Drinking More Than You’d Like? Try the Cage Test

Despite all the promising research on neurotransmitters and drugs for addiction, what can physicians and health professionals do right now to identify alcoholics and attempt to help them? For starters, physicians could look beyond liver damage to the many observable “tells” that are characteristic patterns of chronic alcoholism—like constant abdominal pain, frequent nausea and vomiting, numbness or tingling in the legs, cigarette burns between the index and middle finger, jerky eye movements, and a chronically flushed or puffy face. Such signs of acute alcoholism are not always present, of course. Many practicing alcoholics are successful in their work, physically healthy, don’t smoke, and came from happy homes.

A set of four simple questions, devised back in 1970 by Dr. John A. Ewing, founding Director of the Bowles Center for Alcohol Studies at the University of North Carolina, is still in service as a useful predictive tool for alcoholism. Despite the effort directed into the search for a better way to diagnose alcoholism, many researchers still use what is undoubtedly the simplest, most accurate test for alcoholism yet devised. The clear, informal phrasing of the questions means it can be used successfully in a variety of clinical settings.

The CAGE questionnaire (the name is an acronym derived by taking one letter from each question) can be completed in less than a minute, requires only paper and pencil, and can be graded by test takers themselves. It goes like this:

1. Have you ever felt the need to (C)ut down on your drinking?

2. Have you ever felt (A)nnoyed by someone criticizing your drinking?

3. Have you ever felt (G)uilty about your drinking?

4. Have you ever felt the need for a drink at the beginning of the day—an “(E)ye opener?

People who answer “yes” to two or more of these questions should seriously consider whether they are drinking in an alcoholic or abusive manner, according to Ewing.