Is the result a diagnosis?

No. The CAGE only shows whether there have been signs of a possible drinking problem. Only a doctor or psychotherapist can diagnose an alcohol use disorder.

Why do the questions ask about “ever”?

The CAGE looks at the patient's whole life. A “yes” can refer to something that happened a long time ago, so a positive result does not necessarily mean the patient has a problem today.

Should I use the CAGE or the AUDIT-C?

For a patient's current drinking, the AUDIT-C or the full AUDIT is the better choice: they also pick up risky drinking and work better for women. The CAGE focuses on signs of dependence.

The patient drinks every day. Can they just stop?

If a patient drinks a lot every day, stopping suddenly can cause withdrawal symptoms that can be dangerous. They should see a doctor before stopping, so it can be done safely.

Are the answers stored?

No. The answers are processed only in the browser and are not sent or saved anywhere.

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CAGE

CAGE Questionnaire (Cut down, Annoyed, Guilty, Eye-opener)

Four quick questions that help assess whether alcohol has ever become a problem for a patient.

Category: Alcohol & drugs
Who fills it in: Self-report
Items: 4
Recall period: Lifetime

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Administer the scale

0 of 4 completed

Record the patient's response to every item. Entries stay in your browser and are never sent anywhere.

1. Have you ever felt you ought to cut down on your drinking?
Have you ever felt you ought to cut down on your drinking?
YesNo

Question 1 of 4

What it measures

The CAGE screens for signs of alcohol dependence. Each of the four yes/no questions scores 1 point for “yes”, giving a total from 0 to 4; 2 or more is considered clinically significant. Most questions ask whether something has ever happened, so the CAGE looks at the patient's whole life rather than just their current drinking.

When to use it

The CAGE can be a quick way to check whether alcohol has ever caused signs of a problem in a patient's life. It is mainly useful for picking up possible dependence, not risky drinking. To find out whether a patient's current drinking is risky, the AUDIT-C or the full AUDIT is a better choice.

Origin

The CAGE was developed by Dr. John A. Ewing in the United States. It was in use from 1970 and became widely known after its publication in the Journal of the American Medical Association (JAMA) in 1984.

Validation

The CAGE has been studied extensively in hospitals, primary care, emergency departments, psychiatric settings and addiction services. In clinical settings it detects a large share of people with alcohol dependence, with an average sensitivity of about 71% and a specificity of about 90%. It is less useful for detecting risky drinking, and it performs less well than the AUDIT.

Limitations

The CAGE is a screen, not a diagnosis. It was designed to detect dependence, not risky drinking, so people whose drinking is risky but not yet dependent can easily score 0. The first validation studies were done with men, and studies with women have found poor sensitivity. Because most questions ask about “ever”, a positive result may reflect problems in the past rather than now. It has not yet been established whether the CAGE detects dependence according to the latest DSM-5 criteria. There is no validated German version, which is why it is only available in English here.

Frequently asked questions

Is the result a diagnosis?: No. The CAGE only shows whether there have been signs of a possible drinking problem. Only a doctor or psychotherapist can diagnose an alcohol use disorder.
Why do the questions ask about “ever”?: The CAGE looks at the patient's whole life. A “yes” can refer to something that happened a long time ago, so a positive result does not necessarily mean the patient has a problem today.
Should I use the CAGE or the AUDIT-C?: For a patient's current drinking, the AUDIT-C or the full AUDIT is the better choice: they also pick up risky drinking and work better for women. The CAGE focuses on signs of dependence.
The patient drinks every day. Can they just stop?: If a patient drinks a lot every day, stopping suddenly can cause withdrawal symptoms that can be dangerous. They should see a doctor before stopping, so it can be done safely.
Are the answers stored?: No. The answers are processed only in the browser and are not sent or saved anywhere.

References

Ewing JA. Detecting alcoholism: the CAGE questionnaire. JAMA. 1984;252(14):1905-1907.
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.
Aertgeerts B, Buntinx F, Kester A. The value of the CAGE in screening for alcohol abuse and alcohol dependence in general clinical populations: a diagnostic meta-analysis. J Clin Epidemiol. 2004;57(1):30-39.
Bisson J, Nadeau L, Demers A. The validity of the CAGE scale to screen for heavy drinking and drinking problems in a general population survey. Addiction. 1999;94(5):715-722.
Fischer JA, Roche AM, Duraisingam V. Cut down, Annoyed, Guilty and Eye-opener (CAGE): description, strengths and knowledge gaps. National Centre for Education and Training on Addiction (NCETA), Flinders University; 2021.

Licence & attribution

Ewing, J.A. Detecting alcoholism: the CAGE questionnaire. JAMA, 1984. 252(14): 1905-1907.

Available in the public domain. May be downloaded and used with appropriate acknowledgement (NCETA, Flinders University). Some printed copies carry a 1984 American Medical Association copyright line referring to the original JAMA article.