- The CAGE is a 4-question screening tool for identifying potential alcohol problems
- The acronym stands for Cut down, Annoyed, Guilty, Eye-opener
- Takes less than 1 minute to administer — one of the shortest validated screens
- Two or more "yes" answers suggest a clinically significant alcohol problem
- Sensitivity of 70-96% for detecting alcohol dependence
- Originally developed in 1968 by Dr. John Ewing at the University of North Carolina
- Best at detecting alcohol dependence; less effective for hazardous or at-risk drinking
- Often used as a quick initial screen followed by more comprehensive tools like the AUDIT
Published: February 2026 | Last Updated: February 2026 | Reading Time: 5 min
What Is the CAGE Questionnaire?
The CAGE questionnaire is one of the oldest, shortest, and most widely recognized screening tools for identifying alcohol problems. Developed in 1968 by Dr. John Ewing at the University of North Carolina, the CAGE consists of just four questions, each corresponding to a letter in its acronym.
The Four CAGE Questions
C — Cut down: Have you ever felt you should cut down on your drinking?
A — Annoyed: Have people annoyed you by criticizing your drinking?
G — Guilty: Have you ever felt bad or guilty about your drinking?
E — Eye-opener: Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (an "eye-opener")?
Each question is answered with a simple "yes" or "no." A score of 2 or more positive responses is considered a clinically significant indicator of an alcohol problem and warrants further assessment.
Clinical Significance
Scoring and Interpretation
The CAGE uses a straightforward scoring system. Zero "yes" answers indicates low likelihood of an alcohol problem. One "yes" answer is considered borderline and may warrant further inquiry. Two or more "yes" answers suggests a high likelihood of an alcohol use disorder and warrants comprehensive assessment.
The threshold of 2 positive responses provides sensitivity of approximately 70-96% and specificity of 75-95% for detecting alcohol dependence, depending on the population studied.
Strengths
The CAGE's primary advantages include its extreme brevity (less than 1 minute), ease of administration (no scoring calculations needed), high sensitivity for detecting alcohol dependence, memorability (the acronym makes it easy for clinicians to recall), and minimal training required for administration.
Limitations
The CAGE has several recognized limitations. It was designed to detect alcohol dependence rather than the full spectrum of alcohol misuse, making it less sensitive to hazardous or at-risk drinking. It does not assess drinking quantity or frequency. It asks about lifetime experiences rather than current behavior, potentially identifying resolved past problems. And it may be less sensitive in certain populations including women, younger adults, and certain ethnic groups.
How the CAGE Is Used
In Primary Care
The CAGE is frequently used as a quick initial screen in primary care settings, particularly when time is limited. A positive CAGE screen (2+ "yes" responses) typically triggers administration of a more comprehensive tool like the AUDIT or a direct referral for clinical assessment.
In Emergency Departments
The CAGE's brevity makes it well-suited for emergency department settings where clinicians have limited time but need to identify patients whose presenting complaints may be related to alcohol use.
As a Self-Assessment
The CAGE can be used for personal self-reflection. If you answer "yes" to two or more questions, consider speaking with a healthcare provider about your alcohol use. Even one "yes" answer — particularly to the eye-opener question, which is strongly associated with physical dependence — may warrant further consideration.
Frequently Asked Questions
Is the CAGE questionnaire still used today?
Yes, the CAGE remains widely used, particularly in settings where brevity is essential. However, many clinicians now prefer the AUDIT or AUDIT-C as primary screening tools because they capture a broader range of problematic drinking patterns and assess current behavior rather than lifetime experience.
What does the eye-opener question mean?
The eye-opener question asks whether you have ever needed a drink in the morning to function or relieve hangover symptoms. Morning drinking is a strong indicator of physical alcohol dependence, as it suggests the person is experiencing withdrawal symptoms overnight that they need alcohol to relieve.
Can I use the CAGE for drug screening?
A modified version called the CAGE-AID (Adapted to Include Drugs) has been developed that adds "or drug use" to each question. The CAGE-AID can screen for both alcohol and drug problems simultaneously.
References
- Ewing, J.A. (1984). Detecting alcoholism: The CAGE questionnaire. JAMA.
- Dhalla, S. & Kopec, J.A. (2007). The CAGE questionnaire for alcohol misuse: A review of reliability and validity studies. Clinical and Investigative Medicine.
- O'Brien, C.P. (2008). The CAGE questionnaire for detection of alcoholism. JAMA.
- Brown, R.L. & Rounds, L.A. (1995). Conjoint screening questionnaires for alcohol and other drug abuse: Criterion validity in a primary care practice. Wisconsin Medical Journal.
- National Institute on Alcohol Abuse and Alcoholism. (2023). Screening Tools.
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