CAGE-AID Substance Screening
Quick 4-Question Assessment for Alcohol & Drug Use
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CAGE-AID Screening Questions
The following questions refer to your use of alcohol AND/OR drugs (including prescription medications used for non-medical reasons). Please answer Yes or No to each question.
Understanding the CAGE-AID
History of the CAGE Questionnaire
The original CAGE questionnaire was developed by Dr. John Ewing in 1984 at the University of North Carolina. The acronym CAGE stands for Cut down, Annoyed, Guilty, and Eye-opener — four simple questions designed to identify problematic alcohol use. The CAGE quickly became one of the most widely used alcohol screening instruments in clinical practice due to its brevity and ease of administration.
Adaptation to Include Drugs (CAGE-AID)
In 1995, Brown and Rounds adapted the CAGE questionnaire to include drug use alongside alcohol, creating the CAGE-AID (CAGE Adapted to Include Drugs). This modification was essential because many individuals use both alcohol and drugs, and a screening tool that addressed only alcohol missed a significant portion of substance use problems. The CAGE-AID simply adds the phrase "or drug use" to each of the original four questions.
Clinical Use and Interpretation
The CAGE-AID is used as a brief screening tool, not a diagnostic instrument. It is designed to identify individuals who may have a substance use problem and who should receive a more comprehensive assessment. The standard clinical cutoff is:
- Score of 0: Negative screen — no indicators of problematic substance use detected
- Score of 1: Possible concern — further assessment is recommended
- Score of 2 or higher: Positive screen — clinically significant; formal assessment for substance use disorder is recommended
Sensitivity and Specificity
The CAGE-AID demonstrates good psychometric properties for a brief screening tool:
- Sensitivity: Approximately 70–85% at a cutoff of ≥2 (ability to correctly identify those with a substance use disorder)
- Specificity: Approximately 85–95% at a cutoff of ≥2 (ability to correctly identify those without a disorder)
- Performance varies across populations and settings; the tool works best in primary care and general hospital settings
- The CAGE-AID is a lifetime measure — it asks about experiences "ever," not just current use
Public Domain Status
The CAGE-AID is in the public domain and may be used freely without permission or licensing fees. This makes it an accessible tool for healthcare providers, researchers, and public health organizations worldwide.
Substance Use Disorders
DSM-5 Diagnostic Criteria
The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) defines substance use disorders based on 11 criteria grouped into four categories:
Impaired Control
- Using more or for longer than intended
- Wanting to cut down but unable to
- Spending excessive time obtaining, using, or recovering
- Cravings or strong urges to use
Social Impairment
- Failure to fulfill major role obligations
- Continued use despite social/interpersonal problems
- Giving up important activities
Risky Use
- Recurrent use in physically hazardous situations
- Continued use despite physical or psychological problems
Pharmacological Indicators
- Tolerance (needing more for the same effect)
- Withdrawal symptoms when stopping
Severity Spectrum
The DSM-5 classifies substance use disorders on a continuum of severity based on the number of criteria met:
- Mild: 2–3 criteria met
- Moderate: 4–5 criteria met
- Severe: 6 or more criteria met
Commonly Involved Substances
- Alcohol: The most commonly used substance; approximately 14.5 million Americans have alcohol use disorder
- Opioids: Includes prescription painkillers (oxycodone, hydrocodone) and illicit drugs (heroin, fentanyl)
- Cannabis: Increasingly prevalent with legalization; approximately 4.8 million Americans meet criteria for cannabis use disorder
- Stimulants: Cocaine, methamphetamine, and prescription stimulants (Adderall, Ritalin)
- Benzodiazepines: Prescription sedatives (Xanax, Valium, Klonopin) with high dependence potential
- Tobacco/Nicotine: The most common substance use disorder; approximately 25 million Americans are addicted
Risk Factors
Substance use disorders result from a complex interplay of factors:
- Genetic: Accounts for approximately 40–60% of vulnerability to addiction
- Environmental: Peer pressure, trauma, adverse childhood experiences, stress, and substance availability
- Developmental: Early initiation of substance use significantly increases risk
- Co-occurring mental health conditions: Depression, anxiety, PTSD, ADHD, and bipolar disorder all increase risk
Treatment Options
Medical Detoxification
For substances that cause physical dependence (alcohol, opioids, benzodiazepines), medically supervised detoxification provides safe withdrawal management. Alcohol and benzodiazepine withdrawal can be life-threatening and should never be attempted without medical supervision.
Levels of Care
Inpatient / Residential
- 24-hour structured care in a treatment facility
- Typically 28–90 days duration
- Best for severe disorders or unstable living situations
- Includes medical monitoring and intensive therapy
Outpatient Programs
- Intensive Outpatient (IOP): 9–20 hours per week of structured programming
- Partial Hospitalization (PHP): 20+ hours per week; return home at night
- Standard Outpatient: 1–2 sessions per week for ongoing support
- Allows continuation of work and family responsibilities
Medication-Assisted Treatment (MAT)
MAT combines FDA-approved medications with counseling and behavioral therapies. It is considered the gold standard for opioid use disorder treatment.
- Naltrexone (Vivitrol): Blocks opioid receptors; also effective for alcohol use disorder. Available as daily pill or monthly injection.
- Buprenorphine (Suboxone): Partial opioid agonist that reduces cravings and withdrawal. Can be prescribed in office-based settings.
- Methadone: Full opioid agonist dispensed through certified clinics. Most effective for severe opioid use disorder.
- Disulfiram (Antabuse): Creates unpleasant reaction when alcohol is consumed. Requires high motivation.
- Acamprosate (Campral): Helps maintain abstinence from alcohol by normalizing brain chemistry.
Evidence-Based Therapies
- Cognitive Behavioral Therapy (CBT): Identifies and changes dysfunctional thought patterns and behaviors associated with substance use
- Motivational Interviewing (MI): Enhances intrinsic motivation to change by exploring and resolving ambivalence
- Contingency Management: Uses tangible rewards to reinforce positive behaviors such as abstinence
- Dialectical Behavior Therapy (DBT): Combines CBT with mindfulness; especially useful for co-occurring disorders
- 12-Step Facilitation: Structured approach to engaging with 12-step programs like AA and NA
Holistic and Complementary Approaches
- Mindfulness-based relapse prevention
- Exercise and physical wellness programs
- Art therapy and music therapy
- Yoga and meditation
- Nutrition counseling
Recovery Resources
National Treatment Resources
- SAMHSA Treatment Locator: findtreatment.gov — find treatment facilities nationwide
- SAMHSA National Helpline: 1-800-662-4357 — free, confidential, 24/7 referral service
- NIDA (National Institute on Drug Abuse): nida.nih.gov — research-based information on substance use
- 988 Suicide & Crisis Lifeline: Call or text 988 — available 24/7 for crisis support
Mutual Support Groups
12-Step Programs
Non-12-Step Alternatives
- SMART Recovery: smartrecovery.org — science-based, self-empowerment approach
- Refuge Recovery / Recovery Dharma: Buddhist-inspired recovery program
- LifeRing Secular Recovery: Abstinence-based, secular approach
- Women for Sobriety: Program specifically for women
Harm Reduction
Harm reduction is a set of practical strategies aimed at reducing the negative consequences of substance use. While abstinence is not always the immediate goal, harm reduction approaches save lives and connect people to care.
- Naloxone (Narcan): Opioid overdose reversal medication — available without prescription in most states
- Needle exchange programs: Reduce transmission of HIV and hepatitis C while providing a bridge to treatment
- Drug checking services: Test substances for dangerous adulterants such as fentanyl
- Managed alcohol programs: Provide controlled doses to reduce harm from uncontrolled drinking
- Safe consumption sites: Medically supervised locations that reduce overdose deaths
Recovery Support Services
- Sober living houses: Structured, substance-free living environments during early recovery
- Recovery coaching: Peer support from individuals with lived recovery experience
- Vocational training: Job readiness and employment support programs
- Recovery community organizations: Local nonprofits providing social support and advocacy
- Telehealth services: Virtual counseling and support groups, especially valuable in rural areas
Frequently Asked Questions
The CAGE-AID (CAGE Adapted to Include Drugs) is a brief 4-question screening tool used to identify potential alcohol and drug use problems. The acronym CAGE stands for Cut down, Annoyed, Guilty, and Eye-opener. The original CAGE questionnaire was developed by Dr. John Ewing in 1984 for alcohol screening. In 1995, Brown and Rounds adapted it to include drugs by adding "or drug use" to each question. The CAGE-AID is in the public domain and is widely used in primary care, emergency departments, and behavioral health settings.
A positive screen (score of 2 or higher) means there are clinically significant indicators that warrant a more thorough assessment for substance use disorder. It does not mean you have a diagnosis. A positive CAGE-AID screen is a signal to discuss your substance use with a healthcare provider, who can conduct a comprehensive evaluation. A score of 1 is considered a "possible concern" and also warrants further discussion. Only a qualified healthcare professional can diagnose a substance use disorder using the full DSM-5 criteria.
A substance use disorder is formally diagnosed by a qualified healthcare professional using the DSM-5 criteria. The DSM-5 identifies 11 criteria spanning impaired control, social impairment, risky use, and pharmacological indicators (tolerance and withdrawal). Meeting 2–3 criteria indicates a mild disorder, 4–5 criteria indicates moderate, and 6 or more indicates severe. Diagnosis requires a comprehensive clinical interview, review of medical and substance use history, and may include laboratory testing. Screening tools like the CAGE-AID are a first step, not a diagnosis.
Treatment options include medication-assisted treatment (MAT) with FDA-approved medications like naltrexone, buprenorphine, and methadone for opioid use disorder, and naltrexone, acamprosate, and disulfiram for alcohol use disorder. Behavioral therapies such as cognitive behavioral therapy (CBT), motivational interviewing, and contingency management have strong evidence. Treatment is available at multiple levels of care including outpatient counseling, intensive outpatient programs (IOP), residential treatment, and medical detoxification. Mutual support groups like AA, NA, and SMART Recovery provide ongoing community support. The most effective approach is typically a combination of medication and behavioral therapy.
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Medical Disclaimer
This CAGE-AID Screening Tool is provided for educational and informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
- The CAGE-AID is a screening tool, not a diagnostic instrument.
- Only a qualified healthcare provider can diagnose a substance use disorder.
- Always consult your doctor before starting or stopping any treatment.
- If you are in a crisis, call the 988 Suicide & Crisis Lifeline (call or text 988) or SAMHSA at 1-800-662-4357.
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References & Sources
- Ewing JA. Detecting alcoholism: the CAGE questionnaire. JAMA. 1984;252(14):1905-1907. PubMed
- Brown RL, Rounds LA. Conjoint screening questionnaires for alcohol and other drug abuse: criterion validity in a primary care practice. Wisconsin Medical Journal. 1995;94(3):135-140. PubMed
- Substance Abuse and Mental Health Services Administration (SAMHSA). Key Substance Use and Mental Health Indicators in the United States. SAMHSA Data
- National Institute on Drug Abuse (NIDA). Screening and Assessment Tools Chart. NIDA
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Arlington, VA: American Psychiatric Publishing; 2013.
Last Updated: February 2026