CAGE Alcohol Questionnaire
4-item questionnaire that can indicate potential problems with alcohol use.
CreatorDr. John A. Ewing, MDIntroduction
The CAGE questionnaire is a four-question screen for alcohol dependence. Psychiatrist John A. Ewing, MD, developed it in 1968 at North Carolina Memorial Hospital and published his description in JAMA in 1984. Its name is an acronym of its four questions, which focus on Cutting down, Annoyance by criticism, Guilty feeling, and Eye-openers. The acronym helps clinicians remember the questions. It’s quick and easy to use, and it remains one of the most widely taught alcohol screens in medical and nursing education.
What it asks: The four yes/no questions are: 1. Have you felt the need to Cut down on your drinking? 2. Do you feel Annoyed by people complaining about your drinking? 3. Do you ever feel Guilty about your drinking? 4. Do you ever drink an Eye-opener in the morning to relieve the shakes? The questions are usually asked as “have you ever,” so they cover a person’s lifetime experience rather than a set recent period.
How it’s scored: Each answer is scored 0 (NO) or 1 (YES), and a higher score indicates more likely alcohol problems. The total ranges from 0 to 4 points. A total of two or more indicates alcohol dependence and is the standard cutoff for a positive screen. A “yes” to the eye-opener question deserves attention even when the total is low, since morning drinking to relieve shakes suggests physical dependence.
How results are used: A positive CAGE is a reason for further assessment, not a diagnosis. There are several limitations. The CAGE screens for alcohol dependence, not risky drinking, so it can miss people whose drinking is harmful but not yet dependent. Because it asks about lifetime experience, someone who no longer drinks may screen positive unless the clinician focuses the questions on a more recent timeframe. Its sensitivity at the usual cutoff is also low in older adults, women, and pregnancy. For these reasons, the USPSTF, NIAAA, and RACGP recommend the AUDIT-C or a single consumption question, not the CAGE, for routine adult screening. The CAGE is best used alongside them, or as a quick check for possible dependence.
All questions & possible results
CAGE ItemsTitle not visible
Have you ever felt you should cut down on your drinking?
Select one option:
- No
- Yes
Have people annoyed you by criticizing your drinking?
Select one option:
- No
- Yes
Have you ever felt bad or guilty about your drinking?
Select one option:
- No
- Yes
Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (an eye-opener)?
Select one option:
- No
- Yes
Possible results
Negative CAGE Screen (0 out of 4pts)
Clinically Significant CAGE Screen (≥2 pts)
The higher the score the greater the indication of alcohol problems.
A total score of 2 or greater is considered clinically significant.
A score of 2 points or more was found to have 93% sensitivity and 76% specificity for identifying excessive drinking.
Warrants further discussion of drinking patterns and quantity.
Negative CAGE Screen (1 out of 4 pts)
The higher the score the greater the indication of alcohol problems.
This is below the usual cut-off of two, but a single positive answer warrants further discussion of drinking patterns and quantity.
Citation
Ewing JA. Detecting alcoholism: the CAGE questionnaire. JAMA. 1984;252(14):1905-1907.
Literature
Ewing JA. Detecting alcoholism: the CAGE questionnaire. JAMA. 1984;252(14):1905-1907.
https://pubmed.ncbi.nlm.nih.gov/6471323/
- CreatorDr. John A. Ewing, MDPsychiatry professor and addiction therapy clinician at the University of North Carolina at Chapel Hill
- Provided by
EVAL Foundation
- Contributor · Reviewer
Jennifer Glen, DNP, FNP-BCEVAL Health, Chief Medical Officer EVAL Foundation
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