Psychology RootsCAGE Substance Screening Tool
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About CAGE Substance Screening Tool
Scale Name
CAGE Substance Screening Tool
Author Details
John A. Ewing
Translation Availability
English
Background/Description
The CAGE Substance Screening Tool is a brief, four-item questionnaire designed to detect potential alcohol and substance use disorders. Developed by Dr. John A. Ewing (1984), the tool was originally intended for identifying problematic drinking patterns among adults in medical and psychiatric settings. Over time, it has also been adapted for screening drug use, leading to the CAGE-AID version (CAGE Adapted to Include Drugs).
The acronym CAGE represents the key domains assessed:
- C – Have you ever felt you should Cut down on your drinking or drug use?
- A – Have people Annoyed you by criticizing your drinking or drug use?
- G – Have you ever felt Guilty about your drinking or drug use?
- E – Have you ever had a drink or used drugs first thing in the morning (an Eye-opener) to steady your nerves or get rid of a hangover?
Because of its simplicity and brevity, the CAGE has become one of the most widely used alcohol screening tools worldwide, suitable for primary care, emergency, and mental health settings.
Administration, Scoring and Interpretation
- Type: Screening questionnaire.
- Respondent: Adults and adolescents (self-report or clinician-administered).
- Items: 4 questions.
- Response Format: Dichotomous — Yes (1) or No (0) for each item.
- Scoring:
- Each “Yes” = 1 point.
- Total Score Range: 0–4.
- Interpretation:
- 0–1 = Low risk / No clinically significant issue.
- 2 or more = Clinically significant; further assessment warranted.
- Duration: 1–2 minutes.
- Administrator: Physician, psychologist, counselor, or trained health professional.
Reliability and Validity
- Internal Consistency: Cronbach’s alpha typically ranges from 0.74 to 0.86 across studies.
- Test-Retest Reliability: Stable across repeated administrations (r = 0.80–0.95).
- Criterion Validity: Strong correlation with DSM-5 and ICD-10 diagnostic criteria for substance use disorders.
- Sensitivity and Specificity:
- At a cutoff score of ≥2: Sensitivity ≈ 75–90%, Specificity ≈ 80–95% for alcohol use disorder (Ewing, 1984; Bush et al., 1987).
- CAGE-AID version demonstrates comparable sensitivity for drug misuse (Brown et al., 1995).
- Cross-Cultural Validity: Urdu and Spanish versions have shown acceptable psychometric properties and screening accuracy in both community and clinical populations.
Available Versions
04-Items
Reference
Ewing, J. A. (1984). Detecting alcoholism: the CAGE questionnaire. Jama, 252(14), 1905-1907.
Bush, B., Shaw, S., Cleary, P., Delbanco, T. L., & Aronson, M. D. (1987). Screening for alcohol abuse using the CAGE questionnaire. The American journal of medicine, 82(2), 231-235.
Important Link
Scale File:
Frequently Asked Questions
Q1: What is the purpose of the CAGE questionnaire?
It serves as a quick screening tool to detect potential alcohol or drug misuse, guiding clinicians to determine whether more detailed assessment is required.
Q2: What does a score of 2 or more indicate?
It suggests possible alcohol or substance dependence, warranting further evaluation using standardized diagnostic tools (e.g., AUDIT, DSM-5 interview).
Q3: Can the CAGE be used for adolescents?
Yes, but with caution; items may require simplified language and must be interpreted within a developmental context.
Q4: What is the difference between CAGE and CAGE-AID?
The CAGE assesses only alcohol use, while CAGE-AID expands coverage to include other psychoactive substances.
Q5: How does CAGE compare to AUDIT?
CAGE is shorter and faster, but AUDIT provides more detailed information on frequency, dependence, and harm, making it better suited for public health research.
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