CAGE Questionnaire
Brief 4-item screening tool for alcohol use disorder
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Why use it
Ultra-brief validated alcohol screening tool. Can be completed in under 2 minutes. Recommended by the USPSTF and Joint Commission for alcohol screening. Identifies patients who need further evaluation or intervention for alcohol use disorder.
About
The CAGE questionnaire is a 4-item validated screening tool for alcohol use disorder (AUD). Each letter represents a screening question: Cut down (attempts), Annoyed by criticism, Guilty about drinking, Eye-opener (morning drinking). A score ≥ 2 indicates a positive screen with sensitivity ~70–85% and specificity ~80–90% for harmful/dependent drinking. The CAGE is widely used due to its brevity and ease of administration.
When to use
- Annual wellness visits and preventive health screening
- Preoperative assessment
- Patients presenting with alcohol-related medical complications
- Emergency department triage for suspected alcohol-related issues
- Any clinical setting where alcohol use may be relevant
Formula
Pearls & pitfalls
- A score ≥ 2 is considered a positive screen (sensitivity ~71–85%, specificity ~80–90%).
- Even a score of 1 warrants clinical attention and follow-up questions about drinking patterns.
- The CAGE focuses on lifetime experience — not time-limited like the AUDIT (past year).
- The "Eye-opener" question is the most specific single item for alcohol dependence.
- CAGE may underdetect hazardous drinking without dependence — consider AUDIT for fuller assessment.
- AUDIT-C (3 questions from AUDIT) may be preferable for detecting unhealthy drinking that doesn't meet dependence criteria.
Next steps
CAGE ≥ 2: Positive screen — further evaluation needed. Confirm with detailed alcohol history (AUDIT-C or full AUDIT), assess for dependence, offer brief counseling or referral to addiction medicine. Consider medical complications (liver disease, GI, cardiac, neurological). CAGE 0–1: Low probability of AUD, but does not exclude hazardous drinking — consider brief counseling.
Evidence
Developed by Ewing (JAMA 1984). Validated in multiple populations. Meta-analysis (Buchsbaum et al. 1991) confirmed sensitivity 71%, specificity 90% for alcohol abuse/dependence at cutoff ≥ 2. Recommended by multiple national guidelines including USPSTF.