Cut Down, Annoyed, Guilty, Eye-opener (CAGE) Assessment
Score the four lifetime CAGE questions, check the standard two-Yes cutoff, and see separate safety guidance when Eye-opener is endorsed.{{ summaryTitle }}
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A drinking screen can focus on current quantity or on consequences that may signal dependence. CAGE follows the second route. Its four lifetime questions ask about feeling a need to Cut down, being Annoyed by criticism, feeling Guilty, and taking an Eye-opener drink in the morning. Those initials give the questionnaire its name.
The lifetime wording is central to interpretation. A Yes response may refer to an event many years ago, so the total does not describe current drinking frequency or quantity. A No response also cannot rule out recent binge drinking, hazardous use, or other alcohol-related risk that the four questions never ask about.
| CAGE can support | CAGE cannot establish |
|---|---|
| A brief record of four dependence-oriented concerns | A diagnosis of alcohol use disorder |
| A prompt for fuller assessment at the standard cutoff | Current drinking quantity or clinical severity |
| Specific follow-up after an Eye-opener response | Whether abrupt alcohol withdrawal is safe |
| A voluntary personal or clinical conversation | Fitness, eligibility, employment, insurance, or legal status |
Two or more Yes responses meet the standard positive-screen cutoff. One Yes remains below that cutoff but can still identify a concern worth discussing. Current NIAAA guidance advises against using CAGE as a broad preventive screen because its focus on established consequences misses many people who could benefit from earlier intervention.
The Eye-opener question carries information that a total alone can hide. Morning drinking to steady nerves or relieve a hangover deserves follow-up about possible dependence and withdrawal, even when the other three answers are No. Anyone drinking heavily over a prolonged period should seek qualified medical advice before making an abrupt change.
How to Use This Tool:
Keep “have you ever” in mind for every question and answer Yes or No from lifetime experience.
- Complete all four questions. Use Previous to correct an answer before finishing.
- Read any Safety and support notice before the general score interpretation. A Yes to Eye-opener triggers separate guidance regardless of the total.
- Compare the total with the standard cutoff and check which items were endorsed. Answer-review order and score detail change only how the completed responses are displayed.
Interpreting Results:
A score of 0 means none of the four lifetime concerns was endorsed; it does not clear current hazardous use. A score of 1 is below the standard cutoff but supports reviewing that specific answer. Scores from 2 to 4 form the positive-screen band and call for a fuller alcohol assessment rather than a diagnosis from CAGE alone.
Check the answer pattern as well as the total. Eye-opener guidance takes priority because the morning-drinking response may affect withdrawal safety. For a broader picture of current use, use a current quantity-and-frequency screen or discuss the result with a qualified health professional.
Technical Details:
Each item has a direct binary response map. No contributes 0 and Yes contributes 1. All four questions must be answered before the score is interpreted, and no item is reversed or weighted.
Formula Core:
The CAGE total is the number of Yes responses.
The result is an integer from 0 through 4 with no weighting, normalization, or rounding.
Rule Core:
| Rule | Boundary | Meaning |
|---|---|---|
| No endorsed items | Total = 0 | No CAGE concern endorsed; broader current risk is not ruled out |
| Below standard cutoff | Total = 1 | One concern endorsed; broader-net guidance may still prompt follow-up |
| Positive screen | Total ≥ 2 | Meets the standard cutoff for fuller assessment |
| Stricter comparison | Total ≥ 3 | Optional comparison shown in interpretation, not a separate result band |
A Yes on item 4 activates the Eye-opener safety rule at any total. That rule adds guidance but does not replace or alter the 0 to 4 score.
Responsible Use and Privacy:
Answers and progress update this page's URL as you work. Anyone with the URL can read and edit the responses; the URL is not encrypted or access-controlled. Opening or reloading it sends the URL to this website and may leave it in browser history or server logs.
- Starting over clears this attempt and removes its response state from the current URL; it does not erase previously copied links, browser history or server logs.
- A positive screen supports fuller assessment; it does not diagnose or grade alcohol use disorder.
- A low total does not rule out unhealthy alcohol use, and Eye-opener guidance should not be dismissed because the total is below 2.
- Do not make abrupt alcohol changes from this result alone when dependence or withdrawal may be possible.
References:
- Detecting alcoholism: The CAGE questionnaire, JAMA, 1984.
- CAGE Questionnaire table and scoring guidance, Substance Abuse and Mental Health Services Administration.
- Screen and Assess: Use Quick, Effective Methods, National Institute on Alcohol Abuse and Alcoholism.
- Alcohol Treatment Navigator, National Institute on Alcohol Abuse and Alcoholism.