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CAGE questionnaire: the four alcohol screening questions (Ewing 1984)

The CAGE questionnaire is four yes/no questions about drinking, named for their key words: Cut down, Annoyed, Guilty and Eye-opener. Each yes scores 1 point, so the total runs from 0 to 4. In Ewing's 1984 paper, two or more yes answers is a positive screen. Magent's calculator adds the answers and reports the score and whether the screen is positive.

Not a medical device. Not a diagnosis or dosing recommendation.

Use this calculator via API

What is the CAGE questionnaire?

CAGE is a short alcohol screen. It doesn't ask how much or how often someone drinks. It asks about four experiences linked with drinking: wanting to cut down, being annoyed by criticism, feeling guilty, and drinking first thing in the morning.

Because it is so short, it can be asked in a minute as part of a routine history. A positive screen isn't a finding on its own.

Magent's calculator takes the four answers as yes or no, adds them up, and returns the score, the maximum of 4, whether the score is 2 or more, and the point for each question.

This page explains the questions and the scoring. It doesn't say what a result means for a particular person.

The CAGE questions and scoring

The four questions, as worded in Ewing 1984:

  1. Cut down: "Have you ever felt you should Cut down on your drinking?"
  2. Annoyed: "Have people Annoyed you by criticizing your drinking?"
  3. Guilty: "Have you ever felt bad or Guilty about your drinking?"
  4. Eye-opener: "Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye-opener)?"
each question:   yes = 1, no = 0
CAGE score   =   Cut down + Annoyed + Guilty + Eye-opener      (0 to 4)
screen positive  when  CAGE score ≥ 2

Exact expression the calculator uses:

CAGE = cut_down + annoyed + guilty + eye_opener; each 1 if true; max 4

Inputs

InputQuestionValues
cut_downFelt you should cut down on your drinkingtrue, false
annoyedBeen annoyed by people criticizing your drinkingtrue, false
guiltyFelt bad or guilty about your drinkingtrue, false
eye_openerHad a drink first thing in the morning (eye-opener)true, false

All four answers are required. The person entering them decides whether each answer is a yes. The calculator doesn't interpret the answers.

How the calculation works

  1. Score each question. A yes is 1 point. A no is 0.
  2. Add the four points. The total is 0, 1, 2, 3 or 4.
  3. Apply the screen. The screen is positive when the total is 2 or more.

Every question carries the same weight. Two yes answers give a positive screen whichever two they are.

Units

There are no units. Each answer is true or false, and the score is a count of yes answers.

Worked examples

These use Magent's own expected values for the calculator.

Example 1: no to every question

  1. All four answers are no.
  2. CAGE score 0. Screen not positive.

Example 2: yes to Cut down alone

  1. Yes to Cut down. No to the other three.
  2. CAGE score 1. Screen not positive, because one yes is below 2.

Example 3: yes to Cut down and Annoyed

  1. Yes to Cut down and Annoyed. No to Guilty and Eye-opener.
  2. CAGE score 2. Screen positive.

Example 4: yes to all four

  1. Yes to every question.
  2. CAGE score 4 out of a maximum of 4. Screen positive.

History of the CAGE questionnaire

John Ewing described the CAGE questionnaire in JAMA in 1984. The paper set out the four questions and the screen of two or more yes answers. The calculator follows Ewing 1984 as published and doesn't apply later variants.

When it's used

CAGE is asked when a quick check on drinking is wanted, for example during a routine history, before a fuller assessment.

Where it's used

It can be asked anywhere a history is taken: primary care, emergency departments, hospital wards and clinics.

Who uses it

Doctors, nurses and other clinicians ask the questions. The calculator adds the answers and applies the screen.

Limits of the calculation

  • The score depends on the answers given. The calculator doesn't check them or interpret them.
  • CAGE doesn't measure how much or how often someone drinks.
  • A positive screen isn't a finding about the person, and a negative screen doesn't rule anything out.
  • The calculator applies the Ewing 1984 screen at 2. It doesn't apply other thresholds or other versions of the questions.
  • This page doesn't say what to do with a result.

Clinical decisions belong to a qualified clinician who knows the patient.

  • CIWA-Ar scores the signs and symptoms of alcohol withdrawal. CAGE asks four yes/no questions about drinking.
  • COWS scores opioid withdrawal signs. CAGE is about alcohol and doesn't score signs.

Glossary

  • Screen: a short check that picks out people who may need a fuller assessment.
  • Screen positive: in CAGE, two or more yes answers.
  • Eye-opener: a drink first thing in the morning to steady the nerves or get rid of a hangover.

Common mistakes

  • Counting one yes as positive. Ewing 1984 uses two or more.
  • Reading CAGE as a measure of how much someone drinks. It doesn't ask about amount.
  • Weighting the Eye-opener question more. Every question is worth 1 point.
  • Using a different version of the questions. The calculator follows Ewing 1984.
  • Leaving a question out. All four answers are needed.

Source

Ewing JA. Detecting alcoholism. The CAGE questionnaire. JAMA. 1984;252(14):1905-1907. DOI: 10.1001/jama.1984.03350140051025. PMID: 6471323

Frequently asked questions

What does CAGE stand for?

Cut down, Annoyed, Guilty and Eye-opener, the key word in each question.

How is the CAGE questionnaire scored?

Each yes is 1 point. The score runs from 0 to 4.

What CAGE score is positive?

Two or more yes answers, following Ewing 1984.

Who decides whether an answer counts as yes?

The person entering the answers. The calculator takes each answer as given.

Does CAGE measure how much someone drinks?

No. It asks about four experiences linked with drinking, not amount or frequency.