What is the purpose of CAGE (Cutting down, Annoyance by criticism, Guilty feeling, and Eye-openers) screening?

From the Guidelines

The primary purpose of the CAGE screening is to identify individuals with alcohol use disorders, and I strongly recommend its use as a quick and effective screening method in clinical settings. The CAGE questionnaire consists of four questions: 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 your drinking? Have you ever had an Eye-opener (morning drink) to steady your nerves or get rid of a hangover? According to a meta-analysis, using a cutoff of more than two positive responses, the CAGE questionnaire has an overall pooled sensitivity and specificity of 0.71 and 0.90, respectively 1.

Key Characteristics of the CAGE Questionnaire

• It is short, simple, and easy to implement, making it an ideal screening tool for busy clinical settings
• It focuses on the consequences of alcohol consumption rather than the amount of actual drinking, which can be an effective way to identify individuals with alcohol use disorders
• It has been tested in a wide range of populations and has been suggested for use in general screening 1

Administration and Interpretation

• The CAGE questionnaire should be administered in a non-judgmental manner during routine health assessments
• Two or more positive responses indicate a high likelihood of alcohol dependence and warrant further assessment
• The questionnaire takes less than one minute to complete and can be incorporated into standard intake procedures
• While not diagnostic on its own, the CAGE serves as an excellent initial screening tool that can lead to appropriate referrals for comprehensive evaluation and treatment when needed, as supported by its use in various clinical settings 1

From the Research

Purpose of CAGE Screening

The CAGE screening is used to detect alcoholism and alcohol use disorders. The acronym "CAGE" stands for:

• Cutting down: attempts to cut back on drinking
• Annoyance by criticism: being annoyed at criticisms about drinking
• Guilty feeling: feeling guilty about drinking
• Eye-openers: using alcohol as an eye opener 2, 3, 4, 5, 6

Effectiveness of CAGE Screening

The CAGE questionnaire has been shown to be a useful screening and case-finding tool for alcohol use disorders in clinical populations, with a sensitivity of 77% and a specificity of 94% 4. It has also been found to be effective in detecting alcohol abuse and dependence in medical and surgical inpatients, ambulatory medical patients, and psychiatric inpatients, with an average sensitivity of 0.71 and specificity of 0.90 6.

Limitations of CAGE Screening

While the CAGE questionnaire is a valid tool for detecting alcohol abuse and dependence, it has limitations, including:

• It may not perform well in certain populations, such as white women, prenatal women, and college students 6
• It is not an appropriate screening test for less severe forms of drinking 6
• A positive screen should be followed by a proper diagnostic evaluation using standard clinical criteria 6