The CAGE Questionnaire

The CAGE is a 4 item screening questionnaire used to identify those individuals for whom more extensive evaluation of alcohol use is recommended. It is the oldest and likely most extensively used questionnaire across a variety of clinical and research settings (Ewing 1984). Originally developed for use with adults, it has been used in elderly populations as well. 

Number of items: 4

Procedure/Administration: A self report pen/paper or interview format. Responses of “yes/no” to the following:

• Have you ever felt you should Cut down on your drinking?
• Have people Annoyed you by criticizing your drinking?
• Have you ever felt bad or Guilty about drinking?
• Have you ever taken a drink first thing in the morning (Eye opener) to steady your nerves or get rid of a hangover?

The CAGE questions can be used in the clinical setting using informal phrasing. It has been demonstrated that they are most effective when used as part of a general health history and should NOT be preceded by questions about how much or how frequently the patient drinks.

How scored: 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. 

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).

Acceptability: N/a

Languages: N/a

Usability: N/a

Time to administer: Less than 5 minutes to complete.  Easy to administer and score

Time to score: N/a

Training required: N/a

Availability: The exact wording that can be used in research studies can be found in : JA Ewing Detecting alcoholism: the CAGE questionnaire. JAMA 1984; 252: 1905-7. Researchers and clinicians who are publishing studies using the CAGE questionnaire should cite the above reference.

Equipment required: N/a

Summary:

• 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. 

Psychometric Summary

Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; SS= Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

References

• 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.
• Ewing JA. Detecting Alcoholism: The CAGE Questionnaire. JAMA 1984; 252:1905-1907.
• Tate D. Alcohol Use Among Spinal Cord Injured Patients. Am J Phys Med Rehabil 1993;72:175-183.