CAGE: Alcohol Screening Questionnaire

The CAGE questionnaire is a very short screen for problem drinking. It has four yes/no questions, and the letters in its name are a memory aid for their topics: Cut down, Annoyed, Guilty and Eye-opener. It was developed by Dr John Ewing (1984) and is one of the most widely known alcohol screens.

It asks about drinking over the person's lifetime, not a recent period, and it does not ask how much or how often they drink. That makes it quick, but it is less detailed than the AUDIT.

The CAGE supports quick screening for alcohol problems in adults. A therapist reads it with the person's history, health, medicines and other substance use.

• Intake: a one-minute screen alongside mood and anxiety measures.
• Triage: decide who needs a fuller alcohol assessment.
• Follow-up: a positive screen leads to the AUDIT and a clinical interview.

The person answers four questions, each Yes or No, in private. They ask whether the person has ever felt they should cut down on drinking, whether people have annoyed them by criticising it, whether they have felt bad or guilty about it, and whether they have ever had a drink first thing in the morning (an eye-opener). It takes about a minute.

There is one total score, found in three steps.

1. Give 1 point for every Yes answer and 0 for every No.
2. Add the points. The total runs from 0 to 4.
3. Compare the total with the cut-off, below.

Example: if two of the four answers are Yes, the total is 2, which is a positive screen.

The score is read against a single cut-off.

A score of 2 or more is clinically significant and suggests a problem with alcohol. A single Yes, especially to the eye-opener question, still deserves a conversation, because a morning drink can be a sign of dependence.

A positive screen does not diagnose an alcohol use disorder, and a negative screen does not rule one out. It is a reason to look more closely, for example with the AUDIT.

A person with a high level of dependence may be physically dependent on alcohol. Stopping drinking suddenly can cause dangerous withdrawal, so a person should not be advised to stop abruptly without medical advice.

The CAGE has no question about suicide or self-harm, so a clinician needs to ask about risk directly, whatever the score is. If you or someone you know is in distress or at risk right now, please see our crisis support page.

Crisis support

• It is a screen, not a diagnosis. Only a clinical assessment can diagnose an alcohol use disorder.
• It asks about drinking over a lifetime, so it cannot tell whether the drinking is current.
• It does not ask how much or how often the person drinks.
• It picks up dependence better than hazardous drinking, and is less sensitive for women.
• It relies on honest self-report, and people may under-report.

The CAGE has 4 yes/no questions and asks about drinking over a lifetime. The AUDIT has 10 questions, asks about the past year, covers how much and how often a person drinks, and gives a 0 to 40 score with four risk zones.

Many services use the CAGE as a very quick first screen and follow a positive result with the AUDIT. Others go straight to the AUDIT, because it is better at picking up hazardous drinking.

A review of the CAGE research (Dhalla and Kopec, 2007) found it does well at picking up alcohol dependence and heavier drinking, and less well at picking up lower-level risky drinking. As with any cut-off, how well it works depends on the group tested, so findings from one population should not be assumed to hold for another.