Table of ContentsView AllTable of ContentsPurposeDiagnosisQuestionsScoringOther AssessmentsTreatment
Table of ContentsView All
View All
Table of Contents
Purpose
Diagnosis
Questions
Scoring
Other Assessments
Treatment
The CAGE questionnaire is still one of the most widely used tools for assessing alcohol dependency today. However, it has limitations, and there are mixed opinions about its efficacy.
This article will discuss the purpose of the CAGE questionnaire, diagnosing alcohol use disorders, questions and scoring of the CAGE assessment, other assessments, and treatment plans. It will also discuss the importance of seeking a diagnosis from a healthcare professional rather than relying on self-diagnosis.
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When Is the CAGE Assessment Used?
Healthcare providers use the CAGE questionnaire as an initial screening tool foralcohol use disorder. It is used when alcohol problems are suspected or may be an issue. Healthcare providers need to use these questions as an open-ended approach before asking any other questions about alcohol use to maintain its effectiveness.
The development of the CAGE questionnaire is credited to John Ewing, MD, who served as a professor of psychiatry at the University of North Carolina at Chapel Hill and practiced as an addiction therapy clinician.Dr. Ewing published his research findings on the use and effectiveness of the questionnaire in 1984, but he is thought to have developed and used the tool as early as 1968.
Diagnosing an Alcohol Use Disorder
The CAGE questionnaire, as well as other assessments, can be used as self-assessment tools to identify possible alcohol or substance use disorders. If someone is concerned that they or someone they love might have an alcohol use disorder, a healthcare professional, including a primary care provider, mental health specialist, or addiction specialist, will use specific criteria set in the Diagnostic and Statistical Manual, version 5 (DSM-5) to determine whether someone meets the criteria for alcohol use disorder.
If a healthcare professional diagnoses someone with alcohol use disorder, it is further refined into three categories: mild, moderate, or severe, based on how many symptoms are present.Understanding the severity of alcohol use disorder is not something you can do with a self-assessment.
Substance Use HelplineIf you or a loved one is struggling with substance use or addiction, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat800-662-4357for information on support and treatment facilities in your area.
Substance Use Helpline
If you or a loved one is struggling with substance use or addiction, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat800-662-4357for information on support and treatment facilities in your area.
The Importance of Not Self-Diagnosing
Note that tools cannot and should not be used to self-diagnose. Instead, they can be used as a starting point along with the help of a qualified healthcare professional.
Questions on the CAGE Assessment
The CAGE questionnaire consists of four questions. These questions apply to the entire life of the person, not just their current situation and alcohol use.The letters in the word “CAGE” stand for elements of each of the four questions:
Scoring the CAGE Assessment
Scoring 2 or 3 means there is a high level of concern for alcohol use disorder. Scoring a 4 means the person is likely to have an alcohol use disorder.
Other Substance Use Assessments
The CAGE assessment has another version, the CAGE-AID questionnaire, that also helps detect people who have other substance use disorders. The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and the Single Alcohol Screen Questionnaire (SASQ) are other assessments that can detect alcohol use disorder or the need for further evaluation.
CAGE-AID Questionnaire
The CAGE questionnaire was adapted to apply to problems with other substances as well, not just alcohol. This assessment is called the CAGE-AID questionnaire. The words “or drug use” were added after the word “drinking” in the first three questions, and the words “or used drugs” were added after the words “had a drink” in the fourth question.The scoring of the two assessments is the same.
Questions of the CAGE-AID Questionnaire
The Alcohol Use Disorders Identification Test–Consumption (AUDIT-C)
The AUDIT assessment, as well as the abbreviated version, the AUDIT-C are also assessments people and their healthcare providers can use to screen for alcohol use disorder. The AUDIT assessment has ten questions, while the AUDIT-C is focused on the amount of consumption and has three questions. The AUDIT-C asks about how much alcohol a person consumes, with scores of 0-4 available for each question. The assessment is scored on a scale from 0-12. In men, a score of 4 or more indicates possible alcohol use disorder, and in women, the score threshold is 3.
The NIAAA Single Alcohol Screening Question (SASQ)
This single-question screening does not serve to diagnose alcohol use disorder on its own. Rather, it is a tool to determine who should have follow-up screenings with a healthcare provider. The question asked in the SASQ is “How many times in the past year have you had (4 for women, or 5 for men) or more drinks in a day?”If the answer is one or more, the patient should receive follow-up assessment to determine whether a diagnosis of alcohol use disorder is appropriate.
Recently, the CAGE assessment has begun to fall out of favor with some healthcare professionals. According to the United States Preventive Services Taskforce, the biggest drawback of the CAGE assessment is that it only returns a positive result for people who are already beginning to see negative effects because of their alcohol use.Other assessments like the AUDIT-C and SASQ, they argue, might be able to better screen people who have alcohol use disorder in earlier stages.
Establishing a Treatment Plan
Treatment plans for alcohol use disorders are developed to fit the needs of the individual and their specific situation. The elements may depend on the severity of the condition and how long it has been an issue. For example, someone with a mild alcohol use disorder may experience a lot of benefit fromoutpatient services. In contrast, someone with more severe challenges who has been struggling for many years may require inpatient treatment at a facility.
Treatments for alcohol-related challenges include medications and behavioral treatments. More specifically, psychotherapy (also calledtalk therapy) interventions such as cognitive behavioral therapy (CBT), motivational enhancement therapy, and marital andfamily counselingare sometimes used.There are alsosupport groupsavailable for alcohol use problems.
Summary
The CAGE questionnaire is a screening tool used to assess possible issues with alcohol. It is used as an initial assessment before any other questions about alcohol use are asked. It can also be used as a self-assessment tool, but it should not be used to self-diagnose or rule out alcoholism.
The CAGE-AID questionnaire is a variation of the CAGE questionnaire that was developed to include the use of other drugs in addition to alcohol as part of the assessment. Other screening tools include AUDIT-C and the SASQ.
Alcohol and drug use disorders are treatable. With support, these challenges can be managed. If you have concerns about your own alcohol or drug use, see a healthcare provider for assessment.
What Is Substance Use Disorder?
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Psychological Association.CAGE.Choe YM, Lee BC, Choi IG, Suh GH, Lee DY, Kim JW.Combination of the CAGE and serum gamma-glutamyl transferase: an effective screening tool for alcohol use disorder and alcohol dependence.Neuropsychiatr Dis Treat. 2019;15:1507-1515. doi:10.2147/NDT.S203855Alcohol Rehab Guide.CAGE questionnaire for alcohol use.National Institute on Alcohol Abuse and Alcoholism (NIAAA). National Institutes of Health.Alcohol use disorder: a comparison between dsm–iv and dsm–5.Castillo-Carniglia A, Keyes KM, Hasin DS, Cerdá M.Psychiatric comorbidities in alcohol use disorder.Lancet Psychiatry. 2019;6(12):1068-1080. doi:10.1016/S2215-0366(19)30222-6Tan CH, Hungerford DW, Denny CH, McKnight-Eily LR.Screening for alcohol misuse: practices among U.S. Primary care providers.Am J Prev Med. 2018;54(2):173-180. doi:10.1016/j.amepre.2017.11.008Johns Hopkins Medicine.Cage substance abuse screening tool.National Institutes of Health, Common Date Elements Database.Form: AUDIT-C questionnaire.National Institute on Alcohol Abuse and Alcoholism.Screen and assess: Use quick, effective methods.National Institute on Alcohol Abuse and Alcoholism.Treatment for alcohol problems: Finding and getting help.
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Psychological Association.CAGE.Choe YM, Lee BC, Choi IG, Suh GH, Lee DY, Kim JW.Combination of the CAGE and serum gamma-glutamyl transferase: an effective screening tool for alcohol use disorder and alcohol dependence.Neuropsychiatr Dis Treat. 2019;15:1507-1515. doi:10.2147/NDT.S203855Alcohol Rehab Guide.CAGE questionnaire for alcohol use.National Institute on Alcohol Abuse and Alcoholism (NIAAA). National Institutes of Health.Alcohol use disorder: a comparison between dsm–iv and dsm–5.Castillo-Carniglia A, Keyes KM, Hasin DS, Cerdá M.Psychiatric comorbidities in alcohol use disorder.Lancet Psychiatry. 2019;6(12):1068-1080. doi:10.1016/S2215-0366(19)30222-6Tan CH, Hungerford DW, Denny CH, McKnight-Eily LR.Screening for alcohol misuse: practices among U.S. Primary care providers.Am J Prev Med. 2018;54(2):173-180. doi:10.1016/j.amepre.2017.11.008Johns Hopkins Medicine.Cage substance abuse screening tool.National Institutes of Health, Common Date Elements Database.Form: AUDIT-C questionnaire.National Institute on Alcohol Abuse and Alcoholism.Screen and assess: Use quick, effective methods.National Institute on Alcohol Abuse and Alcoholism.Treatment for alcohol problems: Finding and getting help.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Psychological Association.CAGE.Choe YM, Lee BC, Choi IG, Suh GH, Lee DY, Kim JW.Combination of the CAGE and serum gamma-glutamyl transferase: an effective screening tool for alcohol use disorder and alcohol dependence.Neuropsychiatr Dis Treat. 2019;15:1507-1515. doi:10.2147/NDT.S203855Alcohol Rehab Guide.CAGE questionnaire for alcohol use.National Institute on Alcohol Abuse and Alcoholism (NIAAA). National Institutes of Health.Alcohol use disorder: a comparison between dsm–iv and dsm–5.Castillo-Carniglia A, Keyes KM, Hasin DS, Cerdá M.Psychiatric comorbidities in alcohol use disorder.Lancet Psychiatry. 2019;6(12):1068-1080. doi:10.1016/S2215-0366(19)30222-6Tan CH, Hungerford DW, Denny CH, McKnight-Eily LR.Screening for alcohol misuse: practices among U.S. Primary care providers.Am J Prev Med. 2018;54(2):173-180. doi:10.1016/j.amepre.2017.11.008Johns Hopkins Medicine.Cage substance abuse screening tool.National Institutes of Health, Common Date Elements Database.Form: AUDIT-C questionnaire.National Institute on Alcohol Abuse and Alcoholism.Screen and assess: Use quick, effective methods.National Institute on Alcohol Abuse and Alcoholism.Treatment for alcohol problems: Finding and getting help.
American Psychological Association.CAGE.
Choe YM, Lee BC, Choi IG, Suh GH, Lee DY, Kim JW.Combination of the CAGE and serum gamma-glutamyl transferase: an effective screening tool for alcohol use disorder and alcohol dependence.Neuropsychiatr Dis Treat. 2019;15:1507-1515. doi:10.2147/NDT.S203855
Alcohol Rehab Guide.CAGE questionnaire for alcohol use.
National Institute on Alcohol Abuse and Alcoholism (NIAAA). National Institutes of Health.Alcohol use disorder: a comparison between dsm–iv and dsm–5.
Castillo-Carniglia A, Keyes KM, Hasin DS, Cerdá M.Psychiatric comorbidities in alcohol use disorder.Lancet Psychiatry. 2019;6(12):1068-1080. doi:10.1016/S2215-0366(19)30222-6
Tan CH, Hungerford DW, Denny CH, McKnight-Eily LR.Screening for alcohol misuse: practices among U.S. Primary care providers.Am J Prev Med. 2018;54(2):173-180. doi:10.1016/j.amepre.2017.11.008
Johns Hopkins Medicine.Cage substance abuse screening tool.
National Institutes of Health, Common Date Elements Database.Form: AUDIT-C questionnaire.
National Institute on Alcohol Abuse and Alcoholism.Screen and assess: Use quick, effective methods.
National Institute on Alcohol Abuse and Alcoholism.Treatment for alcohol problems: Finding and getting help.
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