Use of the Family CAGE in screening for alcohol problems in primary care
S. H. Frank, A. V. Graham, S. J. Zyzanski and S. White
Department of Family Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio.
OBJECTIVE: To establish the reliability and validity of the Family CAGE (an
acronym indicating Cut down on drinking; Annoyed by complaints about
drinking; Guilty about drinking; had an Eye-opener first thing in the
morning), a four-item instrument intended to assess family alcohol-related
problems. DESIGN: Two distinct cross-sectional studies using a survey, and
in one study, retrospective chart review. PARTICIPANTS: A random sample of
172 adult patients presenting for nonurgent care to a network of family
practice settings and a convenience sample of 107 patients who smoked
presenting to a university family practice residency training setting. MAIN
OUTCOME MEASURES: The Family CAGE was compared with alcohol-related
variables and scales measuring psychosocial constructs. In the first study,
these scales included the Family Stress and Coping Scale; Profile of Mood
States; the Family Problems Checklist; and the Duke/University of North
Carolina Mini-Health Profile. Chart review included medical utilization
rates and prescription of medications. In the second study, a revised
version of the Family CAGE was compared with other scales such as the
standard CAGE questionnaire; an "Anomy" Scale; the Catchment Epidemiologic
Study-Depression Scale; a global self-assessment of alcohol-related
problems; and a self-report of lifetime history of major depression and
recent self-limited depression. RESULTS: The Family CAGE showed strong
internal consistency reliability, with Cronbach's alpha coefficients of .84
in the first study and .89 in the second. Construct validity was supported
by Family CAGE correlations with family stress, family problems,
depression, anxiety, individual stress, and marital dissatisfaction. The
Family CAGE was strongly correlated with global assessment of family
alcohol-related problems, and was superior to this variable in predicting
help-seeking behavior. The Family CAGE was also significantly correlated
with a higher sick visit rate and more medications prescribed (despite no
difference in functional health status). The standard CAGE was correlated
with a recent history of self-limited depression, while the Family CAGE was
correlated with a lifetime history of major depression. Sensitivity and
specificity rates vary depending on the criterion addressed, but a cutoff
score of 2 or more appears to offer the best clinical information.
CONCLUSION: The Family CAGE appears to be a reliable, valid, utilitarian
measure of family alcohol problems. It offers more information than either
a single-item global assessment regarding family alcohol-related problems
or the standard CAGE questionnaire. The Family CAGE is strongly correlated
with other important psychosocial problems, prescription of psychotropic
medications, and health-care utilization. It is brief, understandable, and
equally effective in interview and self-administered formats.
