How this instrument works
CAGE is four short questions, each answered yes or no: whether someone has ever felt they should Cut down on drinking, whether people have Annoyed them by criticizing it, whether they've felt Guilty about it, and whether they've ever needed a morning Eye-opener drink to steady their nerves or settle a hangover. Every yes is worth one point, and the four points add to a total between 0 and 4. Psychiatrist John Ewing introduced the questionnaire in a 1984 paper in JAMA, distilling years of clinical interview experience into four questions a clinician could ask in under a minute.
A total of 2 or more is the threshold most often cited as worth a closer look for a possible drinking problem — not a diagnosis, but a prompt for a fuller conversation. CAGE's appeal has always been its brevity: four questions fit on an index card, need no scoring key beyond counting yeses, and have stayed in near-constant clinical use for four decades, making it one of the oldest and most widely recognized brief alcohol screens still in circulation.
That brevity comes with a real trade-off. CAGE was built around themes of guilt, criticism, cutting down, and morning drinking — it says little about someone who drinks heavily or binges episodically without yet feeling any of those four things. Newer instruments such as AUDIT-C were developed partly to close that gap, asking directly about drinking frequency and quantity rather than relying on a person having already reached a point of guilt or concern from others.
None of this makes a CAGE total a verdict. A total at or above the usual threshold is best treated as a reason to talk with a doctor or counselor about drinking, not as a label — the questionnaire flags a pattern worth discussing, and the discussion is where the actual assessment happens.
- Answer Felt you should Cut down on drinking — Yes or No.
- Answer People Annoyed you by criticizing your drinking — Yes or No.
- Answer Felt Guilty about drinking — Yes or No.
- Answer Needed a drink first thing (Eye-opener) — Yes or No.
- Read the CAGE score (0-4) — each Yes contributes one point, added automatically.
Worked example — a total of 2, at the common threshold
Someone answers yes to feeling they should cut down on drinking (1 point) and yes to feeling guilty about it (1 point), but no to being annoyed by others' criticism and no to ever needing an eye-opener. The four answers add to 1 + 0 + 1 + 0 = 2 — right at the threshold most often cited as worth a fuller conversation about drinking.
The scale's extremes are just as simple to total. Answering no to all four gives 0 + 0 + 0 + 0 = 0, the lowest possible reading and no flagged signs at all. Answering yes to all four gives 1 + 1 + 1 + 1 = 4, the maximum score, meaning every one of the four classic warning signs the questionnaire asks about is present.
Questions
What does a CAGE score of 2 mean?
It sits at the threshold most often cited as worth a closer look for a possible drinking problem, since 2 or more is the commonly used cutoff. It is a flag for further conversation, not a diagnosis — a clinician would typically follow up with more questions about drinking patterns and their effects before drawing any conclusion.
Is a high CAGE score a diagnosis of alcoholism?
No. CAGE is a brief screening questionnaire meant to flag a pattern worth discussing, not to diagnose alcohol use disorder on its own. A score at or above the usual threshold typically leads to a fuller conversation or assessment with a healthcare provider, who weighs the answers alongside history and context.
What do the four letters in CAGE stand for?
Cut down, Annoyed, Guilty, and Eye-opener — the four themes John Ewing built the questionnaire around in 1984. Each letter corresponds to one yes/no question: ever felt a need to cut down, ever annoyed by others' criticism of your drinking, ever felt guilty about it, and ever needed a drink first thing to steady your nerves or ease a hangover.
How is CAGE different from AUDIT-C?
CAGE asks about guilt, criticism, cutting down, and morning drinking across just four yes/no items, while AUDIT-C asks directly about drinking frequency, typical quantity, and how often heavy episodes happen. CAGE tends to miss binge or heavy drinking patterns that haven't yet produced guilt or complaints from others, which is part of why AUDIT-C and similar tools were developed.
Why doesn't CAGE ask how much or how often someone drinks?
Because Ewing built it around the consequences and feelings that can accompany problem drinking — guilt, criticism from others, a felt need to cut down, morning drinking — rather than the raw amount consumed. That design keeps it short, but it also means a person who drinks heavily without yet experiencing any of those four things can score low despite a risky pattern.
Who created the CAGE questionnaire and when?
Psychiatrist John Ewing published it in JAMA in 1984, in a paper titled Detecting Alcoholism: The CAGE Questionnaire, drawing the four questions from patterns he'd observed across years of clinical interviews. Its four-question format has changed little since and remains one of the most widely taught brief alcohol screens in medical training.
References
Read this first: This instrument computes a screening figure from population formulas — it is not a diagnosis, and it cannot see the whole picture a clinician can. Use it to inform a conversation, not to replace one.