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What Is the CAGE Questionnaire?
The CAGE questionnaire is an international screening tool used by healthcare practitioners to help discuss a patient’s alcohol use/abuse to determine if that patient may have an alcohol use disorder (AUD). The test is comprised of four questions and the name of the assessment, “CAGE,” is derived from the bold phrases in the questions, as below:
|Have you ever felt you needed to Cut down on your drinking?||Yes/No||+1|
|Have people Annoyed you by criticizing your drinking?||Yes/No||+1|
|Have you ever felt Guilty about drinking?||Yes/No||+1|
|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?
The CAGE questions were created in 1968 by Dr. John Ewing, an addiction therapy clinician and psychiatry professor at the University of North Carolina at Chapel Hill. Developed to detect drinking behaviors in patients at North Carolina Memorial Hospital, the assessment received national attention in 1984 after Ewing published a paper in which he describes how the CAGE questions are classified and their successive use in clinical studies. To this day, the CAGE questionnaire is recognized as one of the most efficient and effective screening devices available for alcoholism.
CAGE Questionnaire Scoring
Each response to the four CAGE questions is scored with points; either 0 points for “no” or 1 point for “yes.” The higher the score, the greater the indication that the patient might have problems controlling alcohol consumption or an AUD. A total score of 2 is considered to be clinically significant and that the patient should be subject to further review.
Although the assessment is indicative of problematic drinking, the CAGE questionnaire is only the first step in diagnosing alcoholism. Regardless of what an individual’s score is, it is not an official diagnosis, which can only be made by a licensed professional. If a patient receives a CAGE score of 1 or higher, it is advised that they undergo additional assessment options to determine the next course of action.
When to Use the CAGE Questionnaire
Even though the test was originally designed for individuals over the age of 16 years old, all patients of any age who drink alcohol should be screened with CAGE questions according to the National Institute of Alcohol Abuse and Alcoholism. Healthcare professionals should include the CAGE questionnaire during standard history questions in primary care, emergency department, psychiatric, and inpatient hospital settings.
Doctors should also use CAGE or another alcohol screening tool for at-risk populations in which alcohol use can be particularly damaging and/or problematic, including:
- Pregnant women
- College students
- Arrested and incarcerated persons, especially DUI and domestic violence offenders
In addition to being administered by a healthcare professional, individuals can also take the CAGE test on their own. It is important to remember to just be honest and that the questions relate to the whole of the patient’s life, not just the current circumstances.
Other Alcohol Assessments
CAGE originated during a time when the official diagnosis of alcoholism was less exact and detailed than it is today. Alcoholism wasn’t clearly defined as a mental disorder until the publication of Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R) in 1987. Because of this, the CAGE questionnaire is designed to be a screening tool rather than a diagnostic instrument. It does not inquire information about the quantity, frequency, and pattern of drinking that the patient engages in.
As time has progressed, other alcohol screening assessments have been developed, including the Michigan Alcohol Screening Test and the Alcohol Use Disorders Identification Test. The Michigan Alcohol Screening Test consists of 24 questions that asks about a patient’s drinking behavior and the adverse consequences that patient suffers from because of drinking. The Alcohol Use Disorders Identification Test is a 10 question test that was designed to be sensitive to signs of hazardous and harmful drinking as well as alcohol dependence.
Although the MAST and AUDIT tests may obtain more thorough information and patient history than CAGE, the CAGE questionnaire is still the preferred primary alcohol screening tool by the majority of clinicians. However, many healthcare professionals will utilize the Michigan Alcohol Screening Test or the Alcohol Use Disorders Identification Test and administer them after CAGE for patients that require further investigation.
- Author — Last Edited: February 21, 2019
Buchsbaum, David G. (1991). Screening for Alcohol Abuse Using CAGE Scores and Likelihood Ratios. Retrieved on 19th February 2019 from https://annals.org/aim/article-abstract/705141/screening-alcohol-abuse-using-cage-scores-likelihood-ratios#top
Ewing, Dr. John A. (2019). CAGE Questions for Alcohol Use. Retrieved on 19th February 2019 fromhttps://www.mdcalc.com/cage-questions-alcohol-use#evidence
O’Brien, Charles P. (2008). The CAGE Questionnaire for Detection of Alcoholism. Retrieved on 19th February 2019 from https://jamanetwork.com/journals/jama/fullarticle/182810