CQAIMH - center for quality assessment and improvement in mental health


Substance Use Screening and Assessment

  • Between 40-70% of people with bipolar disorder have a history of substance use disorder. (1)
  • A current or past comorbid substance use disorder may lead to worse outcomes for bipolar disorders, including more symptoms, more suicide attempts, longer episodes and lower quality of life. (1)
  • Substance abuse may obscure or exacerbate mood swings that have no other apparent external cause. (2)
  • Substance abuse may also precipitate mood episodes or be used by patients to self-treat in an attempt to improve the symptoms or episodes. (2)

Audit-C: Alcohol Use Disorder Identification Test – Consumption:

  • The AUDIT-C is a modified version of the AUDIT instrument that was developed by WHO to screen patients in primary health settings for hazardous or harmful drinking.
  • The AUDIT-C is a 3 item instrument that screens for:
    • frequency of alcohol consumption
    • quantity of alcohol consumption
    • quantity of alcohol consumption on a single occurrence
  • The AUDIT-C is a simple 3 question screen that can stand alone or be incorporated into general health history questionnaires.

CAGE-AID: Cut down; people Annoy you, feel Guilty; need Eye-opener – Altered to Include Drugs:

  • The CAGE-AID is a conjoint questionnaire where the focus of each item of the CAGE alcohol use questionnaire was expanded to include alcohol and other drugs.
  • The CAGE-AID is a simple 4 question self-report that is easily scored by the clinician.
  • Advantage to using this screen is the ability to screen for alcohol and drug problems simultaneously rather than separately.


  1. Ostacher MJ, Sachs GS,. Update on Bipolar Disorder and Substance Abuse: Recent findings and treatment strategies, J Clin Psychology 2006; 67(9):e10.
  2. American Psychiatric Association, Practice Guidelines for the Treatment of Patients with Bipolar Disorder, Am J Psychiatry 159: 4, April 2002 Supplement.

Copyright 2007 by the Center for Quality Assessment and Improvement in Mental Health