How is the CAGE score interpreted?

Each "yes" answer scores 1 point (total 0–4). A score of ≥ 2 is considered clinically significant and has a sensitivity of 93% and specificity of 76% for identifying alcohol use disorders. A score of ≥ 3 is highly specific for alcohol dependence.

What are the limitations of the CAGE questionnaire?

CAGE is a screening tool, not a diagnostic instrument. It may miss binge drinking and hazardous alcohol use, performs less well in women and younger populations, and does not assess drinking quantity or frequency. The AUDIT (Alcohol Use Disorders Identification Test) may be more sensitive for identifying the full spectrum of alcohol misuse.

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CAGE Questionnaire

Four-item screening tool for identifying problem drinking and alcohol use disorders.

Questions

C — Have you ever felt you should Cut down on your drinking?

A — Have people Annoyed you by criticizing your drinking?

G — Have you ever felt bad or Guilty about your drinking?

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

0 / 4 positive responses. Screening negative.

0–1 positiveLow suspicion for alcohol use disorder

≥2 positiveClinically significant — further assessment recommended

4 positiveHighly suggestive of alcohol dependence

Disclaimer: For educational purposes only. Not a substitute for clinical judgment.

When to use

The CAGE questionnaire is a brief screening tool for identifying problem drinking. It is best used in primary care, preoperative, and inpatient medical settings as a rapid first-line screen.

Clinical pearls

A score ≥2 has a sensitivity of 93% and specificity of 76% for identifying problem drinking.
CAGE is better at detecting alcohol dependence/abuse than at-risk drinking — consider AUDIT for broader screening.
The "Eye-opener" question (E) is the most specific for alcohol dependence.

References

Ewing JA. Detecting alcoholism: the CAGE questionnaire. JAMA. 1984;252(14):1905-1907.
Dhalla S, Kopec JA. The CAGE questionnaire for alcohol misuse: a review of reliability and validity studies. Clin Invest Med. 2007;30(1):33-41.

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About This Tool

What Is the CAGE Questionnaire?

The CAGE questionnaire is a four-item screening instrument developed by Dr. John Ewing in 1984 for identifying patients with problem drinking and potential alcohol use disorders. The acronym CAGE derives from the four questions: Cut down, Annoyed, Guilty, and Eye-opener. Each question is scored as 0 (no) or 1 (yes), yielding a total score of 0–4. Its brevity and ease of administration have made it one of the most widely used alcohol screening tools in clinical practice, particularly in primary care, emergency departments, and preoperative settings.

Scoring and Interpretation

A score of ≥2 positive responses is considered clinically significant and warrants further assessment for alcohol abuse or dependence. At this cutoff, the CAGE has a sensitivity of approximately 93% and specificity of 76% for detecting problem drinking. A score of 1 may be clinically significant in certain populations and should prompt further discussion. A score of 4 is highly suggestive of alcohol dependence. The CAGE is designed as a lifetime screen — the questions ask about experiences "ever," not just currently — which means it may identify patients with historical but now resolved alcohol problems.

Limitations and Complementary Tools

The CAGE is more effective at detecting alcohol dependence than hazardous or at-risk drinking. It may miss binge drinkers who have not yet developed consequences and has lower sensitivity in women, younger patients, and certain ethnic groups. For comprehensive screening, the AUDIT (Alcohol Use Disorders Identification Test) is preferred by the WHO and USPSTF as it captures the full spectrum from hazardous drinking to dependence. The AUDIT-C (first 3 questions of AUDIT) offers a middle ground between CAGE's brevity and AUDIT's comprehensiveness.

🔑 Clinical Pearls

CAGE is a screening tool, not a diagnostic test — a positive screen should be followed by a comprehensive assessment.
The "Eye-opener" question is the most specific for physiologic alcohol dependence (morning drinking to prevent withdrawal).
Consider AUDIT-C for populations where CAGE has lower sensitivity (women, young adults, college students).
A positive CAGE in a surgical patient should prompt CIWA monitoring for potential alcohol withdrawal post-operatively.

Key References

Ewing JA. Detecting alcoholism: the CAGE questionnaire. JAMA. 1984;252(14):1905-1907.
Dhalla S, Kopec JA. The CAGE questionnaire for alcohol misuse: a review of reliability and validity studies. Clin Invest Med. 2007;30(1):33-41.
USPSTF. Screening and Behavioral Counseling Interventions in Primary Care to Reduce Unhealthy Alcohol Use. JAMA. 2018;320(18):1899-1909.

Formula last verified: February 2026