Modifying the CAGE Questionnaire for Filipino patients: An effective but underused alcohol screening method

Olongapo City, Philippines by Zero Mella MD – “It’s in the first chapter of Bates,” mused one medical student as they were asked what CAGE questionnaire is about.

The problem is that it’s overall utilization in Filipino medical practice is little or nil. Amazingly, textbooks and respected authorities place emphasis on this screening tests as alcoholism is the most important cause of preventable deaths worldwide.

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The CAGE questionnaire is an easy and effective way of suspecting an alcohol problem. It’s in English and it goes like this:

Have you ever felt the need to Cut down on drinking?

Have you ever felt Annoyed by criticism of your drinking?

Have you ever felt Guilty about your drinking?

Have you ever taken a morning Eye opener?

Two “Yes” answers is considered a positive screen. One “yes” answer indicates a possible alcohol abuse going on.

The questionnaire is asked verbally and never put out on a form. Check out the direct translation (courtesy of me):

Pakiramdam mo ba’y kailangan mo na itigil ang paginum mo ng alak?

Pakiramdam mo ba’y nakakaasar ang pagkutya ng iyong paginum ng alak?

Pakiramdam mo ba’y kasalanan mo ang paginum ng alak?

Pakiramdam mo ba’y kailangan mo ng isa pang inum sa umaga?

I use my version of the direct translation a lot and I always come up with negative screening results despite the protest of relatives. The idea is that most Filipinos know they are being screened especially with formal questions like this. They often get castigated for being labeled an alcoholic. Blame for whatever reason placed them on the ER prohibits them from admitting they have a problem.

Using Filipino slang and positive assumptions create a more effective approach. Check this:

Titigil ka na ba sa paglaklak?

Ayaw mo ba na pinagsasabihan ka tungkol sa alak?

Nagsisisi ka na ba at nakainum ka?

Ilang bote ng alak ang iniinum mo sa umaga para mawala amats?

Amazingly, I was able to identify a positive screen with direct questions such as these. You have to assume they are taking alcohol even if they aren’t. They are usually polite enough to tell you if they have abhorred alcohol for a long time and it’s ok for Filipino patients to know your sorry if you assumed alcoholism. They know its a test.

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