CAGE, AUDIT-C and DAST-10: Substance Use Screening Tools
Facts checked against the primary sources listed below. Last reviewed . Last updated: . See sources.
Which substance use screening tools do counselors document?
CAGE is a four-question alcohol screen where a total of 2 or more is considered clinically significant. AUDIT-C is a three-question alcohol consumption screen taken from the AUDIT. The DAST is a drug use screen with 20-item and 10-item formats, developed by Harvey Skinner. Record the tool, the score and your interpretation.
Addiction counselors and therapists commonly use short, validated screens to open a conversation about alcohol and drug use and to track change. This page compares three of them and explains how to write the result into a progress note.
Scoring rules differ between these tools and between versions of each, and the owners publish them with the forms. Where a primary source gave a cutoff, it is below with its source. Where it did not, the page says to use the cutoff printed on the current form. The questions are not reproduced: use the owners' materials linked in the sources.
CAGE, AUDIT-C and DAST at a glance
| Tool | Screens for | Length | Developer and citation | Cutoff confirmed in a primary source |
|---|---|---|---|---|
| CAGE | Alcohol problems | 4 questions | John A. Ewing, JAMA, 1984;252(14):1905 to 1907. | A total score of 2 or greater is considered clinically significant (NIH FITBIR data dictionary, citing the CAGE). |
| AUDIT-C | Heavy drinking and active alcohol abuse or dependence | 3 consumption questions from the AUDIT | Bush, Kivlahan, McDonell, Fihn and Bradley, Archives of Internal Medicine, 1998;158(16):1789 to 1795. | Not confirmed here. Use the cutoff in the current form or your program's protocol. |
| DAST | Problems related to drug use other than alcohol | 20-item and 10-item formats (the original has 28 items) | Harvey A. Skinner, Addictive Behaviors, 1982;7(4):363 to 371. | Not confirmed here. Use the cutoff in the current form or your program's protocol. |
What is the CAGE questionnaire?
The CAGE is four clinical interview questions that, in the words of the 1984 JAMA article, "have proved useful in helping to make a diagnosis of alcoholism." The name is an acronym that helps clinicians recall the questions, which focus on cutting down, annoyance by criticism, guilty feeling and eye-openers.
The NIH FITBIR data dictionary says CAGE items are scored 0 or 1 and states: "A total score of 2 or greater is considered clinically significant." Document the total, say that it meets or does not meet that threshold, and add your interpretation. A CAGE score does not establish a diagnosis.
What is the AUDIT-C?
The AUDIT-C is the three consumption questions of the Alcohol Use Disorders Identification Test. A 1998 study by researchers at VA Puget Sound evaluated these three questions as a brief screening test for heavy drinking and active alcohol abuse or dependence and concluded that they appear to be "a practical, valid primary care screening test."
The score range and the positive cutoff are printed on the form and have been studied in several populations. The sources checked for this page did not give a single cutoff that applies to everyone, so this page does not state one. Use the cutoff in the version your program has adopted and write the number and the cutoff you applied into the note.
What is the DAST-10?
The Drug Abuse Screening Test was designed to provide a brief instrument for clinical screening and treatment evaluation research. NIDA lists it as a drug use screen available in both 20-item and 10-item formats, and notes that it gives a quantitative index of the severity of problems related to drug use other than alcohol.
Because the DAST covers drugs other than alcohol, pair it with an alcohol screen such as the CAGE or AUDIT-C if alcohol use is a concern. As with the AUDIT-C, the sources checked here did not give a confirmed interpretation table, so use the scoring and interpretation printed on the current form, and name the version in the note.
How should a substance use screen change your note?
A screen gives you a number and the client's answers give you a conversation. Record both: the score and cutoff you applied in Objective or Data, and, in Assessment, what the client said about use, consequences and readiness to change. Link the finding to a treatment plan goal, and note the level-of-care decision if the screen led to one. For fuller note structure for this population, see the addiction counseling notes template.
How do you document it in a progress note?
- Step 1: Name the tool and version, the date, and how it was administered.
- Step 2: Record the total score and the cutoff you applied, with its source (form or program protocol).
- Step 3: State which substances the tool covers, since AUDIT-C and CAGE are about alcohol and the DAST is about other drugs.
- Step 4: Record what the client said about use and consequences, in observable terms.
- Step 5: Put your interpretation and any level-of-care reasoning in the Assessment.
- Step 6: State the plan: further assessment, brief intervention, referral or repeat screening.
Where a substance use screen goes in each note format
| Note format | Where the score goes | Where the interpretation goes |
|---|---|---|
| SOAP | Objective: tool, score, cutoff applied. | Assessment: what the result and the client's account mean together. |
| DAP | Data: tool, score, cutoff applied. | Assessment: what the result and the client's account mean together. |
Example wording (fictional, for illustration only)
Objective: CAGE completed in session on 10/09, total 3, which meets the threshold of 2 or greater listed for clinically significant. Assessment: Client acknowledges drinking in the morning on workdays and ties it to missed shifts; readiness to change is ambivalent. Plan: complete a full alcohol assessment next session and discuss options for a higher level of care.
Who owns these tools and can you reproduce them?
The CAGE is credited to John A. Ewing in JAMA, the AUDIT-C to Bush and colleagues at VA Puget Sound, and the DAST to Harvey A. Skinner. The NIDA page for the DAST did not state licensing terms, and the sources checked for this page did not state them for the CAGE or the AUDIT-C either.
Because licensing terms were not confirmed, this page does not reproduce any form and does not say that any of the three is free to copy. Use the version your program provides, or obtain the form from the owner and read its terms before reproducing it.
Frequently Asked Questions
What is a positive CAGE score?
The NIH FITBIR data dictionary states that a CAGE total score of 2 or greater is considered clinically significant. Items are scored 0 or 1. It is a screening result and not a diagnosis.
What does CAGE stand for?
CAGE is an acronym for Cutting down, Annoyance by criticism, Guilty feeling and Eye-openers, the four areas its questions cover.
What is the difference between AUDIT-C and AUDIT?
The AUDIT-C is the three alcohol consumption questions taken from the Alcohol Use Disorders Identification Test (AUDIT). A 1998 study found it appeared to be a practical, valid primary care screening test for heavy drinking and active alcohol abuse or dependence.
Does the DAST screen for alcohol?
No. NIDA describes the DAST as an index of problems related to drug use other than alcohol. Use an alcohol screen such as the CAGE or AUDIT-C alongside it when alcohol is a concern.
Where do I document a substance use screen in a SOAP note?
Put the tool, score and cutoff applied in Objective, and your interpretation together with the client's own account in Assessment.
Does WellNotes score these tools?
No. You score the tool yourself. WellNotes drafts the session note from what you type or dictate, and you review and edit it.
Related references
Sources
- Ewing. Detecting alcoholism: the CAGE questionnaire. JAMA 1984;252(14):1905-1907
- NIH FITBIR data dictionary: CAGE clinically significant indicator
- NIH FITBIR data dictionary: CAGE total score
- Bush et al. The AUDIT alcohol consumption questions (AUDIT-C). Arch Intern Med 1998;158(16):1789-1795
- Skinner. The Drug Abuse Screening Test. Addict Behav 1982;7(4):363-371
- NIDA Data Share: Drug Abuse Screening Test
This page is general reference information, not clinical, coding, or legal advice. Scoring rules and usage terms can change, so confirm them on the instrument owner's current materials and with your payer or supervisor before relying on them. WellNotes does not administer or score screening tools. The treating clinician interprets every result.
Draft the session note with the score in it
Type or dictate the session, include the score and your interpretation, and WellNotes drafts the note in SOAP, DAP, or BIRP. You review and edit every note.