Retrieved on June 12, 2009 from
CAGE Questionnaire
J. A. Ewing
Modified From: Rush J, et al: Psychiatric Measures, APA, WashingtonDC, 2000.
GOALS
The CAGE Questionnaire (Ewing 1984) was designed to briefly screen for clinically significant alcohol problems in a variety of treatment and nontreatment settings. A positive score on the CAGE is meant to alert the clinician to engage in further inquiry about a patient’s alcohol use patterns and alcohol-related problems and symptoms.
DESCRIPTION
The CAGE contains four yes-no items that can be administered in a self-report or clinician-interview format. Items may be grouped together or asked separately by embedding them within the context of questionnaires that cover health and lifestyle issues. The name CAGE is a mnemonic device based on key words from the four questions (see Example 22 –2). Each yes response to a CAGE question is scored as 1.
A total score of 0–4 results from summing positive answers. A score of 2 or higher is considered clinically significant and should raise the clinician’s index of suspicion that the individual has an alcohol-related problem or diagnosis.
PRACTICAL ISSUES
It takes less than 1 minute to administer and score the CAGE. It may be used without
permission. No special training is required to administer, score, or interpret the CAGE. The CAGE has been translated into Flemish, French, Hebrew, Japanese, Polish, Portuguese, and Spanish.
PSYCHOMETRIC PROPERTIES
Validity
The principal measures of the utility of the CAGE have been the sensitivity and specificity of this brief measure in relationship to the detection of individuals determined to have a lifetime history of clinically significant alcohol problems (e.g., DSM-IV alcohol abuse or alcohol dependence) by more extensive assessments (e.g., using structured interviews such as the Composite International Diagnostic Interview [CIDI]). The CAGE has been included in numerous studies with large sample sizes of patients seeking treatment in general medical or psychiatric settings. In general, a cutoff score of 1 or more yields higher sensitivity and lower specificity than a score of 2 or more. From three exemplary studies, sensitivities for a cutoff score of 1 or more range from 0.86 to 0.90, with specificities ranging from 0.52 to 0.93. Sensitivities for a cutoff of 2 or more range from 0.78 to 0.81, and specificities range from 0.76 to 0.96. Studies that compare the CAGE with single items such as “How much do you drink?” or to biological measures such as liver function tests or breath tests for alcohol show greatly improved sensitivity and specificity over those screening procedures.
CLINICAL UTILITY
The CAGE is one of the most widely used methods to screen for alcohol problems. Although other instruments such as the MAST and the TWEAK have better sensitivity-to-specificity ratios, the CAGE is useful because of its brevity and ease in scoring. A cut point of 1 detects approximately 90% of those with an alcohol-related disorder, with 48% false-positive diagnoses. Although the items are worded in a nonthreatening manner, they have great face validity and are subject to falsely negative reporting.
REFERENCES AND SUGGESTED READINGS
Ewing JA: Detecting alcoholism: the CAGE Questionnaire. JAMA 252(14):1905–1907, 1984
Liskow B, Campbell J, Nickel EJ, et al: Validity of the CAGE Questionnaire in screening for alcohol dependence in a walk-in (triage) clinic. J Stud Alcohol 56:277–281, 1995
Magruder-Habib K, Stevens HA, Alling WC: Relative performance of the MAST, VAST, and CAGE versus DSM-III-R criteria for alcohol dependence. J Clin Epidemiol 46(5):435–441, 1993
Mayfield D, McLeod G, Hall P: The CAGE Questionnaire: validation of a new alcoholism screening instrument. Am J Psychiatry 131:1121–1123, 1974