As a psychologist, I use the “Family CAGE test”1 when screening families who come in with adolescents. These four simple questions allow me to identify any alcoholism in the family that may be a contributor to the adolescent’s problems.
The CAGE gets its name from the first letters of the words below in bold. It asks if anyone in the family has:
- Tried to cut down their drinking?
- Been annoyed by complaints about drinking?
- Felt guilty about drinking?
- Had an eye-opener—a drink when first waking up in the morning?
A “yes” answer to any of these questions can lead to another series of questions to assess the possible causes of the adolescent’s problem behavior. I also inquire about a child or adolescent’s alcohol use by asking screening questions specifically for this age group, based upon the “CRAFFT”2. As above, the test gets its name from the first letters of the words below in bold. These are also questions that parents can consider asking their children:
- Have you ever ridden in a car driven by someone (including yourself) who was high or had been using alcohol or drugs?
- Do you ever use alcohol or drugs to relax, feel better about yourself, or fit in?
- Do you ever use alcohol or drugs while you are by yourself, alone?
- Do you ever forget things you did while using alcohol or drugs?
- Do your family or friends ever tell you that you should cut down on your drinking or drug use?
- Have you ever gotten into trouble while using?
Again, these are screening questions that may surface the need for a full assessment. And when I work with a family or an adolescent, I continue to screen for alcohol use throughout treatment of an adolescent, knowing that due to the developmental challenges of this age group, an adolescent, even one in treatment, can develop a “new” problem. 3, 4 I refer parents to Al‑Anon Family Groups when I determine that a child has an alcohol problem. Al‑Anon and parenting work very well together. The results have been particularly outstanding in communities where parents meet together with other parents in an Al‑Anon group. What better place to learn how to parent better than from peers who have experience with similar issues?
At Al‑Anon meetings, parents learn they are not alone. They come to understand more about the disease of alcoholism. They also learn the Twelve Steps, which help them to recover from the effects of their child’s alcoholism.
My clinical experience led me to write guidelines for parents, using the ideas found in Al‑Anon’s Twelve Steps. For example:
- Reach out for help and acknowledge that you are not alone.
- Take stock in yourself as a parent.
- Become ready to change by giving up the demand to be perfect.
- Make conscious changes in your parenting by identifying specific strategies for healthy parenting.
Eventually, parents put their energy into controlling what they can, instead of wasting energy on the rest. Then their children begin to make needed changes. Healthcare professionals should seriously consider referring parents of underage drinkers to Al‑Anon where they will be connected to a network of caring and knowledgeable individuals who can mentor and support them.
By Patricia O’Gorman is a psychologist from East Chatham, New York.
- S.H. Frank, A.V. Graham AV, S.J. Zyzanski, S. White, “Use of the Family CAGE in Screening for Alcohol Problems in Primary Care,” Arch Fam Med. 1992 Nov;1(2):209-16.
- J.R. Knight, L. Sherrit, L.A. Shrier, et al. “Validity of the CRAFFT Substance Abuse Screening Test Among Adolescent Clinic Patients,” Arch Pediat Adolesc Med. 2003; 157:4333-439.
- P. O’Gorman, P. Diaz, Breaking the Cycle of Addiction, Deerfield Beach, Florida: HCI, 1987.
- P. O’Gorman, P. Diaz. The Lowdown on Families Who Get High: Successful Parenting for Families Affected by Addiction, Washington DC: CWLA Press, 2004
© Al-Anon Family Group Headquarters, Inc., Virginia Beach, VA,
Al-Anon Faces Alcoholism 2010 magazine.
Note: Al-Anon cooperates with therapists, counselors, and other professionals but does not affiliate with or endorse any organization. Articles written by professionals are their personal perspective on how Al-Anon Family Groups can help patients, clients, or consumers affected by someone else’s drinking.