The CAGE questionnaire is a list of four questions that are used as a tool to identify a person's dependency on alcohol. Though it was initially developed by John Ewing, MD, in 1984, it has since been adapted into a variation called the CAGE-AID questionnaire that is used to identify dependency on alcohol or other drugs.
The CAGE questionnaire is still one of the most widely used tools for assessing alcohol dependency today. However, it does have limitations, and there are some mixed opinions about its efficacy. Learn about the questionnaire, the purpose, when it is used, how it works, and more.
Purpose of CAGE Questionnaire
The purpose of the CAGE questionnaire is to assess a person's dependency on alcohol. It is an initial step that can be taken by healthcare professionals, or it can be used as a self-assessment tool, to detect the signs of alcohol dependency. The questions on this tool consider not just the current situation of the person, but they apply to their whole life.
Who Developed It?
John Ewing, MD, served as a professor of psychiatry at the University of North Carolina at Chapel Hill and practiced as an addiction therapy clinician. He is credited with the development of the CAGE questionnaire. Dr. Ewing published his research findings of the use and effectiveness of the questionnaire in 1984, but he is thought to have developed and used the tool as early as 1968.
What Is Addiction?
When the CAGE Questionnaire Is Used
Healthcare providers use the CAGE questionnaire as an initial screening tool for alcohol use disorder. It is used when alcohol problems are suspected or may be an issue. It is important for healthcare providers to use these questions as an open-ended approach before asking any other questions about alcohol use to maintain its effectiveness.
What Is Alcohol Use Disorder?
The CAGE questionnaire consists of four questions. These questions apply to the entire life of the person, not just their current situation and alcohol use. The letters in the word "CAGE" stand for elements of each of the four questions: "cut down," "annoyed," "guilty," and "eye-opener."
Questions in 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 a drink first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)?
Tallying Up Your Score
The questions of the CAGE questionnaire can have either "yes" or "no" answers. Each "no" answer receives a score of 0 and each "yes" answer receives a score of 1. The total score is obtained by adding the four individual scores together, so it can range from 0 to 4.
Scoring a 2 or 3 means there is a high level of concern for alcohol use disorder. Scoring a 4 means the person is likely to have alcoholism.
Substance Use Helpline
If you or a loved one is struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 800-662-4357 for information on support and treatment facilities in your area.
For more mental health resources, see our National Helpline Database.
Related Substance Misuse Assessment
The CAGE questionnaire was adapted to apply to problems with other substances as well, not just alcohol. This assessment is called the CAGE-AID questionnaire. The words "or drug use" were added after the word "drinking" in the first three questions and the words "or used drugs" were added after the words "had a drink" in the fourth question. The scoring of the two assessments is the same.
Questions of the CAGE-AID Questionnaire
- Have you ever felt you ought to cut down on your drinking or drug use?
- Have people annoyed you by criticizing your drinking or drug use?
- Have you felt bad or guilty about your drinking or drug use?
- Have you ever had a drink or used drugs first thing in the morning to steady your nerves or to get rid of a hangover (eye-opener)?
Prescription Drug Addiction: Signs and Symptoms
Reasons to Avoid Self-Diagnosis
The CAGE questionnaire and CAGE-AID questionnaire can be used as self-assessment tools to identify possible alcohol or substance use disorders. This, however, does not mean that these tools can or should be used to self-diagnose. Instead, they can be used as a starting point along with the help of a qualified healthcare professional.
One reason to avoid self-diagnosis is that people have biases even when attempting to answer the questions subjectively. This interferes with accuracy. Also, the number of drinks, frequency of drinking, and drinking circumstances to be considered heavy or hazardous drinking vary by person, which can be confusing and impact the scoring.
There also are many complexities that go along with diagnosing—such as overlapping symptoms and signs between different medical conditions and ranges of severity—that can easily be confused by those who are not extensively trained in those specific areas.
Establishing a Treatment Plan
Treatment plans for alcohol use disorders are developed to fit the needs of the individual and their specific situation. The elements may depend on the severity of the condition and how long it has been an issue. For example, someone with a mild alcohol use disorder may experience a lot of benefit from outpatient services, while someone with more severe challenges who has been struggling for many years may require inpatient treatment at a facility.
Distinctions of Inpatient, Outpatient, Observation, Hospital Admission
Treatments for alcohol-related challenges include medications and behavioral treatments. More specifically, psychotherapy (also called talk therapy) interventions such as cognitive behavioral therapy (CBT), motivational enhancement therapy, and marital and family counseling are sometimes used. There are also support groups available for alcohol use problems.
Choosing the Right Therapist
The CAGE questionnaire is a screening tool used to assess possible issues with alcohol. It was developed by John Ewing, MD, a psychiatrist and professor who practiced in the field of addiction therapy. The CAGE questionnaire is used as an initial assessment before any other questions about alcohol use are asked. It can also be used as a self-assessment tool, but it should not be used to self-diagnose or rule out alcoholism.
The CAGE-AID questionnaire is a variation of the CAGE questionnaire that was developed to include use of other drugs in addition to alcohol as part of the assessment. Alcohol and drug overuse are both treatable. With support, these challenges can be managed.
A Word From Verywell
Dependency on alcohol—or any substance—is difficult. It is also something that can be treated and managed. If you suspect that you or someone close to you is experiencing alcohol or substance use problems, help is available. Seek the support of a qualified healthcare professional such as a primary care provider, psychologist, psychiatrist, or substance specialist.
Frequently Asked Questions
What does the "CAGE" acronym mean?
The letters "C," "A," "G," and "E" stand for "cut down," "annoyed," "guilty," and "eye-opener," respectively. Each letter represents one of the four questions of the CAGE questionnaire to assess alcohol dependency.
Does the CAGE questionnaire prove someone is an alcoholic?
No, the CAGE questionnaire does not prove someone is an alcoholic. It is one tool that is used, along with other tools and the help of a qualified healthcare professional, to assess for the possibility of an alcohol use disorder.
How different is the CAGE questionnaire from the AUDIT?
Like the CAGE questionnaire, the AUDIT is a screening tool used to assess for an alcohol use disorder. The AUDIT has more questions (10 instead of four) and has been found to be more sensitive than the CAGE questionnaire.
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By Ashley Olivine, Ph.D., MPH
Dr. Ashley Olivine is a health psychologist and public health professional with over a decade of experience serving clients in the clinical setting and private practice. She has also researched a wide variety psychology and public health topics such as the management of health risk factors, chronic illness, maternal and child wellbeing, and child development.
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