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CAGE Questionnaire

This PatientPlus article is written for healthcare professionals so the language may be more technical than the condition leaflets. You may find the abbreviations list helpful.

This easy to use patient questionnaire is a screening test for problem drinking and potential alcohol problems.1
The CAGE questions should not be preceded by any questions about alcohol intake - ie its sensitivity is dramatically enhanced by an open-ended introduction.2

CAGE Questionnaire
This is best used in a clinical setting as part of a general clinical history taking, and may be phrased informally.
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 to get rid of a hangover (Eye opener)?
Total= /4

Developed by Dr. John Ewing, founding Director of the Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, CAGE is an internationally used assessment instrument for identifying alcoholics. The CAGE questionnaire is reproduced here with permission. Original in Ewing JA; Detecting alcoholism. The CAGE questionnaire. JAMA. 1984 Oct 12;252(14):1905-7. © 1984 American Medical Association. All rights reserved.


A total score of 2 or greater is considered clinically significant (sensitivity of 93% and a specificity of 76% for the identification of problem drinking);3 compared with GGT liver function test which detected only a third of patients having more than 16 "drinks" per day.
The Alcohol Use Disorders Identification Test (AUDIT) is a longer screening tool recommended by the WHO.4

Document references

  1. Ewing JA; Detecting alcoholism. The CAGE questionnaire. JAMA. 1984 Oct 12;252(14):1905-7. [abstract]
  2. Steinweg DL, Worth H; Alcoholism: the keys to the CAGE. Am J Med. 1993 May;94(5):520-3. [abstract]
  3. Bernadt MW, Mumford J, Taylor C, et al; Comparison of questionnaire and laboratory tests in the detection of excessive drinking and alcoholism. Lancet. 1982 Feb 6;1(8267):325-8. [abstract]
  4. The AUDIT (Alcohol Use Disorders Identification Test) questionnaire, World Health Organisation

Internet and further reading

Acknowledgements

EMIS is grateful to Dr Huw Thomas for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2010.
Document ID: 1899
Document Version: 26
Document Reference: bgp25275
Last Updated: 1 Jun 2009
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