CAGE and AUDIT-C: alcohol screening in PLAB 2
CAGE and AUDIT-C are the two alcohol screens worth knowing cold for PLAB 2. CAGE is four questions probing dependence; AUDIT-C is three questions quantifying consumption. In the station you will rarely announce either by name - you weave the questions into an alcohol history, without judgement, and let the answers steer whether this is brief advice or a dependence conversation.
Step by step, with exam phrasing
| Step | What it means in the cubicle | |
|---|---|---|
| C | Cut down | Ever felt you should cut down on your drinking? "Have you ever felt you ought to cut back on how much you drink?" |
| A | Annoyed | Ever been annoyed by people criticising your drinking? "Has anyone close to you ever commented on your drinking in a way that bothered you?" |
| G | Guilty | Ever felt guilty about your drinking? "Do you ever feel guilty the day after drinking?" |
| E | Eye-opener | Ever needed a drink first thing in the morning to steady nerves or shift a hangover? The strongest single dependence signal in the set. "Have you ever needed a drink first thing in the morning to get yourself going?" |
When it carries the marks
Any station where alcohol may be driving or complicating the presentation: abnormal LFTs, hypertension, low mood, insomnia, gastritis, falls, or the direct alcohol-counselling station. Two or more positive CAGE answers suggests dependence; the eye-opener alone should raise it. AUDIT-C (how often, how much per occasion, how often six or more units) quantifies intake alongside.
Where candidates lose the marks
- Asking with visible judgement, which shuts the honest answers down for the rest of the station.
- Screening without quantifying: CAGE tells you about dependence, not units. You need both.
- A positive screen changing nothing: two or more positives should trigger the dependence conversation, withdrawal safety and referral options.
- Forgetting the safety-critical warning that a dependent drinker must not stop suddenly because withdrawal can cause seizures.
- Missing driving, work and childcare implications when dependence is likely.
Apply it in a real station
These station guides use this framework directly:
Practise it out loud, free Browse the free stations
Frequently asked questions
What are the CAGE questions?
Cut down: have you ever felt you should cut down? Annoyed: have people annoyed you by criticising your drinking? Guilty: have you ever felt guilty about drinking? Eye-opener: have you ever needed a drink first thing in the morning? Two or more positive answers suggests alcohol dependence and warrants a fuller assessment.
What is AUDIT-C and how is it scored?
AUDIT-C is a three-question consumption screen: how often you drink, how many units on a typical occasion, and how often you have six or more units in one sitting. Each scores 0 to 4; a total of 5 or more indicates higher-risk drinking. It quantifies intake where CAGE probes dependence.
Which should I use in a PLAB 2 station?
In practice, both, woven into a natural alcohol history: quantify with AUDIT-C-style questions (what, how much, how often), then screen for dependence with the CAGE themes, especially morning drinking and failed attempts to cut down. The examiner marks the coverage and the tone, not the label.
Frameworks stick when you say them out loud.
Sit a free timed station and practise the phrasing against a patient who answers back.
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