Primary Care
CAGE Questionnaire
Brief screen for problem drinking.
Education and reference only. Not a substitute for clinical judgement, local policy or product labelling. Always verify before clinical use. Values are calculated in your browser and never stored.
Background
The CAGE questionnaire is a four-item screening tool for problem drinking and possible alcohol dependence, designed to be quick and easy to remember. Its name is a mnemonic for its four yes/no questions: feeling you should Cut down, being Annoyed by criticism of your drinking, feeling Guilty about drinking and needing an Eye-opener (a drink first thing in the morning). Each "yes" scores one point, giving a total of 0–4. It was introduced by Ewing in 1984 and remains a familiar bedside and primary-care screen.
Interpreting the result
A score of two or more positive answers is the established threshold for a clinically significant result, suggesting possible alcohol dependence and warranting fuller assessment. A score of 0–1 is a negative screen. Because the questions probe consequences and loss of control rather than quantity, CAGE is oriented towards dependence and is less sensitive for hazardous drinking that has not yet caused such features. A single positive answer can still merit attention in the right context.
Worked example
A patient answers yes to having felt they should cut down and to feeling guilty about their drinking, but no to being annoyed by criticism or needing an eye-opener. The CAGE score is 2, a positive screen that should prompt a fuller alcohol history and assessment for dependence.
Pearls / pitfalls
- CAGE is weighted towards dependence and is relatively insensitive to early hazardous or binge drinking, so a negative CAGE does not exclude risky consumption.
- It asks about lifetime experiences, so a positive answer may reflect past rather than current drinking — clarify the timeframe.
- AUDIT-C is generally preferred when the aim is to detect hazardous drinking before dependence develops.
- Like all screens it relies on honest self-report and can be affected by denial or stigma.
Evidence & validation
Introduced and validated by Ewing (1984) and reproduced in many settings; it is endorsed as a brief screen in numerous guidelines, though tools such as AUDIT-C are now often preferred for detecting hazardous use earlier.
Frequently asked questions
What CAGE score is significant?
Two or more positive answers is the accepted threshold for a clinically significant result, suggesting possible dependence. This should prompt a fuller alcohol history and assessment.
How does CAGE compare with AUDIT-C?
CAGE focuses on the consequences and loss of control associated with dependence, while AUDIT-C measures consumption and detects hazardous drinking earlier. AUDIT-C is often preferred for routine screening, with CAGE valued for its brevity.
Does CAGE detect binge or hazardous drinking?
Not reliably — its questions are oriented towards dependence rather than quantity, so it may miss hazardous drinkers who have not yet developed those features. A consumption-based tool is better for that purpose.
Does the questionnaire ask about current drinking?
The classic questions are framed over a lifetime, so a positive answer may reflect past behaviour. Clarifying whether the experiences are recent helps interpret the result.
What should a positive CAGE lead to?
A positive screen should prompt a fuller alcohol assessment, including a consumption history and evaluation for dependence and withdrawal risk. Brief intervention or referral may follow depending on the findings.
References
- Ewing JA. Detecting alcoholism: the CAGE questionnaire. JAMA. 1984;252(14):1905–1907.
- NICE CG115: Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. 2011.
About the creator
John Ewing
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