A 50-year-old male presents for an annual wellness visit. The NP screens with the CAGE questionnaire. He answers "yes" to feeling he should cut down on his drinking and to feeling guilty about his drinking. He answers "no" to feeling annoyed by others' criticism and to having an eye-opener drink in the morning. What is the correct interpretation of this CAGE result?

Question

Accepted Answer

✅ D. Positive screen
2 yes answers meets the threshold for probable alcohol use disorder
The CAGE cutoff is ≥2 yes answers. Two positives is approximately 93% sensitive for alcohol use disorder in primary care. This patient requires further assessment — AUDIT-C for quantity/frequency, a focused history to differentiate current from past use, and a brief intervention or referral as appropriate.

❌ A. Negative screen — the patient denied morning drinking (eye-opener), which is the most diagnostic question
All four CAGE questions carry equal weight. There is no weighted scoring — a yes to any 2 of the 4 is positive. The "eye-opener" is not more heavily weighted than the others.

❌ B. Equivocal
3 yes answers are required to confirm alcohol use disorder
The validated cutoff is ≥2, not 3. A 3-cutoff would miss many patients with true AUD. CAGE is a screen, not a diagnostic confirmation — so DSM-5 criteria still need to be applied after a positive screen.

❌ C. Negative screen
CAGE requires all 4 questions to be positive to be considered positive
Requiring all 4 positives would render CAGE nearly useless as a screen (too specific, too insensitive). The tool is designed as a brief, sensitive primary-care screener with the ≥2 threshold.

:::important
CAGE cutoff = ≥2 yes answers = positive screen. It does NOT diagnose AUD — follow up with AUDIT-C for quantity and DSM-5 criteria for diagnosis.
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CAGE

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