CAGE Questions for Alcohol Use
Screens for excessive drinking and alcoholism.
When to Use
Pearls/Pitfalls
Why 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)
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Next Steps
Evidence
Creator Insights
Dr. John A. Ewing
About the Creator
John A. Ewing, MD, (d. 2006) was an addiction therapy clinician and professor of psychiatry emeritus at the University of North Carolina. He served as the founding director of the Bowles Center for Alcohol Studies, where he developed the CAGE questionnaire.
To view Dr. John A. Ewing's publications, visit PubMed
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