CAGE Questionnaire — 4-Question Alcohol Screening

Frequently asked questions

What is the CAGE questionnaire?

The CAGE questionnaire is a brief 4-question screening instrument for alcohol problems, developed by Dr. John Ewing and published in JAMA in 1984 (252(14):1905–1907). Its name is an acronym of the key word in each question: Cut down, Annoyed, Guilty, and Eye-opener. It is a screening tool, not a diagnosis.

What are the four CAGE questions?

The four items, answered yes or no, are: 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 to get rid of a hangover (Eye opener)?” Each “Yes” scores 1 point, each “No” scores 0.

How is the CAGE scored?

Each “Yes” counts as 1 and each “No” counts as 0; add the four answers for a total of 0–4. Example: answering Yes to “Cut down” and “Guilty” and No to the other two gives 1+0+1+0 = 2, which meets the clinical-significance cutoff (≥ 2).

What does a CAGE score of 2 or more mean?

A total of 2 or more is considered clinically significant: a positive screen, meaning further evaluation by a health professional is warranted. A score of 0 or 1 is a negative screen. Neither result is a diagnosis — a positive screen flags that a conversation with a professional is worthwhile, and a negative screen does not guarantee there is no problem.

How is the CAGE different from the AUDIT?

The CAGE is the quick 4-question screen: yes/no answers about your lifetime experience, completable in under a minute. The AUDIT is the World Health Organization’s 10-item instrument about the past 12 months, scored 0–40 across four WHO risk zones — more detailed, but longer. Use the CAGE for speed and the AUDIT alcohol test when you want the detailed WHO-zone breakdown.

What is CAGE-AID?

CAGE-AID is an adapted version of the CAGE for broader substance use: each question adds “or drug use” (for example, “Have you ever felt you ought to cut down on your drinking or drug use?”), with the same scoring and the same ≥ 2 cutoff. This calculator implements the original alcohol-focused CAGE.

Is the CAGE a diagnosis?

No. The CAGE is a validated screening instrument — it flags patterns that deserve attention. It cannot diagnose an alcohol use disorder, and a low score does not guarantee there is no problem. Only a qualified health professional, with a full assessment, can make a diagnosis. Your result is never a label for you as a person.

I scored 2 or more — what should I do?

First, remember this is screening information, not a verdict about you. The general guidance for a positive screen is to talk with a health professional — a doctor, counselor, or addiction specialist — who can assess your situation properly. Many people find it helps to bring their item-by-item answers along. If drinking ever feels unsafe or out of control, seek professional help promptly.

Why do the questions ask about “ever” (lifetime)?

The CAGE asks about your lifetime experience rather than only recent drinking, so a person who no longer drinks can still screen positive — the result reflects history, not necessarily current drinking. A clinician may direct the questions toward a more current timeframe when that is more useful.

How accurate is the CAGE?

The original Ewing (1984) paper reported a sensitivity of 93% and a specificity of 76% for identifying problem drinking, and the instrument has been studied extensively since. No screening test is perfect: answers depend on honest self-report, and clinical judgment applies when a score does not match other evidence. Treat the result as a starting point for a conversation with a professional, not a final answer.