Your guide to the CAGE questionnaire for substance abuse

Defining Substance Abuse

The idea of substance abuse is a complex one. Its definition can be hazy – at least outside of clinical settings. Likewise, the symptoms and risks associated with substance abuse can vary significantly depending on the substance and user.

However, substance abuse can pose a significant threat to health and well-being across the board. Substance use can impact the brain and affect how medications or treatment methods function. As such, substance use disorders, substance dependence, and addiction can all be considered health conditions worthy of proper intervention.

So, when does substance use cross the line and become substance abuse? Generally speaking, substance abuse occurs when using a substance begins causing harm or distress. This might include physical symptoms, psychological challenges, or social consequences, like struggling in relationships or problems at work.

Virtually any substance can lead to dependence, but some substances tend to be the cause of abuse more than others, including:

• Alcohol
• Cannabis
• Nicotine
• Prescription medications
• Heroin
• Cocaine
• Methamphetamine

A key trait of substance dependency is its impact on a user’s perception of their own behaviors. Substance abuse often makes it difficult for individuals to identify their own symptoms.

That’s where a screening tool like the CAGE questionnaire can come in handy. This screener can help healthcare professionals and patients alike understand if their actions or symptoms indicate a potential substance use disorder.

What is the CAGE questionnaire?

The CAGE questionnaire, also known as the CAGE assessment, is a personal assessment for measuring substance abuse. In other words, it’s a short and useful screener for alcohol and substance dependence.

The CAGE in the instrument’s name is an acronym that represents keywords present in each of its items:

• Cut down
• Annoyed
• Guilty
• Eye-opener

While the CAGE questionnaire can be a useful tool, it does not lead to a formal diagnosis. It’s a preliminary assessment that helps providers identify patients who may require a more thorough evaluation.

A healthcare professional can verbally administer the CAGE assessment, or patients can complete it independently using a self-report version.

However, it is important to note that experts recommend limiting the use of the CAGE screening tool, and many consider it somewhat outdated. The US Preventive Services Task Force (USPSTF) specifically does not recommend CAGE for screening because it may not identify all patients who could benefit from intervention.

Because the CAGE questionnaire only captures patients who are already experiencing the adverse consequences of substance abuse, it might not give providers the insight they need to offer early intervention to patients who need it.

Still, the tool may be useful for measuring the severity of substance abuse or prompting patients to consider their own behaviors.

CAGE Questionnaire Items

There are two versions of the CAGE questionnaire. First is the traditional CAGE questionnaire for alcoholism, which focuses on drinking behaviors. The other option is the CAGE-AID questionnaire, which extends its focus to drug use in general.

Each version of the questionnaire is short. There are just four CAGE questionnaire questions, and each is focused on one letter of the aforementioned CAGE acronym. Below is a list of questions focused on the substance covered in the original CAGE questionnaire: alcohol. Click to access a preview of the CAGE questionnaire (PDF) from USPSTF.

Directions: Ask your patients these four questions to determine if substance abuse exists and needs to be addressed.

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 to get rid of a hangover (eye-opener)?

Cage Questions Adapted to Include Drug Use (CAGE-AID)

The items for the CAGE-AID questionnaire are nearly identical to the original version, with slight changes in language to cover substance use of all kinds.

1. Have you ever felt you ought to cut down on your drinking or drug use?
2. Have people annoyed you by criticizing your drinking or drug use?
3. Have you ever felt bad or guilty about your drinking or drug use?
4. Have you ever had a drink or used drugs first thing in the morning to steady your nerves or get rid of a hangover?

CAGE Questionnaire Scoring

All item responses on the CAGE screener are scored with a 0 for “no” and 1 for “yes” answers. A higher score may be an indication of alcohol or drug use problems. Meanwhile, a score of 2 or higher is typically considered to be clinically significant.

While the normal cutoff for CAGE questionnaires is two positive answers, some clinicians may choose to lower the threshold to one positive answer. Doing so can help providers cast a wider net with their assessments and identify more patients who may be affected by substance abuse.

What happens after the CAGE questionnaire?

Since CAGE is not a diagnostic tool, it doesn’t indicate that a patient has a substance use disorder or any related condition. Instead, it might point to respondents who could benefit from more thorough assessments and evaluations.

Patients who score high on the CAGE screener may need to be referred to specialists or community services that can support their needs. Likewise, their treatment plans may need to be adjusted to consider the impact of substance use on their wellness.

Automate clinical assessments like the CAGE questionnaire with Linear Health

Building a personalized CAGE questionnaire for your practice and automating its distribution – whether it’s part of patient intake or a routine assessment  – can help your team save time and resources while still capturing as much patient health information as possible.

Linear Health empowers behavioral healthcare providers to create digital clinical assessments and screening tools to streamline workflows for health workers. Skip the hassle of managing paperwork and manually entering questionnaire results into your health records system.

With Linear Health, you can reduce the administrative burden on your staff so your whole team can focus on delivering top-quality care to your patients. Ready to get started? Contact us today to book a demo.