What is the CAGE questionnaire?
The CAGE questionnaire is a series of four questions that doctors can use to check for signs of possible alcohol dependency. The questions are designed to be less obtrusive than directly asking someone if they have a problem with alcohol.
What are the questions?
CAGE is an acronym that makes the four questions easy to remember. Each letter represents a specific question:
- Have you ever felt you should cut down on your drinking?
- Have people annoyed you by criticizing your drinking?
- Have you ever felt bad or guilty about your drinking?
- Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)?
How is it scored?
Each question requires a simple yes or no answer. Each yes answer increases the chances that someone may have an alcohol dependency. Generally, two or three yes answers suggest heavy alcohol use or alcohol use disorder.
Doctors sometimes attach more significance to certain questions. For example, many consider the final question about drinking in the morning to be the most important question, since it’s a sign that someone may be having symptoms of withdrawal.
Are there any variations?
There are a few similar tests that doctors use to check for alcohol or substance use disorder.
The most similar one is called the CAGE-AID questionnaire. The addition of AID stands for “Adapted to Include Drugs.” It’s the same four questions as the CAGE questionnaire, but adds drug use alongside drinking.
Similar tests used to check for signs of alcohol use disorder include:
- Michigan alcohol screening test (MAST). This is one of the oldest screening tests for alcohol use disorder. It includes 24 questions that ask about both behavior and negative consequences. It tries to evaluate someone’s long-term history, rather than their current state.
- Alcohol use disorders identification test (AUDIT). This 10-question test checks for both potentially dangerous drinking habits and alcohol dependence.
- Fast alcohol screening test (FAST). This is a four-question test adapted from the AUDIT questionnaire that checks for drinking patterns that might increase someone’s risk of psychological or physical complications.
- TWEAK. This test includes five questions that check for signs of alcohol misuse, such as blacking out and having a very high tolerance. It was originally developed to check for dangerous drinking habits in pregnant women.
How accurate is it?
There’s a strong stigma surrounding alcohol misuse and dependency. This can make it hard for doctors to effectively ask questions about a person’s drinking habits.
The CAGE questionnaire, along with related tests, try to remove any potential for personal judgement by asking very simple, direct questions that don’t accuse someone of any wrongdoing. For example, the second question asks how other people perceive their drinking, rather than asking how someone’s drinking directly affects those around them.
The CAGE questionnaire is reported to accurately identify people with alcohol dependence issues 93 percent of the time. This makes the CAGE questionnaire a relatively accurate, quick way to screen people for alcohol dependence without making someone defensive or upset.
The bottom line
The CAGE questionnaire is a list of four simple questions that’s used to check for signs of alcohol dependence. While it’s not a foolproof test, it can be a useful tool that only requires a minute or two of time and avoids some of the social stigmas surrounding alcohol use.