The CAGE questionnaire, developed in 1968, is a brief assessment containing four questions that is used by doctors to check for signs of potential alcohol dependency (alcohol abuse or alcoholism). The acronym, CAGE, makes the questions easy to remember:
- Have you ever felt you should cut down on your drinking?
- Have people annoyed you by criticizing your drinking?
- Have you ever felt 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)?
Two or three yes answers usually indicate heavy alcohol use or some form of alcohol use disorder. Additionally, doctors may treat certain questions with more weight, such as the last question which may signal that the patient could be having symptoms of withdrawal.
The questionnaire takes less than one minute to administer and complete and is frequently used in primary care settings as a quick screening tool, in lieu of having an in-depth interview for those who may be uncomfortable talking about their possible alcoholism. The questions are designed to be non-intrusive, and have proven to be a useful tool in identifying patients who drink excessively and may need treatment.
The CAGE questionnaire is susceptible to the inevitable response biases and other possible inaccuracies due to it being a self-reported assessment. The questions can also make it harder to distinguish between current or past drinking issues.
In addition, it is not valid for diagnosis of other substance use disorders, but some modified versions of the CAGE questionnaire have been created for that purpose. Thus, it is not adequate when used on its own in screening for alcohol problems.
Despite the inevitable biases, the CAGE assessment has proven to be accurate about 93% of the time. It is a short, easy screening process for physicians to use in tandem with other tools to assess need for alcohol abuse/dependency treatment.