CAGE, AUDIT, DAST - California Society of Addiction Medicine

The AUDIT-C is scored on a scale of 0-12 (scores of 0 reflect no alcohol use). In men, a score of 4 or
more is considered positive; in women, a score of 3 or more is considered positive. Generally, the higher
the AUDIT-C score, the more likely it is that the patient’s drinking is affecting his/her health and safety.
2. What does a positive AUDIT-C score mean?
A positive score means the patient has a higher likelihood for at risk drinking or active alcohol
abuse or dependence.
3. Why don’t we use the CAGE anymore?
The CAGE fails to identify many patients with at risk drinking who are not alcohol dependent.[2]
It is important to identify at risk drinkers because they may also benefit from advice from primary care
providers about their drinking.[3]
4. What is at risk drinking?
At risk drinking is drinking above recommended limits that increases a patient’s risk of injury
and/or medical problems. Most patients who report at risk drinking are not alcohol dependent. However,
there are so many of these non-dependent, at risk drinkers that they account for most of the morbidity and
mortality that is attributed to drinking.[4]
5. If a patient screens positive on the AUDIT-C, is it likely they are alcohol
dependent?
Most patients who screen positive on the AUDIT-C will be at risk drinkers who are not alcohol
dependent. By using both the AUDIT-C score, and the patient’s history of alcohol treatment, it is
possible to identify those most likely to be alcohol dependent. For patients who have never been in
alcohol treatment (or attended AA), scores > 8 are associated with relatively high rates of dependence.
Patients who have had past alcohol treatment are at high risk of dependence with any positive AUDIT-C
score.
6. What is appropriate follow-up for a positive AUDIT-C screen?
See recommendations under Interpretation/Follow-up of AUDIT-C Scores.
7. Does everyone who screens positive on the AUDIT-C need a full assessment
or referral?
Not everyone needs a full assessment or referral. Since the AUDIT-C reflects severity, the raw
score can be used to assess the likelihood that the patient has alcohol dependence. For patients with
AUDIT-C scores 4-7 and no prior alcohol treatment, the provider should offer a brief intervention as
follows:
1). Express concern about the patient’s drinking, if drinking above recommended limits;
2) Provide feedback linking the patient’s drinking to his/her health concerns, noting that
patient is drinking above recommended limits, and
3) Offer explicit advice to stay below recommended limits
Patients with more severe problems due to drinking who are do not to accept referral can also be offered
brief intervention. If providers want more information on specific symptoms due to drinking, questions
#4-10 of the full AUDIT can be used as a brief assessment or patients can be referred to a mental health
specialist.
What is SBIRT? How Do You Do It and Teach It Effectively?
October 7, 2009 / Hotel Kabuki, San Francisco
Resident and Faculty Education offered by the
Medical Education and Research Foundation for the Treatment of Alcoholism and Other Drug Dependencies (MERF)
and the California Society of Addiction Medicine (CSAM)