CAGE Assessment

Last Updated: May 10, 2024

David Levin Reviewed by David Levin
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CAGE assessment is a perfect example of quick screening tools for alcoholism. The CAGE screening method is extremely time-efficient as it can be administered in less than a minute. As such, the CAGE method is widely used in primary care facilities, when a quick assessment of alcoholism is needed.

CAGE Questionnaire

CAGE Assessment Test

Have you ever felt you needed to Cut down on your drinking?

Have people Annoyed you by criticizing your drinking?

Have you ever felt Guilty about drinking?

Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?


Having a minimal score on this drug abuse screening test usually means that the interviewee isn’t an alcoholic. However, the CAGE screening tool is rather straightforward and it’s obvious what it’s about, which is why some alcoholics might lie in order to pass this test. In other words, alcoholics may dissimulate, and try to hide their disorder. This is one of the biggest flaws of the CAGE assessment technique, and it can only be compensated by the introduction of an in-depth clinical interview.

How serious is this CAGE score? It depends. Most clinicians agree that one “yes” answer simply isn’t enough for the assessment of alcoholism. While the CAGE score of 1 may warrant further investigation, most people with this score don’t have substance abuse problems.

It’s important to consider which CAGE question has a “yes” answer. Numerous individuals who drank a lot of alcohol the night before might give a “yes” answer to the first CAGE alcohol screen question. However, an individual who needs an “eye-opener” (morning drinking)- yes answer on the last question- is a bit more likely to have a serious problem.

Two “yes” answers on the CAGE screening test are the cut-off score. It can be stated that individuals who score 2 on the CAGE model didn’t pass the test. Upon closer inspection, it is usually proven that these individuals indeed exhibit major symptoms of substance abuse disorder, which is why this is the most important CAGE criteria.

It’s important that clinicians don’t draw unnecessary conclusions from the fact that somebody scored 2 on CAGE questionnaire for alcohol substance abuse. Substance abuse disorder is an extremely complex mental health problem and it simply cannot be explored thoroughly with this procedure.

Having CAGE questionnaire score of 3 further increases the likelihood that the patient exhibits substance abuse disorder. It is possible to draw some conclusions from this CAGE assessment score. For instance, an alcoholic who refuses to accept that he has a problem might not have the feeling of guilt (which is identified with the third assessment question). On the other hand, an alcoholic who succeeded in adapting his lifestyle might refuse that the problem exists in the first place (e.g. “no” answer on the first assessment question).

This is the maximum score on CAGE alcohol screen tool. A person who has 4 “yes” answers is likely to exhibit the main symptoms of alcoholism in all the main spheres of functioning. CAGE drinking assessment tool is more and more reliable and valid as the scores go up, which means that scoring 4 on this test is a good sign of chronic, pervasive alcoholism.

What does CAGE mean? This is an acronym of the 4 CAGE questions:

  1. Have you ever felt you needed to Cut down on your drinking?
  2. Have people Annoyed you by criticizing your drinking?
  3. Have you ever felt Guilty about drinking?
  4. Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?

In other words, the CAGE acronym was made as it is easy to remember, by taking parts of each question that is a part of this assessment procedure. The 4 alcoholism assessment questions aim to interrogate 4 important aspects of addiction:

  1. Intrapersonal (C)
  2. Interpersonal (A)
  3. Conscience (G)
  4. Tolerance and abstinence symptoms (E)

Most substance abuse criteria include the assessment of a person’s functioning in both individual and social spheres (the first two questions). Furthermore, tolerance and abstinence are perhaps the most important symptoms of addiction, which is assessed by the fourth CAGE question.
The CAGE is sometimes used as a general substance abuse assessment, but it has to be noted that it is primarily developed for the detection of alcoholism.

doctor sitting in the office

History And Methodology Of CAGE Test

CAGE alcohol assessment procedure was developed at North Carolina Memorial Hospital, in 1968. The staff wanted to make a quick assessment tool and make their screening procedures a lot more efficient. The 4 questions of the CAGE assessment tool were chosen from a wider pool of substance abuse examination questions, due to their ability to discern alcoholics from non-alcoholics.
CAGE methodology is rather straightforward, the interviewee answers with “yes” or “no”, and the final CAGE score is the number of “yes” answers. Two such answers are regarded as a sufficient prerequisite for further investigation of potential alcoholism. CAGE scale thus has 5 possible values, from 0 to 4.

Variations of CAGE test

The main variant of the CAGE screen test is used to assess alcoholism, but there is a modified version, used for the assessment of other types of substance abuse.

These are 4 CAGE-AID questions:

  1. Have you ever felt you ought to cut down on your drinking or drug use?
  2. Have people annoyed you by criticizing your drinking or drug use?
  3. Have you felt bad or guilty about your drinking or drug use?
  4. 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)?

It is obvious that the modified version of the CAGE is essentially the same as the original assessment procedure.

Accuracy Of The CAGE test

Numerous psychometric studies have proven that the CAGE alcohol screening procedure is a good and reliable way to quickly assess the presence of alcoholism. More concretely, this assessment technique is sensitive and specific. CAGE alcohol abuse test can identify most alcoholics, without many false positives and false negatives, which is essentially what test specificity and sensitivity are about.

CAGE questionnaire for alcohol abuse is a reliable and valid instrument for the quick assessment of alcoholism. Its 4 questions have been proven to be efficient in discerning alcoholics from non-alcoholics.

Finally, there are special variants of the CAGE method, specifically modified for the assessment of other substance abuse disorders. The procedure has been approved by the National Institute on Alcohol Abuse and Alcoholism.

Page Sources

  1. Ewing JA. Detecting alcoholism. The CAGE questionnaire. JAMA. 1984 Oct 12;252(14):1905-7.
  2. Assessing Alcohol Problems: A Guide for Clinicians and Researchers. CAGE Questionnaire.

Published on: February 11th, 2020

Updated on: May 10th, 2024


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