CAGE: four-question lifetime alcohol screen
The CAGE asks four yes-or-no questions about lifetime alcohol-related concerns. Scores run from 0 to 4; a result of 2 or higher supports fuller assessment.
Overview
The CAGE is a four-question screen about lifetime experiences with alcohol. Its name comes from Cut down, Annoyed, Guilty, and Eye-opener. Each Yes adds one point, for a 0-to-4 total. A score of 2 or higher supports fuller assessment but does not diagnose an alcohol use disorder or rule out current harm below that boundary.
History and scope
Mayfield, McLeod, and Hall published a validation study of the four questions in 1974. John Ewing's 1984 paper later described the CAGE name and mnemonic.
The original CAGE asks only about alcohol, while CAGE-AID is a separate adaptation that adds drug use. They are not interchangeable. A CAGE result should not be described as a general substance-use result.
Who may find it useful?
The questionnaire may be useful if you:
- Want a brief starting point for discussing alcohol with a provider
- Have concerns about past or current drinking
- Are completing alcohol screening as part of a healthcare visit
- Want to understand what the four lifetime questions ask
The CAGE does not ask how much or how often you currently drink, so a provider may use another questionnaire when current consumption matters. Scope matters.
Score interpretation
| Score | Survey Doctor label | How to read it |
|---|---|---|
| 0-1 | Low risk | Below the standard CAGE boundary; current concerns are not ruled out |
| 2-4 | Clinically significant | A fuller assessment of current and past alcohol use may be useful |
What the screening boundary means
The administered form marks 2 or more Yes answers as clinically significant. It also reports guidance to discuss one Yes answer in primary care. Neither boundary confirms a diagnosis or chooses a treatment.
Sensitivity and specificity vary by population, setting, and the comparison assessment used. Survey Doctor does not present one performance pair as universal.
For a plain-language walkthrough, see what your CAGE score means.
Every item has the same scoring weight
Each Yes answer contributes one point. The eye-opener question does not create a separate scoring rule. One answer alone cannot establish why someone drank in the morning or whether they have physical dependence.
What the questions cover
- Cut down: Whether you have ever felt you should reduce your drinking
- Annoyed: Whether criticism of your drinking has ever annoyed you
- Guilty: Whether you have ever felt bad or guilty about drinking
- Eye-opener: Whether you have ever had a morning drink to steady your nerves or ease a hangover
These are lifetime questions. A Yes answer may describe something recent or something that happened years ago.
Timing stays unknown.
Administration
The SAMHSA registry entry describes verbal and self-administered use. Survey Doctor presents the questions directly to the person answering.
The questionnaire is brief, but there is no fixed repeat schedule built into its score. Because every question asks whether something has ever happened, the CAGE cannot measure short-term change, current cravings, or weekly progress.
What the CAGE cannot tell you
The total does not show:
- How much or how often you currently drink
- When each endorsed experience happened
- Whether a past concern is still active
- Why a particular answer was Yes
- Whether you meet diagnostic criteria
- Which kind of support, if any, fits your situation
A low total can occur when current drinking is risky because the questionnaire does not measure consumption, while a higher total can reflect distant experiences. Context is essential.
Ask more questions.
What to do with a result
Use the result as a starting point, not a verdict. The number is not the answer. If your score is 2 or higher, consider sharing it with a doctor or another qualified provider. Bring information about how often you drink, how much you drink, and whether anything has changed recently.
You can ask for help at any score. Concerns about alcohol, health, relationships, or safety matter even when the CAGE total is below 2.
Evidence and limitations
The supporting sources establish four Yes-or-No questions, lifetime wording, and a boundary of 2 or higher. The 1974 validation and later guidance used different samples and thresholds, so one accuracy estimate should not be treated as universal.
Related assessments
MAST (Michigan Alcohol Screening Test): A longer lifetime screen that uses weighted answers.
PHQ-9: Patient Health Questionnaire-9: A depression symptom screen for the past two weeks.
GAD-7: Generalized Anxiety Disorder-7: An anxiety symptom screen for the past two weeks.
Related assessment information
These pages cover related assessments. They may measure different constructs or use different populations and recall periods.
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