π₯ CAGE Alcohol Screening
The 4-question screen clinicians use. Answer honestly.
A screening tool, not a diagnosis. Only a clinician can diagnose alcohol use disorder.
The CAGE questionnaire is four questions, takes thirty seconds, and has been catching alcohol problems in clinics since 1970. Each letter is a question: Cut down, Annoyed, Guilty, Eye-opener. Two or more yes answers flag the need for a real conversation with a clinician. Answer honestly; the questionnaire only works if you do.
How to Use This Screening
Read each question and answer yes or no from your own experience, not what you think the "right" answer is.
Answer all four questions. "Ever" means ever, not just this year.
Count the yes answers. Zero to one is reassuring; two or more warrants follow-up.
If you scored 2+, treat it as a prompt, not a verdict: talk to your doctor, who may use a fuller tool like AUDIT. Free confidential help: SAMHSA 1-800-662-4357.
The Four Questions, and Why These Four
Dr. John Ewing designed CAGE in 1970 to fit the reality of busy clinics: memorable, fast, and focused on the lifetime pattern rather than last week's intake. The questions escalate cleverly. "Cut down" catches self-awareness. "Annoyed" catches social friction, often the first external signal. "Guilty" catches internal conflict. "Eye-opener" catches physiological dependence, the morning drink to steady nerves or stave off withdrawal, which is the most serious single answer here. A yes on the eye-opener alone deserves a clinical conversation regardless of the total.
At the 2-point cutoff, CAGE detects alcohol use disorder with roughly 70 to 90 percent sensitivity in most studies, respectable for four questions. Its weakness is that it asks about "ever," so it can flag people whose drinking is long resolved, and it is less sensitive in some populations, including women and older adults. Clinicians who want current-pattern detail follow up with AUDIT, the WHO's 10-question tool. Think of CAGE as the smoke alarm and AUDIT as the fire inspector.
Worked Example
Someone answers yes to Cut down and Guilty, no to the others: score 2. That meets the clinical cutoff for further evaluation, even though their drinking might look moderate from the outside. The guilt and the self-recognition are the signals: this person already knows something is off. Contrast yes only to Annoyed: score 1, below cutoff, but worth honest reflection about why others are commenting. And yes to Eye-opener alone: score 1, yet most clinicians would still want a conversation, because morning drinking suggests dependence physiology. The total guides; the individual answers inform.
What Low-Risk Drinking Looks Like
US Dietary Guidelines define low-risk limits as 2 drinks or fewer per day for men and 1 or fewer for women, with several alcohol-free days weekly. Less is better at every level; there is no safe threshold for some outcomes. Binge drinking (4-5+ drinks within hours) carries acute risks, injury, alcohol poisoning, bad decisions, even in people who never drink daily. If you scored 0-1 but regularly binge, the score is reassuring about dependence and silent about the binges: both matter.
And an honest note about honesty: most people under-report drinking by 30 to 50 percent on questionnaires, including to themselves. If you hesitated on any question before answering no, count the hesitation as information. The questionnaire cannot help someone it cannot see, so the bravest version of this test is the truthful one.
If the Score Concerns You
A score of 2+ is a starting gun, not a sentence. Effective help exists at every level: brief counseling with your primary care doctor helps many people cut back; mutual support groups, therapy, and medications (naltrexone, acamprosate) help with dependence. In the US, SAMHSA's helpline (1-800-662-4357) is free, confidential, and 24/7. Withdrawal can be medically serious for heavy daily drinkers: tremors, sweating, and nausea when stopping warrant medical supervision, and seizures are possible, which is also what our CIWA assessment screens for in clinical settings. Asking for help is the strong move here, not the shameful one.
Related Calculators
Keep exploring: try our CIWA alcohol withdrawal scale and Maddrey's discriminant function for the next piece of the picture.
For informational purposes only, not medical advice. Consult a healthcare professional.
Frequently Asked Questions
What is the CAGE questionnaire?
A 4-question alcohol screening tool developed by Dr. John Ewing in 1970: Cut down, Annoyed, Guilty, Eye-opener. Each yes scores 1 point; 2 or more suggests further evaluation for alcohol use disorder. It is used worldwide for its speed and memorability.
How is the CAGE questionnaire scored?
One point per yes answer, total 0-4. A score of 2 or higher is the standard clinical cutoff warranting further assessment. A yes on the eye-opener question alone often prompts clinical follow-up regardless of total.
How accurate is the CAGE test?
At the 2-point cutoff, sensitivity for alcohol use disorder runs roughly 70-90% across studies, which is strong for four questions. It is weaker at detecting current risky drinking in some groups and can flag resolved past problems, since it asks about "ever."
What should I do if I score 2 on CAGE?
Talk to your doctor, who may follow up with the fuller AUDIT questionnaire. In the US, SAMHSA (1-800-662-4357) offers free confidential guidance 24/7. A score of 2 is a prompt for evaluation, not a diagnosis.
What is an eye-opener drink?
A drink taken first thing in the morning to steady nerves or relieve hangover or withdrawal symptoms. It is the most clinically significant CAGE question because it suggests physiological dependence rather than just heavy use.
What is the difference between CAGE and AUDIT?
CAGE is 4 quick lifetime-pattern questions for screening; AUDIT is the WHO's 10-question tool covering current consumption, dependence symptoms, and alcohol-related problems in detail. Clinicians often screen with CAGE and assess with AUDIT.
Can the CAGE questionnaire diagnose alcoholism?
No. It is a screening instrument that identifies who needs further evaluation. Diagnosis of alcohol use disorder requires a clinical interview against DSM-5 criteria by a qualified professional.
What are low-risk drinking limits?
US guidelines suggest 2 drinks or fewer daily for men and 1 or fewer for women, with alcohol-free days each week. Less is better at every level. Binge drinking (4-5+ drinks in a sitting) carries acute risks even without daily drinking.
Is it normal to feel guilty about drinking?
Occasional guilt after overindulging is common and not necessarily a disorder signal. But recurring guilt about drinking patterns is exactly what the CAGE "G" question targets, because persistent guilt often tracks with loss of control. Take it seriously as information.
Where can I get help for drinking?
Start with your primary care doctor, who can counsel or refer. Mutual support groups, addiction therapists, and medications like naltrexone all have good evidence. SAMHSA's US helpline 1-800-662-4357 is free and confidential around the clock.