CAGE Alcohol Screening Questionnaire
A widely used, clinically validated 4-question screening tool to help identify potential alcohol use problems. Used by healthcare providers worldwide since 1968.
Last Updated: February 2026
About the CAGE Assessment
The CAGE Questionnaire is one of the oldest and most widely used alcohol screening instruments in clinical practice. Developed by Dr. John Ewing in 1968, its name is an acronym for the four questions it asks about Cutting down, Annoyance by criticism, Guilt, and Eye-openers (morning drinking).
Despite its simplicity (just 4 yes/no questions), the CAGE has proven remarkably effective at identifying individuals who may have alcohol use problems and would benefit from further evaluation. It is commonly used in:
- Primary care settings for routine screening
- Emergency departments
- Psychiatric evaluations
- Workplace health assessments
- Self-assessment for personal awareness
📋 What This Screening Measures
The CAGE questions identify behaviors and feelings commonly associated with alcohol dependence: the need to cut down, annoyance at others' concerns, guilt about drinking, and the need for "eye-opener" drinks. These patterns often indicate that drinking has moved beyond social use to potential dependency.
⚠️ Important Disclaimer
This is a screening tool, NOT a diagnostic instrument. A positive CAGE score suggests the need for further evaluation by a healthcare professional. Only a qualified clinician can diagnose alcohol use disorder (AUD). A positive score does not automatically mean you have AUD, and a negative score doesn't guarantee you don't.
CAGE Alcohol Screening Questions
Answer each question honestly based on your lifetime experience with alcohol. Have you ever...
Understanding CAGE Scores
The CAGE scoring is straightforward: each "Yes" answer = 1 point. The total score ranges from 0 to 4.
📊 Clinical Accuracy
Using a cutoff score of 2 or more:
- Sensitivity: 71-93% (ability to correctly identify those with alcohol problems)
- Specificity: 77-96% (ability to correctly identify those without)
- Important: CAGE is more sensitive for alcohol dependence than for less severe alcohol problems
For detecting less severe problems or current drinking patterns, the AUDIT questionnaire may be more appropriate.
Understanding Alcohol Use Disorder
Alcohol Use Disorder (AUD) is a medical condition characterized by an impaired ability to stop or control alcohol use despite negative consequences. It's a spectrum disorder ranging from mild to severe, based on the number of criteria met.
Alcohol Use in the US (NIAAA, 2023)
DSM-5 Criteria for Alcohol Use Disorder
A diagnosis of AUD requires meeting at least 2 of these 11 criteria within a 12-month period:
- Drinking more or longer than intended
- Wanting to cut down but unable to
- Spending a lot of time drinking or recovering
- Craving alcohol
- Drinking interfering with responsibilities
- Continuing despite relationship problems
- Giving up important activities for drinking
- Drinking in physically dangerous situations
- Continuing despite physical or mental health problems
- Tolerance (needing more to get the same effect)
- Withdrawal symptoms when not drinking
Severity: 2-3 criteria = Mild AUD | 4-5 criteria = Moderate AUD | 6+ criteria = Severe AUD
Sources: National Institute on Alcohol Abuse and Alcoholism (NIAAA), DSM-5
Warning Signs of Problem Drinking
Alcohol problems develop gradually. Recognizing early warning signs can help you or a loved one get help before the situation worsens.
🍺 Behavioral Signs
- Drinking more than intended
- Failed attempts to cut down
- Drinking alone or in secret
- Making excuses for drinking
- Neglecting responsibilities
- Legal problems (DUI, etc.)
- Relationship conflicts about drinking
- Giving up hobbies/activities
🧠 Psychological Signs
- Preoccupation with drinking
- Drinking to cope with stress
- Feeling guilty about drinking
- Irritability when not drinking
- Memory blackouts
- Mood swings
- Denial about drinking amount
- Anxiety or depression
💊 Physical Signs
- Increased tolerance (needing more)
- Withdrawal symptoms (shaking, sweating)
- Morning drinking to feel "normal"
- Frequent hangovers
- Weight changes
- Sleep problems
- Neglected appearance
- Health problems (liver, stomach)
🚨 Alcohol Withdrawal Can Be Dangerous
Unlike many other substances, alcohol withdrawal can be medically dangerous, potentially causing seizures or delirium tremens (DTs). If you've been drinking heavily and want to stop, please consult a healthcare provider first. Medical supervision may be necessary for safe detoxification.
Health Effects of Excessive Alcohol Use
Alcohol affects nearly every organ system in the body. The health risks increase with the amount and duration of heavy drinking.
Short-Term Effects
- Impaired judgment and coordination
- Memory lapses/blackouts
- Risk of injuries and accidents
- Alcohol poisoning (can be fatal)
- Risky sexual behavior
- Violence and aggression
Liver
- Fatty liver disease
- Alcoholic hepatitis
- Cirrhosis (scarring)
- Liver cancer
Heart & Cardiovascular
- High blood pressure
- Cardiomyopathy (heart muscle damage)
- Arrhythmias (irregular heartbeat)
- Stroke
Brain & Mental Health
- Memory and cognitive problems
- Wernicke-Korsakoff syndrome
- Depression and anxiety
- Increased suicide risk
Cancer Risk
Alcohol increases risk of multiple cancers:
- Mouth, throat, esophagus
- Liver
- Colon and rectum
- Breast (in women)
Other Effects
- Weakened immune system
- Pancreatitis
- Digestive problems
- Sexual dysfunction
- Fetal alcohol spectrum disorders (pregnancy)
Sources: CDC, NIAAA, World Health Organization
Treatment Options for Alcohol Use Disorder
Recovery is possible. Many people with AUD recover and lead fulfilling lives. Treatment approaches vary based on severity, but often include a combination of medical care, behavioral therapy, and support groups.
🏥 Medical Treatment
Medical professionals can help with safe detoxification and prescribe medications that support recovery:
- Naltrexone (Vivitrol, ReVia): Reduces cravings and the rewarding effects of alcohol
- Acamprosate (Campral): Helps restore brain chemistry and reduce cravings
- Disulfiram (Antabuse): Causes unpleasant effects if alcohol is consumed
- Medical Detox: Supervised withdrawal for those with severe dependence
🗣️ Behavioral Treatments
🤝 Support Groups
- Alcoholics Anonymous (AA): The most well-known 12-step program. Free peer support meetings worldwide. Find a meeting
- SMART Recovery: Science-based self-help program using cognitive-behavioral techniques. smartrecovery.org
- Al-Anon: Support for family members and friends of those with drinking problems. al-anon.org
- Moderation Management: For those who want to reduce drinking but not necessarily abstain completely
📍 Types of Treatment Settings
- Outpatient Treatment: Allows you to live at home while attending scheduled sessions
- Intensive Outpatient (IOP): More frequent sessions (9+ hours/week) while living at home
- Partial Hospitalization: Day programs with structure, go home at night
- Residential/Inpatient: 24-hour care in a treatment facility, typically 30-90 days
Finding Treatment
- SAMHSA Treatment Locator: findtreatment.gov
- SAMHSA Helpline: 1-800-662-4357 (free, confidential, 24/7)
- Talk to your doctor: Primary care physicians can provide referrals and some treatment
About the CAGE Questionnaire
History and Development
The CAGE questionnaire was developed by Dr. John Ewing at the University of North Carolina in 1968. It was designed as a practical, easy-to-remember screening tool that could be quickly administered in clinical settings.
The name "CAGE" is a mnemonic device representing the key word in each question:
- C - Cut down
- A - Annoyed
- G - Guilty
- E - Eye-opener
Clinical Use and Validation
The CAGE has been validated in numerous studies across different populations:
- Over 50 years of clinical use and research validation
- Translated into multiple languages
- Particularly effective at detecting alcohol dependence
- Standard cutoff: 2+ positive responses suggests clinically significant alcohol problem
- Some clinicians use 1+ for certain populations or for more sensitive screening
📊 Strengths and Limitations
Strengths:
- Brief and easy to administer (4 questions)
- Good sensitivity for alcohol dependence
- Well-validated over decades
- Easy to remember (mnemonic)
- Non-confrontational question format
Limitations:
- Less sensitive for hazardous drinking that hasn't become dependence
- Asks about lifetime rather than current use
- May miss binge drinking patterns
- Less validated in women, elderly, and some ethnic groups
- AUDIT may be more appropriate for detecting less severe problems
CAGE vs. Other Screening Tools
| Assessment | Questions | Time | Best For |
|---|---|---|---|
| CAGE | 4 | <1 min | Quick screening for alcohol dependence |
| AUDIT | 10 | 2-3 min | Hazardous drinking, current patterns, more comprehensive |
| AUDIT-C | 3 | <1 min | Brief screening for hazardous drinking |
| MAST | 25 | 15 min | Comprehensive assessment, research |
Primary Source: Ewing JA. Detecting alcoholism: The CAGE questionnaire. JAMA. 1984;252(14):1905-1907.
Frequently Asked Questions
Not necessarily. A positive CAGE score (2 or more) indicates that you may have an alcohol problem that warrants further evaluation. It's a screening tool, not a diagnosis. Some people may score positive without meeting full criteria for alcohol use disorder, while others may have problems not detected by CAGE. A healthcare professional can provide a proper assessment.
One positive answer is generally considered below the clinical threshold, but it may still warrant reflection. Many people without alcohol problems have never felt they should cut down or felt guilty about drinking. If you have any concerns about your drinking, it's worth discussing with a healthcare provider, even with a score of 1.
The CAGE was designed to identify alcohol dependence, which tends to be a persistent condition. Asking about lifetime experience captures patterns even if someone is currently abstinent or reducing. If you want to assess current drinking patterns, the AUDIT questionnaire may be more appropriate.
No. All calculations happen entirely in your web browser. We do not collect, store, transmit, or share any of your responses or results. Your health information remains completely private on your device.
You can answer based on what you know about another person's behavior, but results may not be as accurate since you might not know about private feelings like guilt or desires to cut down. If you're concerned about a loved one's drinking, resources like Al-Anon can help you regardless of their screening results.
📚 Sources & References
Primary CAGE Research:
- Ewing JA. Detecting alcoholism: The CAGE questionnaire. JAMA. 1984;252(14):1905-1907. PubMed
- Dhalla S, Kopec JA. The CAGE questionnaire for alcohol misuse: a review of reliability and validity studies. Clin Invest Med. 2007;30(1):33-41. PubMed
Alcohol Use Disorder:
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
- National Institute on Alcohol Abuse and Alcoholism. Understanding Alcohol Use Disorder. NIAAA
Statistics and Health Information:
Last Updated: February 2026
Review Schedule: Quarterly or when new clinical guidelines are published
⚕️ Medical Disclaimer
This CAGE alcohol screening calculator is provided for educational and informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
Important points:
- The CAGE is a screening tool, not a diagnostic instrument. Only a qualified healthcare provider can diagnose alcohol use disorder.
- A positive score suggests you should discuss your alcohol use with a healthcare provider.
- A negative score does not guarantee absence of alcohol problems.
- If you are currently in treatment, continue following your provider's recommendations.
⚠️ Important Safety Warning:
- Alcohol withdrawal can be medically dangerous. If you've been drinking heavily and want to stop, consult a healthcare provider first.
- Never attempt to detox from alcohol alone if you've been drinking heavily for an extended period.
- If you experience severe withdrawal symptoms (tremors, hallucinations, seizures), seek emergency medical care.
If you or someone you know needs help:
- SAMHSA National Helpline: 1-800-662-4357 (free, confidential, 24/7)
- Treatment Locator: findtreatment.gov
- In crisis: Call 988 or 911
Privacy: All calculations are performed in your browser. We do not collect, store, or share any personal health information you enter.