CAGE Questionnaire

The CAGE questionnaire is a four question screen for alcohol problems. Its name derives from the four items, which ask about cutting down, annoyance by criticism, guilt, and the eye opener, which is morning drinking to relieve withdrawal.

It is a brief screen, and a positive result prompts a fuller assessment. It is quick to administer and is used in busy settings where time is limited.

Usage. It is used in primary care, emergency settings, and as a first step before a more detailed tool.

Indications. Rapid screening for alcohol problems, particularly in hospital and emergency settings.

Preparation and technique. The four questions are asked in private, and each yes answer scores one point. A total of 2 or more is the usual positive screen.

Contraindications and precautions. Cognitive impairment, acute intoxication, and language barriers limit the validity of the answers.

Interpretation.

• A total of 0 or 1 is a negative screen.
• A total of 2 or more is a positive screen, and a fuller assessment is required.
• A positive screen does not establish dependence, which needs clinical assessment.

Causes of a positive screen. Alcohol dependence, hazardous drinking, and co-existing mental health conditions.

Critical values and findings needing immediate action. A positive screen with withdrawal symptoms or a history of seizures requires urgent medical assessment.

Limitations and artefacts. The CAGE has lower sensitivity for hazardous drinking than longer tools, and it misses some cases. Denial and stigma reduce the accuracy of answers.

Follow up tests. The AUDIT for a fuller assessment, liver function tests, gamma glutamyl transferase and full blood count.

Special groups. Pregnant women are screened with tools that address foetal risk. Older adults and adolescents may need adapted questions.