Addiction Medicine: Closing the Gap between Science and Practice

The CAGE Questionnaire and the CAGE-

Adapted to Include Drugs (AID)

The CAGE Questionnaire, developed in 1984, is
a four-item alcohol screening tool that gets its
name from the questions that are asked:

1. Have you ever felt you should Cut down on
   your drinking?


2. Have people Annoyed you by criticizing
   your drinking?


3. Have you ever felt bad or Guilty about your
   drinking?


4. Have you ever had a drink first thing in the
   morning to steady your nerves or get rid of a
   hangover (Eye-opener)?^37

Generally, if respondents answer affirmatively
to at least two of these questions they are
thought to be at risk for addiction involving
alcohol and in need of a brief intervention or
further diagnostic assessments.^38 The CAGE
can be administered through an interview with a
professional or technician or it can be self-
administered.^39

The CAGE-Adapted to Include Drugs (AID)
instrument, developed in 1991, is identical to the
CAGE with the exception of the phrase “or drug
use” (which appears to excludes smoking)
tacked on to the end of each question.^40

Neither of the questionnaires is copyrighted and
both are widely available.^41 The tools require no
training to administer and the scoring process is
straightforward.

Populations and Settings Served. The CAGE
instrument can identify risky alcohol use in
adolescent, adult and elderly populations.^42 Due
to its brevity and ease of administration and
scoring, CAGE is well-suited to primary care
settings. It has proven to be a practical tool for
identifying risky alcohol use in emergency
department settings as well.^43 The CAGE-AID
questionnaire generally is recommended for use
with adult primary care patients.^44

Clinical Utility. Multiple studies with different

populations have found the CAGE and the

CAGE-AID instruments to be valid and

reliable.^45 Across various primary care settings,

the CAGE has demonstrated high sensitivity--

identifying accurately up to 94 percent of

patients with current or lifetime addiction

involving alcohol, and high specificity--

identifying accurately 97 percent of those

without addiction involving alcohol.^46 When

used in an emergency department setting, CAGE

results were correlated with biological indicators

of addiction involving alcohol.^47 When tested in

a general population sample, individuals with

positive scores were 37 times more likely than

those with negative scores to have addiction

involving alcohol, based on criteria for alcohol

dependence in the DSM-IV and the International

Classification of Diseases (ICD).^48

The CAGE instrument is less effective at

detecting risky substance use (vs. addiction

involving alcohol);^49 it does not appear to be

effective at detecting low but risky alcohol use

among college students--an important category

of risky users;^50 and its utility in screening

pregnant populations has yet to be established.^51

Like its counterpart, the CAGE-AID

questionnaire is better at identifying symptoms

of addiction than risky substance use. The

instruments also do not distinguish between

current and former risky substance use.^52

CRAFFT

The CRAFFT is a six-item questionnaire for

screening for lifetime risky alcohol and other

drug use (excluding nicotine) among

adolescents.^53 The items are:^54

1. Have you ever ridden in a Car driven by
   someone (including yourself) who was high
   or had been using alcohol or drugs?


2. Do you ever use alcohol or drugs to Relax,
   feel better about yourself or fit in?


3. Do you ever use alcohol or drugs while you
   are by yourself (Alone)?