The CAGE Assessment (also called the CAGE Questionnaire) is a preliminary screening tool used by physicians to help with diagnosing alcohol use disorder (AUD). It’s a set of questions used to screen for possible problems with alcohol use.
The letters CAGE stand for:
- Cutting Down
- Annoyance by Criticism
- Guilty Feeling
- Eye-openers
The questions represented by the CAGE acronym are:
- Have you ever felt you should cut down on your drinking?
- Have people annoyed you by criticizing your drinking?
- Have you felt bad or guilty about your drinking?
- Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)?
Your answers can help your health care provider detect a possible alcohol abuse problem. Typically, answering “yes” to two or more questions suggests you may have alcohol use problems.
What is Alcohol Use Disorder?
The term alcohol use disorder includes conditions referred to as alcohol abuse, alcohol addiction, alcoholism, and alcohol dependence. AUD is a relapsing, long-term condition in which you’re unable to control your intake of alcohol even though it can have negative effects on your life.
AUD can range from mild, moderate, or severe. Screening tools like the CAGE Assessment help health care providers diagnose AUD.
Alcohol abuse versus substance abuse
Alcohol abuse is one type of substance abuse. Substance abuse disorders affect your brain, leading to a lack of control over drugs or medications.
The symptoms and risks posed by substance abuse depend on the type of substance and the person. Substance abuse is harmful and requires intervention.
Alcohol, along with cannabis, nicotine, and prescription medications, are common legal substances that are abused.
Causes of AUD
Misusing alcohol, which includes factors like drinking too much or too fast, can put you at an increased risk of developing AUD. Other risk factors for AUD include:
- Family history of alcohol misuse
- Your genes
- Childhood trauma or stress
- Less nurturing parenting
- Mental health conditions like attention-deficit hyperactivity disorder or depression
Symptoms of AUD
Doctors use the 11 criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to diagnose how severe AUD is, which include the following signs and symptoms:
- Frequently using alcohol more often or in larger quantities than intended
- Repeatedly and unsuccessfully trying to lessen alcohol use
- Spending too much time getting, using, and recovering from alcohol use
- Having strong cravings for alcohol
- Frequent alcohol use that interferes with responsibilities at school or work
- Drinking alcohol in harmful settings, such as while driving
- Letting your relationships be affected by your substance use
- Giving up on other activities you enjoy because of alcohol use?
- Using alcohol use despite knowing the problems it can cause
- Displaying an increased tolerance, requiring more of the substance for the same effects
- Experiencing withdrawal symptoms
Other Tools Used for AUD Screening and Diagnosis
The CAGE assessment is one screening tool for alcohol abuse. Doctors may use it and/or other tests to confirm a diagnosis of AUD. Other tools include:
The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This tool is used to diagnose substance abuse (including alcohol abuse) and mental health disorders, and the severity is classified by how many criteria are met. Meeting at least 2 of these 11 criteria confirms an AUD diagnosis.
The DSM-5 is considered the gold standard for diagnosing an alcohol or substance abuse disorder, however doctors may use other tools to confirm diagnosis.
The Alcohol Use Disorders Identification Test (AUDIT) Alcohol Screen Assessment. This screening instrument was developed by the World Health Organization as an international tool to note at-risk alcohol use. It includes 10 questions including how much and how frequent alcohol is used and can be completed by self report or by a clinician. Modifications to the tool include versions that take into account the U.S. definition of alcohol misuse (the US AUDIT) and a shortened 3-question version that lets healthcare providers know if additional screening is needed (the AUDIT-C).
The CAGE Adapted to Include Drugs (CAGE-AID). The CAGE-AID was adapted from the CAGE assessment to screen for problems with drug abuse. In the CAGE-AID, terms used in the CAGE assessment for “drinking” are swapped to include “drinking or drugs.”
The CAGE-AID focuses on patterns of alcohol and drug misuse and lifetime use, and not for occasional use.
CAGE Assessment and Diagnosing Alcohol Abuse
The CAGE Assessment is not a formal diagnosis. It’s simply a preliminary assessment. Formal diagnosis requires a thorough assessment and evaluation by your doctor.
Some studies show that the tool isn’t useful for identifying preliminary cases of alcohol misuse. Some organizations discourage use of the tool for this reason.
After the CAGE Assessment
If you complete a self report using the CAGE questionnaire and find that you may have a dependency on alcohol, talk to your doctor. They can recommend evaluation by a psychiatrist, psychologist, or drug counselor and work with you on an effective treatment plan.
AUD Treatment
Exact treatment plans will depend on your own medical history, mental health, and the substances that were used. Other factors that affect your treatment plan might include your age and how severe your symptoms are.
Detox programs. These detoxification programs allow you to gradually clear alcohol from your system. You’ll likely take part in withdrawal therapy during a detox program, and move on to an inpatient or outpatient program.
Medications. You may be prescribed certain medications to help curb the desire to drink. There are three FDA-approved medications to help stop or lessen drinking and prevent relapse, including:
- Naltrexone (Vivitrol, ReVia)
- Acamprosate (Campral)
- Disulfiram (Antabuse)
These medications may be used alone or along with behavioral therapy or mutual-support groups.
Behavioral therapy. Treatment programs for AUD can be provided in an inpatient or outpatient center. A commonly used behavioral therapy is cognitive behavioral therapy, where you can learn to manage negative thoughts and prevent relapse.
Mutual-help groups. Many support groups use a step-based program that leads you through the steps of becoming sober. There are a variety of mutual-help groups, like Alcoholics Anonymous, that can help you meet people who are going through the same process of recovery.
If you or someone you know are worried about having AUD, visit the Rethinking Drinking website. For more information about treatment options, try the NIAAA Alcohol Treatment Navigator.
