What Is the CAGE Assessment?

You wake up on a Monday morning after a weekend of partying with that all-too-familiar “hung over” feeling. Some of the details from last night are blurry, and you’re dreading getting out of bed to tackle your workday. A thought creeps into the back of your mind: ”Do I really want to feel this way anymore?”

Have you ever wondered if you drink too much, but you’re not quite sure how to find out? You’re not alone. If you’re looking for a quick way to assess your drinking habits, the CAGE Assessment is a great place to start.

What Is the CAGE Assessment?

The CAGE Assessment (also called the CAGE Questionnaire) is a set of four questions used to test whether someone might have an alcohol use disorder. Each letter in the CAGE acronym stands for a word in one of the questions. 

Here are the questions with the CAGE letters in bold:

1. C: Have you ever felt that you ought to Cut down on your drinking?
2. A: Do you get Annoyed by criticism of your drinking?
3. G: Do you ever feel Guilty about your drinking?
4. E: Do you ever take an Early-morning drink (eye-opener) to get the day started or to get rid of a hangover ("hair of the dog")?

The assessment was developed in 1968 by Dr. John Ewing, founding director of the Bowles Center for Alcohol Studies at the University of North Carolina at Chapel Hill. Since then, the CAGE Assessment has developed into the tool most widely used internationally to help identify alcohol dependency. 

Healthcare providers commonly use the assessment as a way to identify patients who may be struggling with alcohol misuse. So, what exactly are they looking for?

What Is Alcohol Misuse?

Alcohol misuse is more than just drinking a lot. It’s not a formal diagnosis; rather, it encompasses a broad range of harmful drinking patterns. It’s characterized by drinking habits that interfere with our health, finances, relationships, or work life. 

These drinking habits can include heavy drinking or binge drinking, but any level of harmful or risky drinking can be considered “misuse.” According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), our drinking may be considered risky if our alcohol consumption exceeds five or more drinks a day for men and four or more drinks a day for women.

Alcohol misuse can have many warning signs and symptoms, and it’s not always easy to recognize if we have a drinking problem. If we’re experiencing negative consequences from our drinking and continuing to drink anyway, we may need to reconsider our relationship with alcohol. Luckily, there are many tools and resources out there to help us get a full picture of our drinking habits. 

This is where the CAGE Assessment comes in. We included the assessment above, but it’s also available for free all over the internet. So how does the quiz work, and what do the results mean? Let’s dive into how to interpret our results.

How Do I Interpret My CAGE Score?

Based on the assessment criteria, if we answer “yes” to two or more of the questions, we may have a substance dependency issue.

It’s also important to note that the assessment isn’t meant to apply to a specific time period in our lives. For example, if we complete the quiz after doing a Dry January challenge or taking a six-month break from alcohol, that doesn’t necessarily mean we don’t have a potential alcohol dependency issue. Rather, the assessment is intended to cover the range of our lives. So, when we take the quiz, we should consider all the years of our life that we’ve been drinking alcohol.

Regardless of how many questions we answer “yes” to, if we’re asking the question in the first place, it may be time to adjust our drinking habits.

Signs of Alcohol Dependency

It can be uncomfortable to confront certain truths about ourselves, but asking hard questions about ourselves is an important step in prioritizing our well-being.

Alcohol Use Disorder (AUD) is not always easy to catch — and every person’s case is different. Here are seven questions to ask ourselves if we’re concerned we may have problematic or harmful drinking behaviors:

1. Have there been times when I ended up drinking more alcohol or drinking for longer than intended?

2. Have I tried (or wanted) to reduce or stop drinking but could not?

3. Have I spent a lot of time drinking or being sick from the aftereffects of drinking?

4. Have I ever wanted a drink so badly I couldn't think of anything else?

5. Has drinking — or being sick from drinking — frequently interfered with work, family, or school duties?

6. Have I continued to drink alcohol even though it was causing trouble with my family or friends?

7. Have I given up or cut back on activities that were important, interesting, or pleasurable in order to drink?

8. Am I still drinking despite being diagnosed with drinking-related health issues?

If we answered “yes” to any of these questions, then it may be time for us to rethink our drinking habits. Thankfully, there are many options for help.

Think You May Need Help?

If you think you might need help with alcohol misuse, you are not alone! Reach out to a support group (such as Alcoholics Anonymous), a therapist, a trusted friend or family member, a physician, or a supportive online community like the Reframe forum. A healthy, sober life awaits!

Healthy Alternatives To Drinking Alcohol

Speaking of a healthy sober life, luckily there are many ways we can still enjoy our social and personal life without alcohol and its negative effects!

Here are a few healthy alternatives to drinking alcohol: 

• Opt for a mocktail. We love mocktails here at Reframe. They give us the feeling of drinking a cocktail without the negative effects! Check out these healthy (and fun!) mocktail recipes or try ordering a mocktail at a bar — best of all, mocktails are often free (or very cheap!). 
• Try non-alcoholic wine or beer. You may be scrunching up your nose at the idea of non-alcoholic beer or wine, but if you’re really craving the flavor, give one of these a try. With the rise of the sober-curious movement, N/A beers are increasingly common and fancy. Many craft breweries have N/A options, and there are even entire breweries dedicated to making a variety of craft N/A beer styles. There’s no harm in trying! You may end up really enjoying the flavor without the results (or price tag) of alcoholic beer.
• Juice it up. Juices and smoothies are a healthy alternative to drinking and also can be made with heart-healthy ingredients like fruits, veggies, nuts, and seeds. On top of that, they’re easy to make — delicious! Consider a detox drink packed with nutrients like Vitamin C, B, and antioxidants (think blueberries), or inflammation-busting ingredients like citrus or turmeric.

We’re also all about finding fun ways to spend the weekends without booze! Don’t believe us? Check out these creative ideas to have fun while staying sober.

Summing Up

If we’re looking at quizzes like the CAGE Assessment or waiting for someone or something to “tell us” we have a drinking problem, chances are we know deep down that our relationship with alcohol may be unhealthy. There is no one single “answer” to what makes drinking problematic — the answer depends on many individual differences. The bottom line is that all of us can benefit from examining which of our habits enhance our well-being or take away from it — including how alcohol shows up in our life. If you’re ready to change your relationship with alcohol, Reframe is here and ready to be your champion the whole way!