around 55 years of age). Alcohol consumption patterns (detailed seven day recall) and problem drinking (CAGE questionnaire) were ascertained in 1990/2 (at around 59 years of age). A relative index of inequality was computed to explore the comparative strength of different indicators of social circumstances from different periods of the life course.ResultsSocioeconomic adversity in both early life and in adulthood was related to an increased risk of exceeding the weekly and daily alcohol guidelines, with adult indicators of socioeconomic position revealing the strongest associations. Of these, material indicators of socioeconomic deprivation in adulthood – car ownership, housing tenure – were marginally more strongly related to heavy alcohol intake and problem drinking than education, income and occupational social class. A substantial proportion of the influence of early life deprivation on alcohol intake was mediated via adult socioeconomic position. Similar results were apparent when problem drinking was the outcome of interest.ConclusionIn men in this cohort, exposure to disadvantaged social circumstances across the lifecourse, but particularly in adulthood, is associated with detrimental patterns of alcohol consumption and problem drinking in late middle age.