A recent article in the British Medical Journal (Kmietowicz 2009) reports that "The chief medical officer for England has called for a minimum price of 50 pence (0.54; $0.70) to be charged for a unit of alcohol to reduce excessive drinking and its associated harms.  Liam Donaldson said that antisocial drinking should be targeted in the same way as smoking in public places so that being drunk is no longer an aim or socially acceptable.  ‘England has a drink problem and the whole of society bears the burden,' said Professor Donaldson at the launch of his 2008 annual report. ‘The passive effects of heavy drinking on innocent parties are easily underestimated and frequently ignored. The concept of passive drinking and the devastating collateral effect that alcohol can have on others must be addressed on a national scale.'  He said that evidence shows that price and access are the two key factors that can help to change drinking habits, as they were for tobacco."  

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. 

Here are a series of forms that I use almost every session with clients, or for screening and orientation at the start of therapy:

The fourth and final session of the "Non-pharmacological management of depression" SIGN seminar was entitled "Self help, guided and alternative/complementary therapies".<