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Letters |

Screening for Alcoholism Using CAGE

John A. Ewing, MD
JAMA. 1998;280(22):1904-1905. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-22-jac80017.
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To the Editor.—The University of North Carolina's CAGE (Cut down, Annoyed, Guilty, Eye opener)questionnaire is now so familiar that it is sometimes used without its source1 being cited. Such is the case in a recent article in JAMA.2

The CAGE questionnaire was first described at an international conference and published in the proceedings of that meeting.3 There, and in my article in JAMA, I emphasized that a medical diagnosis of alcoholism should not be based solely on a questionnaire. Dr Bradley and colleagues2 conclude that, for women, the reasonable cut point is answering positively to 1 or more of the CAGE questions. I agree, but I also apply this to men. As I stated, "The physician should use the questions to determine his index of suspicion that alcoholism may exist. Thus, even one positive reply calls for further inquiry."1 Bradley et al2 refer to "the traditional cut point of 2 or more." I regret the development of any such tradition.

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