CAGE Questionnaire
CAGE Alcohol Screening Questionnaire · Also known as: CAGE, Cut-Annoyed-Guilty-Eye Opener, Alcohol Dependency Screen
The CAGE is a 4-item brief alcohol screening questionnaire developed by Ewing and colleagues in the 1970s. The acronym represents the four questions: Cut down, Annoyed, Guilty, Eye opener. Published in 1984, it has become one of the most widely used brief alcohol screens in medical practice due to its simplicity and historical validation.
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When to use it
The CAGE is appropriate for rapid screening in primary care, emergency departments, and general medical settings. It is particularly useful for older adults and women, where it has reasonable sensitivity. However, the AUDIT and AUDIT-C have greater evidence base in modern practice. The CAGE is less suitable when detailed assessment of consumption quantity is needed (use AUDIT).
Strengths & limitations
- Extremely brief (4 items, <1 minute); memorable acronym makes it easy to administer and recall
- High specificity (87–94%) for identifying alcohol dependence in primary care populations
- Simple yes/no format maximizes accessibility across literacy and language levels
- Historically validated in thousands of studies; extensive evidence base for effectiveness
- Can be administered verbally, making it suitable for illiterate populations and telehealth
- Lower sensitivity (45–79%) compared to AUDIT in diverse populations; misses some alcohol problems
- Designed primarily for identifying dependence, not hazardous use; may miss early-stage problem drinking
- Performance varies substantially across demographic groups; women and ethnic minorities may have different thresholds
- Dependent on self-report and insight; many individuals with alcohol problems deny or minimize symptoms
Frequently asked
How does CAGE compare to AUDIT?
CAGE is shorter (4 vs. 10 items) and simpler but less comprehensive. CAGE focuses on dependence symptoms; AUDIT assesses consumption, dependence, and consequences. AUDIT has greater overall sensitivity and specificity. CAGE is primarily historical; AUDIT is the current evidence-based standard. Modern practice favors AUDIT/AUDIT-C over CAGE.
What does a CAGE score of 2 mean?
A score of 2 meets the screening threshold for possible alcohol dependence, indicating the patient should receive detailed assessment including quantity/frequency of drinking, dependence symptoms, and health consequences. A positive CAGE does not diagnose dependence; it indicates need for further evaluation.
Can CAGE miss people with alcohol problems?
Yes. CAGE has lower sensitivity (45–79%) compared to AUDIT and may miss people with hazardous drinking who have not yet developed dependence. Additionally, denial and shame cause many people with dependence to deny the behaviors CAGE assesses. CAGE should be followed by clinical assessment if suspicion is high.
Should I use different CAGE cutoffs for men versus women?
Some research suggests lower cutoff (1) may be more appropriate for women, though this is not universally adopted. Sex differences exist in alcohol metabolism and social factors affecting drinking patterns. Clinical judgment and follow-up assessment are more important than rigid adherence to cutoffs.
Sources
- Ewing, J. A. (1984). Detecting alcoholism: the CAGE questionnaire. JAMA, 252(14), 1905–1907. DOI: 10.1001/jama.1984.03350140051025 ↗
- Mayfield, D., McLeod, G., & Hall, P. (1974). The CAGE questionnaire: validation of a new alcoholism screening instrument. American Journal of Psychiatry, 131(10), 1121–1123. DOI: 10.1176/ajp.131.10.1121 ↗
- U.S. Department of Health and Human Services. (2002). Alcohol Use Disorders: Drinking Levels Defined. National Institute on Alcohol Abuse and Alcoholism. link ↗
How to cite this page
ScholarGate. (2026, June 3). CAGE Alcohol Screening Questionnaire. ScholarGate. https://scholargate.app/en/health-measurement/cage-questionnaire
Which method?
Set this method beside its closest kin and read them side by side — the library lays the books on the table; the choice is yours.
- AUDIT Alcohol Use Disorders Identification TestHealth Measurement↔ compare
- AUDIT-CHealth Measurement↔ compare
- PROMISHealth Measurement↔ compare
- SF-36 Health SurveyHealth Measurement↔ compare
- WHOQOL-BREFHealth Measurement↔ compare