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CAGE Questions for Alcohol Use

CAGE Questionnaire
Answer the following 4 questions about your alcohol use. This screening tool helps identify potential alcohol problems.

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 (a drink first thing in the morning) to steady your nerves or get rid of a hangover?

About the CAGE Questionnaire

The CAGE questionnaire is a widely used screening tool for identifying potential alcohol problems. Developed by Dr. John Ewing in 1984, it consists of four simple questions that can be easily administered in clinical settings. The name "CAGE" is an acronym formed from the key words in each question: Cut down, Annoyed, Guilty, and Eye-opener.

Clinical Significance

The CAGE questionnaire is valued for its brevity and ease of use. It serves as a quick initial screening tool that can help healthcare providers identify patients who may benefit from further assessment for alcohol use disorders. While not diagnostic on its own, a positive CAGE score indicates the need for a more comprehensive evaluation.

Interpretation of Results

The CAGE questionnaire consists of four yes/no questions, with each "yes" answer scoring one point:

  • C - Have you ever felt you should Cut down on your drinking?
  • A - Have people Annoyed you by criticizing your drinking?
  • G - Have you ever felt bad or Guilty about your drinking?
  • E - Have you ever had an Eye-opener (a drink first thing in the morning) to steady your nerves or get rid of a hangover?

Score Interpretation:

  • 0 points: No risk of alcohol use disorder identified
  • 1 point: Low risk, but may indicate some concern with alcohol use
  • 2 points: Moderate risk, suggests potential alcohol problems
  • 3-4 points: High risk, strongly suggests alcohol use disorder

Limitations

While the CAGE questionnaire is a valuable screening tool, it has several limitations:

  • It focuses primarily on dependence symptoms rather than harmful use
  • It does not assess the quantity, frequency, or pattern of alcohol consumption
  • It may be less sensitive in women, certain ethnic groups, and elderly populations
  • It does not screen for binge drinking, which is a common pattern of harmful alcohol use
  • It asks about lifetime experiences, which may not reflect current drinking behavior

Clinical Recommendations

A positive CAGE score (≥2) should prompt further assessment using more comprehensive tools such as the Alcohol Use Disorders Identification Test (AUDIT) or a detailed clinical interview. Patients with positive scores should be evaluated for:

  • Pattern and quantity of alcohol consumption
  • Physical, psychological, and social consequences of drinking
  • Signs and symptoms of alcohol dependence or withdrawal
  • Comorbid medical and psychiatric conditions
  • Readiness to change drinking behavior

References

  1. Ewing JA. Detecting alcoholism: The CAGE questionnaire. JAMA. 1984;252(14):1905-1907.
  2. O'Brien CP. The CAGE questionnaire for detection of alcoholism: a remarkably useful but simple tool. JAMA. 2008;300(17):2054-2056.
  3. Dhalla S, Kopec JA. The CAGE questionnaire for alcohol misuse: a review of reliability and validity studies. Clin Invest Med. 2007;30(1):33-41.
  4. National Institute on Alcohol Abuse and Alcoholism. Helping Patients Who Drink Too Much: A Clinician's Guide. NIH Publication No. 07-3769. Bethesda, MD: National Institutes of Health; 2005.