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The CAGE questionnaire as a screen for alcohol problems

An article in one of this month's editions of the Journal of the American Medical Association celebrates the publication of the CAGE alcohol screening questionnaire by Charles Ewing 25 years ago.  CAGE is a mnemonic to help remember the four simple questions.  "Have you ever ...

1.) felt the need to cut down your drinking?
2.) felt annoyed by criticism of your drinking?
3.) had guilty feelings about drinking?
4.) taken a morning eye opener?

An affirmative answer to 2 or 3 of these questions makes an alcohol problem likely, while a score of 4 suggests a diagnosis of alcoholism is almost certain. 

The questions can be used in most clinical settings to identify people who need to be checked out more fully.  In the United States, 30% of primary care physicians report  regularly screening for substance abuse.  Of these physicians 55% use the CAGE.  See too the January blog posting on The demon drink. 

Handouts & questionnaires for “outcomes toolkit” (IAPT)

The "Improving Access to Psychological Therapies" (IAPT) initiative is very ambitious and exciting.  It states its principal aim is to support English Primary Care Trusts in implementing "National Institute for Health and Clinical Excellence" (NICE) guidelines for people suffering from depression and anxiety disorders.  IAPT go on to say that "At present, only a quarter of the 6 million people in the UK with these conditions are in treatment, with debilitating effects on society."

One aspect of this carefully planned initiative is strong encouragement to assess and monitor the progress of those who are getting help.  Visiting the IAPT "Outcomes Toolkit and FAQ" web page provides access to several freely downloadable documents.  The emphasis is on good assessment measures that are free to use.  See below:

IAPT Outcomes Toolkit 2008/9 PDF - this 81 page 1.1Mb Adobe PDF is the September 08 version with amended IAPT Paper Based Data Set Questionnaires.

Pain assessment & information

Happiness is a kind of gratitude; it is not how much we have, but how much we enjoy what we have that really counts.  - E. Edwards

For many years my work split fairly evenly between helping people with psychological difficulties and helping people with pain problems.  Quite a few people were troubled with both.  In the last several years I have done much less work with pain, although I still see some people for overall pain management.  This has been partly because I was trying to keep up-to-date with too many fields, so stepping back from pain work made sense.  It has also been partly because the flourishing of research into happiness & wellbeing has fascinated me and taken up time.  Here are a collection of pain-associated assessment and information sheets that I accumulated over the years.  They are obviously relevant for work with pain, and some (e.g. one year symptom diary) can be adapted for work with stress & psychological difficulties. 

Emotions, feelings & personality

“ The life I touch for good or ill will touch another life, and that in turn another, until who knows where the trembling stops or in what far place my touch will be felt. ” - Frederick Buechner

This section contains handouts and questionnaires about emotions, feelings & personality.  It seems helpful to understand emotions through an evolutionary perspective - we have emotions, to a large extent, because they had (and have) survival value.  We are the descendants of people with adaptive emotional systems that helped them stay alive and function well.  Typically unwelcome feelings that seem maladaptive are due to emotions that are firing off inappropriately.  As a rule of thumb, if an emotion is an appropriate reaction to a situation it can help us respond successfully.  If the emotion is inappropriate then it's likely to be more useful to work to change the emotional response - through therapy or other approaches. 

Life review, traumatic memories & therapeutic writing

“ Only dead fish swim with the stream. ” - Anonymous

This section includes charts to help clarify life history, traumatic events, childhood experiences, and therapeutic writing.  It overlaps with some of the handouts given in the linked "PTSD assessment, images, memories & information" section .  I use "therapeutic" writing as a general term covering all types of writing that have been shown to be helpful & "therapeutic".  When describing the form of therapeutic writing, developed by Jamie Pennebaker and other researchers, that focuses particularly on writing one's "deepest thoughts & feelings" about life traumas & difficulties, I tend to use the term "expressive" writing (to distinguish it, for example, from other forms of therapeutic writing focusing on diverse topics such as "best possible selves", "intensely positive

Relationships, families, couples & psychosexual

Far and away the best prize that life has to offer is the chance to work hard at work worth doing.

- Theodore Roosevelt

Here are a series of questionnaires and handouts on couples, sexuality, parenting, attachment, and abuse.  The first sequence of 20 or so handouts are from a two day workshop I run - for more details including downloadable copies of the slides, see the blog post "Psychotherapy with couples & other close relationships".  Listed below these are further relevant handouts & questionnaires.

Relationships in general

“ If in your head you undertake hatha yoga as a form of exercise or body building, you will end up with just what you reached for ... a more beautiful body. On the other hand, if you undertake hatha yoga as a form of yoga then it will, in a relatively short time, bring about a profound metamorphosis in your body calmness, sensitivity, and lightness ... all of which will facilitate your sadhana. ” - Ram Dass

Relationships are right at the heart of human health and wellbeing.  The first four sets of handouts listed below highlight the increased death rates, poorer psychological health and lowered wellbeing in those with worse relationships.  There is a rather confusing plethora of different questionnaires for assessing relationship networks.  I like the large amount of helpful information one can elicit from the "Personal community map" and associated sheets (below).  Sheldon Cohen has argued convincingly that social intimacy, social integration, and social conflict all make independent contributions to our health and wellbeing - we want higher scores for intimacy & integration and (usually) lower scores for conflict.  The community map overall question sheet and the associated brief three question current a

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