Four questions, each "yes" answer = 1 point
Primary source: Ewing JA. JAMA 1984; 252(14): 1905-1907
CAGE is a brief 4-question screening tool for alcohol dependence, developed by JA Ewing (JAMA 1984). The acronym stands for Cut down (attempts to reduce drinking), Annoyed (irritation at others' criticism), Guilty (feelings of guilt), and Eye-opener (morning drink to relieve withdrawal or steady nerves).
Each "yes" answer scores 1 point, for a total of 0–4. A score ≥ 2 constitutes a positive screen, with sensitivity of 71–93% and specificity of 70–95% for alcohol dependence. A positive CAGE warrants further evaluation with the full AUDIT and a clinical interview.
CAGE remains popular for its simplicity, the four questions can be asked in about a minute. However, it detects dependence better than it detects hazardous or risky drinking, which is why current guidelines often favor AUDIT-C for primary screening in general practice.
Assesses insight into drinking behavior and past attempts at self-control.
Assesses defensiveness or denial in response to others' concern.
Assesses internalized awareness of a problem.
Assesses physical dependence and withdrawal symptoms relieved by morning drinking.
A 56-year-old man with alcoholic hepatitis. CAGE questions: (C) tried to cut down — yes; (A) annoyed by criticism — yes; (G) felt guilty — sometimes ("yes"); (E) morning drink — yes.
4 positive answers = 4 points.
CAGE ≥ 2 indicates high probability of alcohol dependence. Management: further evaluation with the full AUDIT, referral to addiction specialist, treatment of alcoholic hepatitis, assessment with Maddrey score or GAHS to guide corticosteroid decision, and discussion of transplantation (typically requiring documented abstinence ≥ 6 months at most centers).
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