The use of the CAGE-AID screening tool in the emergency department (ED) was linked to increased referral to an addiction recovery coach for treatment of substance use disorders, according to the results of a poster presentation at the 2022 American Academy of Nurse Practitioners (AANP) National Conference, held June 21 to June 26, 2022, in Orlando, FL.

“Amid the country’s opiate crisis, these findings are significant and have implications for ED providers and hospital administrations throughout the country,” said Julie M. Daly, DNP, MSN, APN, who led the study from Jefferson Health, Washington Township, New Jersey.1

Approximately 1 in 4 ED patients screen positive for risky alcohol and/or drug use, according to a study by Hankin et al.2  Previous attempts to integrate screening for alcohol and drug use into ED nurses’ workflow have had mixed results. According to Barata et al, there was no difference between short- or long-term outcomes in patients who received a single-session intervention and those with follow-up sessions.3 The authors did note, however, that when a provider voiced concern regarding alcohol use, the patient’s often altered their potentially risky behavior.

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Study Design

The researchers studied the benefits of administration of CAGE-AID and SBIRT (screening, brief intervention, and referral to treatment) over a 10-week period and compared that to standard of care during the preceding 10 weeks. (Table).

CAGE-AID Substance Abuse Screening Tool

CHave you ever felt the need to cut down on your drinking or drug use?YesNo
AHave people annoyed you by criticizing your drinking or drug use?YesNo
GHave you ever felt guilty about drinking or drug use?YesNo
EHave you ever felt you needed a drink or used drugs first thing in the morning to steady your nerves or to get rid of a hangover?YesNo
A “yes” answer to one item indicates a possible substance use disorder and a need for further testing.

All patients who presented to Jefferson Health that were more than 18 years and did not qualify for emergency or mental health services, were assessed for social history by a licensed provider (physician, nurse practitioner, or PA). All patients who answer yes to either question about a history of alcohol or drug use were administered CAGE-AID by the ED physician. Those who answered yes to 1 or more of the CAGE-AID questions were encouraged by the provider to accept a referral to an addiction recovery coach. 

Over the 10-week control period, 15.70% of 209 patients were referred to an addiction recovery coach. According to Dr Daly, “recovery coaches serve as personal guides and mentors to people seeking or already in long-term recovery.” They connect patients to resources, develop wellness plans, monitor progress with recovery, and provide encouragement. They complement counseling, 12-Step recovery programs, and other recovery support systems.

During the intervention period, the percentage of patients referred to an addiction recovery coach rose to 33% and included 77 patients. “It was noted that 59% of patients with a documented positive CAGE-AID screening were also documented as having agreed to and received a referral to ARC,” noted Dr Daly.

“Drug and alcohol health-related issues have reached epidemic proportions,” commented Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP, clinical assistant professor at Stony Brook University School of Nursing in Stony Brook, New York. “So often these patients arrive in the ED where they are detoxed, discharged without follow-up services, and then find themselves back in the ED to be detoxed again … if they are lucky enough to survive. This NP-led project using the very simple to use CAGE-AID tool increased the referrals to an addiction recovery coach rather than sending these patients out without any services.” While such referrals may not always lead to recovery, “a referral always offers patients that chance. If no services are offered, then there is little to no possibility to stop these deadly spirals,” Dr Koslap-Petraco said.

“This study is the first to link the use of the CAGE-AID screening tool to increased referral for treatment from the ED,” Dr Daly concluded.

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1. Daly JM, Tayman L, Baird JF. Development and evaluation of an addiction recovery coach referral program in an academic medical center emergency department. Poster presented at: AANP 2022; June 21-26, 2022; Orlando, Fl. 

2. Hankin A, Daugherty M, Bethea A, Haley L. The emergency department as a prevention site: a demograph analysis of substance use among ED patients. Drug Alcohol Depend. 2013;130(1-3):230-233. doi:10.1016/j.drugalcdep.2012.10.027

3. Barata IA, Shandro JR, Montgomery M, et al. Effectiveness of SBIRT for alcohol use disorders in the emergency department: a systemic review. West J Emerg Med. 2017;18(6):1143-1152. doi:10.5811/westjem.2017.7.34373