Alcohol Screening Questionnaire (CAGE)

Four questions make up the screen, and their initials give it its name: whether a person has ever felt they should Cut down on drinking, whether people have Annoyed them by criticizing their drinking, whether they have felt bad or Guilty about drinking, and whether they have ever had a drink first thing in the morning to steady their nerves or get rid of a hangover, an Eye-opener. The questions concern the lifetime experience of concern and consequences rather than how much is consumed.

Ewing developed the questions in the late 1960s, and they were first evaluated by Mayfield, McLeod and Hall (1974); Ewing (1984) later described the questionnaire in detail. Its brevity made it one of the most widely taught alcohol screens in medicine.

Each yes answer adds one point. A total of zero indicates no reported concern; higher totals indicate more signs of a drinking problem, and the report explains what each level tends to mean. Because the questions ask about the lifetime, a positive answer may reflect the past rather than the present, and the screen does not measure current consumption.

The questionnaire is used as a quick first step in medical history-taking and in research. On this site, the Alcohol Use Disorders Identification Test (AUDIT) gives a fuller picture of current consumption and harm, and the Drug Abuse Screening Test (DAST-10) covers other drugs.

The CAGE questionnaire asks about cutting down, annoyance at criticism, guilt and morning eye-openers, and its scores converge with clinical diagnoses of alcohol abuse and dependence (Ewing, 1984). A review of validation studies found that it identifies lifetime alcohol dependence well in medical and psychiatric settings (Dhalla & Kopec, 2007).

Because its items describe consequences rather than amount, it is less sensitive than consumption-based screens to heavy drinking that has not yet caused problems, which marks a discriminant boundary between dependence and risky use (Dhalla & Kopec, 2007).

At the published cutoff, pooled sensitivity is about 0.71 and specificity about 0.90 for alcohol abuse and dependence (Dhalla & Kopec, 2007).

“Have you ever felt you should cut down on your drinking?”

Illustrative only. During administration items are presented one screen-set at a time; response-key direction is never shown to respondents.

Item responses are summed to a total score and compared against published screening cutoffs.

The report explains which published screening bands your score falls in and what they mean.