CAGE Questions for Alcohol Use
Screens for excessive drinking and alcoholism.
When to Use
- CAGE should be included among standard history questions in primary care, emergency department, psychiatric and inpatient hospital settings.
- The recommendation of the National Institute of Alcohol Abuse and Alcoholism is that all patients who drink alcohol should be screened with the CAGE questions. (Fiellin DA 2000)
- CAGE is designed for adults and adolescents >16 years.
- Other at-risk populations where CAGE or another alcohol screening assessment is indicated include:
- Pregnant women
- College students
- Arrested and incarcerated persons, especially DWI and domestic violence offenders
- The CAGE questions are 4 simple and easy-to-remember to screen for alcohol use problems.
- The scale can be administered in < 1 minute by clinicians.
- CAGE is a screening tool: screening measures are NOT intended to provide a diagnosis; diagnosis occurs if/when a patient screens positive.
- An abnormal or positive screening result may thus “raise suspicion” about the presence of an alcohol use problem, while a normal or negative result should suggest a low probability of an alcohol use problem.
- Scores of 2 or more are a typical cut-off as “screening positive,” as studies show >90% sensitivity for diagnoses of alcohol disorders (excessive drinking, alcoholism).
- Physicians often overlook alcohol problems in patients. (Kitchens JM 1994)
- Simply asking patients how much they drink often leads to an estimate lower than the actual number of alcoholic drinks per day.
- Alcohol disorders are treatable despite physician bias otherwise. (Kitchens JM 1994)
- Without identification and treatment, alcohol problems lead to significant morbidity and mortality:
- Alcohol is a major factor in suicides, homicides, violent crimes, and fatal motor vehicle accidents. Nearly 88,000 people die from alcohol-related causes annually, making it the third leading preventable cause of death in the United States. (Centers for Disease Control and Prevention 2014)
- Alcohol is primarily or secondarily implicated in a large number of medical problems.
- The mortality rate in those who drink six or more drinks per day is 50% higher than the rate in matched controls. (Klatsky AL 1992)