CAGE Assessment

Do you think you could benefit from alcohol addiction treatment? You can take a simple assessment at home that may help you decide. There are three frequently-used questionnaires that can indicate the possibility of an alcohol problem. Of these assessments, the CAGE Assessment is the shortest with only four questions.

Online alcohol use screenings like the CAGE, MAST and AUDIT assessments have been used for decades by doctors and other licensed professionals to help diagnose challenges with substance use. The CAGE Assessment is considered a reliable indicator of heavy drinking but a less dependable tool for less problematic forms of alcohol use.

Despite its limitations, the CAGE can be a good starting point if you wonder whether your alcohol use has become unhealthy. Using a quick, online assessment can indicate the need for a follow-up alcohol evaluation by a licensed provider.

As you explore the varying alcohol use assessments available, consider some of the data associated with each one to determine which questionnaire you wish to use. Each of these assessments is well-tested and can indicate risky alcohol use patterns, but some assessments are considered more clinically reliable than others, depending on factors such as age or your progression of drinking patterns.

The CAGE questionnaire is a self-guided assessment that can be used as a first step in determining whether your drinking habits are cause for concern. It is used in a variety of settings, including medical practices and emergency rooms. It’s often a first-line questionnaire given to patients before other questions about substance use are asked.

The questionnaire asks questions from a lifetime perspective rather than just a few months or a particular moment in time. The CAGE Assessment is scored by simply counting how many affirmative responses are noted. A score of two or more is clinically significant and indicates a high likelihood of an individual with an alcohol problem. Please consult a medical professional if this self-screening indicates a likelihood of alcohol abuse or addiction.

Developed in 1970 and published in 1984, the CAGE alcohol use screening tool was created by Dr. John Ewing, founding director of the Bowles Center for Alcohol Studies at the University of North Carolina at Chapel Hill. The name of the test is an acronym that pulls one letter from each of the four questions. “C” is for “cut down,” “A” is for “annoyed,” “G” is for “guilty,” and “E” is for “eye-opener.”

The CAGE assessment, which was based on the results of a 130-patient study, is one of the most popular alcohol addiction assessments designed to test for potential alcoholism. In the original study, the patients were randomly chosen to participate in an in-depth interview that included the four questions (the current CAGE questions). The questions were selected for the test after they were successful in identifying 16 alcoholics from the group.

The CAGE Assessment consists of four brief questions:

1. “Have you ever felt you should cut down on your drinking?” It is important to remember that the question is from the individual’s perspective and should reflect on their lifespan rather than just a moment in time.
2. “Have people annoyed you by criticizing your drinking?” This question helps determine the ways alcohol has impacted a person’s relationships and whether it has reached the point of getting criticism from others.
3. “Have you ever felt bad or guilty about your drinking?” The question about guilt can help determine one’s relationship with themselves around the drinking behavior and whether it’s initiating feelings of inadequacy or shame.
4. “Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (eye-opener)?” This question indicates whether alcohol use has merged into other periods of the day to manage withdrawal symptoms or discomfort experienced from the previous day’s alcohol use.

Each response to the four alcohol assessment questions is scored, either zero or one point. Responses determine the probability of alcoholism, ranging to 95% probable. Higher scores indicate a potential problem with alcohol.

While a total score of two or higher is considered clinically significant, some clinicians, such as John Hopkins, believe a score of one is worth a further evaluation. According to JAMA: “A score of 2 to 3 indicates a high index of suspicion and a score of 4 is virtually diagnostic for alcoholism.”

The CAGE questionnaire score is only the first step in diagnosing a drinking problem. Regardless of what the score is, it is not an official diagnosis. A substance use disorder diagnosis, or any other type of mental health diagnosis, can only be made by a licensed professional. If your CAGE score is one or higher, you may want to consider additional assessment options, including a consultation and assessment with a licensed provider.