CAGE-AID Questionnaire for Substance Abuse

CAGE-AID for Substance Abuse

The CAGE-AID is a screening tool for substance abuse, adapted from the original CAGE screening for alcoholism. It consists of 4 questions and has been deemed as more sensitive but less specific for substance abuse than the CAGE.

The CAGE-AID is addressed to general adult population and can be safely employed for screening patients with suspected alcohol and drug disorders in primary care settings.

The four self-report questions can be remembered by the acronym CAGE that comes from the keywords: “cut down”, “annoyed”, “guilty” and “eye-opener”:

• Have you ever felt that you ought to Cut down on your drinking or drug use?
• Have people Annoyed you by criticizing your drinking or drug use?
• Have you ever felt bad or Guilty about your drinking or drug use?
• Have you ever had a drink or used drugs first thing in the morning to steady your nerves or to get rid of a hangover (Eye opener)?

The normal cut-off for the original CAGE is two positive answers, however, the consensus on the CAGE-AID was that a cut-off of just 1 positive answer is more appropriate, in order to identify more patients suffering from varying degrees of substance abuse disorder.

The screening method has the following psychometric properties:

In order to avoid denial attitudes regarding how much or how frequent substance use is, the questionnaire focuses on behavioral effects of the substance use (drink and drug), in order to increase chances of drawing out honest responses.

Similar to the original questionnaire, CAGE-AID is limited for not distinguishing between active and inactive problems and its lack of validation for identifying harmful substance use.

Please note this is merely a screening method, not a diagnosis tool and should only be used at the initial stages of evaluating the patient’s substance use.

References

Original reference

Brown RL, Rounds LA. Conjoint screening questionnaires for alcohol and other drug abuse: criterion validity in a primary care practice. Wis Med J. 1995; 94(3):135-140.

Other references

Hinkin CH, Castellon SA, Dickson-Fuhrman E, Daum G, Jaffe J, Jarvik L. Screening for drug and alcohol abuse among older adults using a modified version of the CAGE. Am J Addict. 2001; 10(4):319-326.

Basu D, Ghosh A, Hazari N, Parakh P. Use of Family CAGE-AID questionnaire to screen the family members for diagnosis of substance dependence. Indian J Med Res. 2016; 143(6):722-730.

Couwenbergh C, Van Der Gaag RJ, Koeter M, De Ruiter C, Van den Brink W. Screening for substance abuse among adolescents validity of the CAGE-AID in youth mental health care. Subst Use Misuse. 2009; 44(6):823-834.