Results of the CAGE questionnaire for smoking, modified from the test for alcoholism, are considered positive if two of the four questions are answered affirmatively.
The CAGE questionnaire is a simple, accurate tool that has been used for many years to screen patients for addictive disorders. The CAGE questions have been revised to apply to smoking behavior, as shown in Table 1, and can be included in a clinical interview.
Examples of actual patient responses to these questions include the following:
Cut down: "I wanted to quit smoking, but I couldn't do it, so I switched to a low-tar cigarette."
Annoyed: "Last week, my granddaughter said to me, 'Grandma, I wish you would stop smoking,' and I snapped at her, 'Well, I'm old enough to smoke--are you?'"
Guilty: "I should have stopped smoking long ago--my family wouldn't have to suffer on my account like this if I had."
Eye-opener: "I smoke my first cigarette before my feet hit the floor."
Experience has shown the CAGE questionnaire to be nonthreatening. In one study, medical outpatients were given the CAGE questions embedded in a self-administered questionnaire about health habits, and most of them did not realize that they were filling out an assessment for addictions.
| CAGE Questionnaire Modified for Smoking Behavior* |
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1. Have you ever felt a need to Cut down or control your smoking, but had difficulty doing so? 2. Do you ever get Annoyed or angry with people who criticize your smoking or tell you that you ought to quit smoking? 3. Have you ever felt Guilty about your smoking or about something you did while smoking? 4. Do you ever smoke within half an hour of waking up (Eye-opener)? |
| *--Two "yes" responses constitute a positive screening test. Information from Lairson DR, Harrist R, Martin DW, Ramby R, Rustin TA, Swint JM, et al. Screening for patients with alcohol problems: severity of patients identified by the CAGE. J Drug Educ 1992;22:337-52. |