• 4 item screening questionnaire used to identify those individuals for whom more extensive evaluation of alcohol use is recommended
  • The oldest and likely most extensively used questionnaire across a variety of clinical and research settings. Originally developed for use with adults, it has been used in elderly populations as well.

Clinical Considerations

  • Susceptible to underreporting. Minimum age 16 years, and not recommended for use with adolescents.
  • Questions refer to whole life history rather than a particular period. Thus, the questionnaire does not discriminate between active and inactive drinkers and should be used in combination with information regarding usual consumption patterns (e.g., frequency/quantity/heaviest consumption). In some populations, such inquiry can inhibit responses to CAGE questions, if it precedes them.
  • The CAGE contains sensitive items, therefore clinicians should take care to carefully present the questions
  • The CAGE is simple and easy to administer
  • The four CAGE questions are:
    1. Have you ever felt you should cut down on your drinking?
    2. Have people annoyed you by criticizing your drinking?
    3. Have you ever felt bad or guilty about your drinking?
    4. Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (eye-opener)?

ICF Domain

Body Function ▶ Mental Functions

Administration

  • Self-report pen/paper or interview format
  • Time for administration is approximately 5 minutes
  • Responses of “yes/no” to the following:
  1. Have you ever felt you should Cut down on your drinking?
  2. Have people Annoyed you by criticizing your drinking?
  3. Have you ever felt bad or Guilty about drinking?
  4. Have you ever taken a drink first thing in the morning (Eye opener) to steady your nerves or get rid of a hangover?

Number of Items

4

Equipment

None

Scoring

Typically, two or more of the questions answered affirmatively are considered to be “CAGE positive”, though some suggest a positive response to a single item warrants more in-depth investigation of consumption.

Languages

English

Training Required

Does not require advanced training.

Availability

The CAGE Questionnaire can be found here.

# of studies reporting psychometric properties: 1

Interpretability

  • Score correlates positively with pre-SCI consumption patterns and a greater incidence of medical complications (Tate 2003).
  • In non-SCI populations, the CAGE test scores > = 2 has a sensitivity of 93% and a specificity of 76% for the identification of problem drinkers (Bernadt et al. 1982). There have been recommendations to lower the cutoff to a score of 1 for the identification of problem drinkers.
  • No cut-points or normative data have been established for the SCI population

MCID: not established
SEM: not established
MDC: not established

Reliability

No values were reported for the reliability of the CAGE questionnaire for the SCI population.

Validity – Low to Moderate

The CAGE questionnaire had significant Low to Moderate correlations with:

  • Self-reported alcohol abuse history (r = 0.53)
  • Average number of drinks consumed weekly prior to injury (r = 0.38)
  • Drug abuse history (r = 0.28)

(Tate et al. 1993: n=155, 121 males, 34 females; mean age = 34 years; complete and incomplete SCI; paraplegia and tetraplegia; traumatic SCI)

Responsiveness

No values were reported for the responsiveness of the CAGE questionnaire for the SCI population.

Floor/Ceiling Effect

No values were reported for the presence of floor/ceiling effects in the CAGE questionnaire for the SCI population.

Reviewers

Dr. Carlos L. Cano-Herrera, Tyra Chu

Date Last Updated

31 December 2024

Bernadt MW, Mumford J, Taylor C, Smith B, Murray RM. Comparison of questionnaire and laboratory tests in the detection of excessive drinking and alcoholism. Lancet 1982;1:325–328.
http://www.ncbi.nlm.nih.gov/pubmed/6120322

Ewing JA. Detecting Alcoholism: The CAGE Questionnaire. JAMA 1984; 252:1905-1907.
http://jama.jamanetwork.com/article.aspx?articleid=394693

Tate D. Alcohol Use Among Spinal Cord Injured Patients. Am J Phys Med Rehabil 1993;72:175-183.
http://www.ncbi.nlm.nih.gov/pubmed/8363813

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