CAGE Alcohol Abuse Questionnaire, Screening & Assessment

What is the CAGE Questionnaire?

The CAGE questionnaire is a series of questions that medical professionals use to screen patients for alcohol misuse. It may also be self-administered.

Dr. John Ewing developed the CAGE questionnaire in 1984 as a simple tool to identify alcohol dependence.⁹ 

CAGE stands for cut, annoyed, guilty, and eye-opener.

This is in reference to the 4 questions on the CAGE questionnaire:

• “Have you ever felt you should cut down on your drinking?”
• “Have people annoyed you by criticizing your drinking?”
• “Have you ever felt bad or guilty about your drinking?”
• “Have you ever had an eye-opener (drink in the morning) in order to steady your nerves or get rid of a hangover?”

It's important to recognize that the CAGE questionnaire was designed to be a method of screening for alcohol misuse. It's not a diagnostic instrument.

Moreover, any inquiries about drinking frequency can significantly reduce the effectiveness of the questions. 

However, after completion, the CAGE questionnaire may be followed up with more questions about alcohol usage and consumption rates.

How Does the CAGE Assessment Screen for Alcohol Misuse?

The CAGE Assessment is easy. The widely validated screening technique asks open-ended questions about a person’s drinking habits and behaviors. 

It also looks at how someone feels about their own alcohol consumption, as well as their feelings about people’s opinions about it.

All of these questions can give insights into whether or not a drinking problem is possible.

How is the CAGE Screening Tool Scored?

The CAGE questionnaire scoring is simple.

Each question is given a 1 if the patient answers “yes” and a 0 if the patient answers “no.”⁹ 

The more “yes” responses (and, as such, the higher the score), the more likely it is that the patient has an alcohol problem. 

If the patient answers at least half of the questions with a “yes” to earn a total score of 2 or more, this is considered “clinically significant.”⁴

How Effective is the CAGE Questionnaire?

Unfortunately, the CAGE questionnaire is largely underused, and people with alcohol problems are regularly undiagnosed and untreated.

For example, only 30 percent of primary care physicians report regularly screening their patients for substance use. And, of them, only about half (55 percent) report using the CAGE assessment.⁵ 

However, the CAGE questionnaire is largely considered an effective assessment of alcohol misuse. 

CAGE measures for sensitivity and specificity:

• Sensitivity means that people with alcohol dependence will test positive for it.
• Specificity refers to the percentage of true negatives, meaning people who don't have alcohol dependence will test negative.

CAGE shows a 91 percent sensitivity rate for alcohol dependence and 87.5 percent for alcohol misuse. It also shows 87.8 percent specificity for alcohol dependence and 80.9 percent for alcohol misuse.¹

Because the CAGE questionnaire is just four questions, it’s a quick and easy assessment. In fact, it’s one of the most efficient ways to detect alcoholism.⁵

What Are the Limitations of the CAGE Assessment?

The CAGE assessment does have some limitations. For example, it doesn't take gender, race, and cultural differences into account when assessing consequences or perceptions of problem drinking.⁸

The questions are also inadequate in assessing the extent of the drinking problem if one is detected.³ The questionnaire is not a valid assessment of substance misuse.

However, CAGE-AID is a variation of the CAGE questionnaire that substitutes “drink” with “drink or drugs” in each question. It can help determine if alcohol addiction treatment is necessary.