Alcohol Use Disorders (55) How to identify people with AUD (2) The CAGE Assessment

15 February, 2024

[Re: ]

In answer to your questions about the CAGE, here is a reply (I have attempted to reference most things, after each paragraph).

CAGE: "Has anyone used this questionnaire in their work? Can you give examples of how you have used it?

I do not think that we have used the CAGE in our work in India, but some studies in India have used the CAGE – see our review: Nadkarni A et al (2022) Alcohol use among adolescents in India: a systematic review.

As Nadkarni (2018) argues (my underlining [*see note below]): “Two commonly used screening tools include the CAGE questionnaire and the Alcohol Use Disorders Identification Tool (AUDIT). They serve two different purposes; *the CAGE questions (Cut Down, Annoyed, Guilty and Eye Opener) are better suitable to identify patients with alcohol dependence* while the AUDIT is more sensitive for hazardous and harmful drinkers. It is feasible to use AUDIT in settings where time allows for more in depth interviewing, while *the much shorter CAGE is more suitable in busy clinical settings*.”


Nadkarni A. Increasing access to psychosocial interventions for alcohol use disorders: Home based interventions. Indian J Psychiatry 2018;60:564-570.

Nadkarni A et al (2022) Alcohol use among adolescents in India: a systematic review. Global Mental Health 9, e1, 1–25.

"The questionnaire is offered as a 'screening test'.”

The CAGE certainly CAN be used as a screening test (see eg Cherpitel et al, 2005), but as stated above, it is better at screening for alcohol DEPENDENCE than for hazardous and harmful drinkers, where the AUDIT is better. In our work on the PREMIUM project in India (Nadkarni et al, 2017 a, b), we used the AUDIT to screen before recruiting harmful drinkers to enter our bespoke intervention (Counselling for Alcohol Problems), delivered by trained lay health workers / counsellors.


Cherpitel, C.J., Ye, Y., Moskalewicz, J., Swiatkiewicz, G., 2005. Screening for alcohol problems in two emergency service samples in Poland: comparison of the RAPS4, CAGE and AUDIT. Drug Alcohol Depend. 80, 201–207.)

Nadkarni, A., Weobong, B., Weiss, H.A., McCambridge, J., Bhat, B., Katti, B., Murthy, P., King, M., McDaid, D., Park, A.L., Wilson, G.T., Kirkwood, B., Fairburn, C.G., Velleman, R., Patel, V., 2017a. Counselling for Alcohol Problems (CAP), a lay counsellor-delivered brief psychological treatment for harmful drinking in men, in primary care in India: a randomised controlled trial. Lancet 389, 186–195.

Nadkarni, A., Weiss, H.A., Weobong, B., McDaid, D., Singla, D.R., Park, A.L., Bhat, B., Katti, B., McCambridge, J., Murthy, P., King, M., Wilson, G.T., Kirkwood, B., Fairburn, C.G., Velleman, R., Patel, V., 2017b. Sustained effectiveness and cost-effectiveness of Counselling for Alcohol Problems, a brief psychological treatment for harmful drinking in men, delivered by lay counsellors in primary care: 12-month follow-up of a randomised controlled trial. PLoS Med. 14, e1002386.]

“Is it feasible to apply it to everyone, or might it be applied to selected people when a problem is suspected.” If screening for alcohol dependence, then it is feasible to only use on selected people (as the signs of dependence are somewhat more obvious than for harmful drinking). But you would miss a great proportion if you only screened the more ‘obvious’ cases, as often dependence is NOT obvious, so I think that, if feasible, universal screening is much better. In our PREMIUM work (above), we screened almost 15,000 primary care patients, many of whom screened positive for dependence.

"How honest are people when answering these questions?"

In my experience, generally pretty honest, but as with getting people to answer any questions, it all depends on the level of engagement you have built up between yourself and whoever is answering. Also, it is not only people with alcohol problems who are not completely honest when asked about alcohol consumption (see eg Knibbe et al, 2001) – in population studies, the amount of alcohol claimed to have been drunk is far lower than the amount of alcohol known to have been sold (although there are a number reasons for this, with not answering honestly being only one).


Knibbe R. et al (2001) Alcohol consumption estimates in surveys in Europe: comparability and sensitivity for gender differences. Substance Abuse, 22(1), 23–38.

Honesty continued: Evidence has also been available for a long time that many people are even more honest if they are assessed by a computer (or now an app) – see: eg

Lucas, R., et al (1977) Psychiatrists and a Computer as Interrogators of Patients with Alcohol-Related Illnesses: A Comparison. British Journal of Psychiatry, 131, 160-167.

Duffy, J. and Waterton, J. (1984) Under-reporting of alcohol consumption in sample surveys: the effect of computer interviewing in fieldwork. Addiction, 79 (3), * 303-308.

Bungey, J., et al (1989) Screening alcohol & drug use in a general practice unit: comparison of computerised and traditional methods. Australian and New Zealand Journal of Public Health, 13 (4), 471-483.

Hope this is useful

Richard Velleman

Professor Richard Velleman <>

Emeritus Professor of Mental Health Research, University of Bath

Co-Director, Addictions and related Research Group, Sangath Community Health NGO, Goa, India

Trustee and Treasurer, AFINet (Addiction and the Family International Network)

HIFA profile: Richard Velleman is Emeritus Professor/ C-Director, Addictions and related Research Group. Organisation: Sangath, Goa, India/University of Bath, UK. Professional interests: Addiction; families; mental health. Email address: r.d.b.velleman AT

[*Note from HIFA moderator (NPW): HIFA is a plain-text forum. I have indicated the underlines with asterisks [*]. For more information about the CAGE Assessment see ]