CAGE-AID: CAGE Adapted to Include Drugs

What this assessment is

CAGE-AID is a four-item screen for warning signs related to alcohol or drug use across a person's lifetime.

Its full name is CAGE Adapted to Include Drugs. Richard Brown and Linda Rounds introduced the adapted form in a 1995 primary care validation study.

CAGE-AID is a rapid screen. It does not diagnose an alcohol or drug use disorder.

It is deliberately brief.

Who it was designed for

The original study involved adults attending an academic family medicine practice. The form is now used in other healthcare and behavioral health settings.

Evidence from one primary care sample does not establish the same accuracy in every population. Age, language, culture, setting, and the consequences of a positive result can change the best decision rule.

The screen is brief enough to start a conversation. It is not detailed enough to replace that conversation.

That distinction matters.

How it is administered

CAGE-AID uses four yes-or-no questions. The questions ask about lifetime experiences rather than one fixed recent period.

Timing matters.

It can be self-completed or asked by an interviewer. A neutral approach and clear explanation of confidentiality can support more accurate disclosure.

Use the complete adapted form. The original alcohol-only CAGE and the CAGE-AID are related, but they do not ask the same screening question.

What it measures

CAGE-AID covers four broad warning-sign domains associated with alcohol or drug problems. It does not measure how often a substance is used, how much is used, or when the last use occurred.

This lifetime focus means an endorsement may describe a past problem rather than current severity.

The DAST-10 is a longer drug-specific screen with a past-year timeframe. It does not combine alcohol and drug warning signs in the same way.

How scoring works

Each endorsed response scores 1. Each non-endorsed response scores 0. Add the four values for a total from 0 to 4.

Higher totals mean that more warning signs were endorsed. The total is a count, not a severity scale with established mild, moderate, and severe bands.

Keep it as a count.

Complete all four responses before applying a decision rule. Do not assume that a missing response is negative.

How to interpret a CAGE-AID score

Two published decision rules are common.

The SAMHSA TIP 42 guidance uses one or more endorsements as a sensitive signal for further assessment. This rule is designed to miss fewer possible problems, but it can identify more people who do not have a current disorder.

Other SAMHSA guidance uses two or more endorsements to identify probable alcohol or drug problems. That higher threshold is more specific, but it can miss some people who would benefit from follow-up.

State which rule is being used and why. Do not choose between one and two after seeing the score.

Choose in advance.

A positive result supports a fuller assessment. It does not prove a diagnosis.

What the score cannot tell you

CAGE-AID cannot show whether a problem is current, which substance is involved, or how severe the pattern is now.

That requires context.

It does not assess amount, frequency, intoxication, withdrawal, overdose risk, or the full effect on daily life. A score of 0 does not prove that alcohol or drug use is safe.

The total also cannot select treatment or determine whether urgent medical care is needed.

Evidence and limitations

In the original family practice study, lowering the positive-screen rule improved sensitivity and reduced specificity. That tradeoff explains why one-point and two-point rules can both appear in guidance.

Neither rule removes the need for context. A useful screening process names the threshold in advance and defines what follow-up will occur.

The score starts a review. It does not finish one.

CAGE-AID works best as an opening screen. A detailed assessment is needed to understand current use, consequences, diagnosis, and safety.