CAGE-AID: CAGE Adapted to Include Drugs
The CAGE-AID (CAGE Adapted to Include Drugs) is a 4-item yes/no questionnaire that screens for alcohol and drug use disorders by extending the CAGE questions to all substances. A score of 2 or more is a positive screen requiring further evaluation.
For professional reference, research, and education only. Not for diagnosis or medical advice.
CAGE-AID Score Interpreter
Enter a total score to see its range.
4 yes/no items scored 0 (No) or 1 (Yes); total ranges from 0–4. Higher scores indicate greater likelihood of a substance use disorder.
Total score Interpretation 2+ Positive screenScore ≥2 warrants further clinical evaluation for a substance use disorder. This is a screen, not a diagnosis. 0–1 Negative screenScore of 0–1 suggests lower likelihood of a substance use disorder; clinical context should still guide decision-making. Brown RL, Rounds LA. Wis Med J. 1995;94(3):135-140. Positive screen threshold (≥2) per original criterion validity study.
The CAGE-AID (CAGE Adapted to Include Drugs) is a brief 4-item screening questionnaire that extends the original CAGE alcohol screener to drug use. It was developed and first validated in a primary care family practice [1].
What does the CAGE-AID measure?
The CAGE-AID asks the four CAGE questions (cutting down, annoyance at criticism, guilt, and an eye-opener) about drinking or drug use together, so a single screen covers alcohol and other drugs [1].
It is useful when a clinician suspects use of more than one substance, or when the original CAGE (alcohol only) may miss drug-related problems.
- Alcohol only. The AUDIT or CAGE are built for alcohol, and the AUDIT separates hazardous from harmful drinking.
- Adolescents. The CRAFFT was developed specifically for that age group.
How do you give the CAGE-AID?
The CAGE-AID can be self-completed by clients during intake or asked as part of a structured clinical interview. Later studies have examined self-report and parent-report versions in adolescents [2].
For clinical use and educational reference only. A positive screen does not constitute a clinical evaluation. Clinical judgment is required.
How do you score and interpret the CAGE-AID?
Each of the 4 items is answered Yes (1) or No (0), giving a total score from 0 to 4.
- 2 or higher: a positive screen; further clinical evaluation for a substance use disorder is warranted.
- 0 or 1: a negative screen.
A positive screen is not a diagnosis; clinical judgment is required before drawing any conclusions.
Psychometric properties
- Original validation. In 124 adults attending a community family practice, compared with DSM-III-R diagnoses from a structured diagnostic interview, the CAGE-AID was more sensitive but less specific for substance abuse than the CAGE, especially when a reduced criterion score was used. It was more sensitive than the CAGE across sex, income, education level and most patterns of substance use disorder [1].
- Adolescents in mental health care. In 190 Dutch treatment-seeking adolescents aged 12–18 and their parents, both self-report and parent-report versions showed excellent diagnostic accuracy for substance use disorders against DSM-IV clinical diagnoses [2].
- Northern Plains American Indians. In 50 adults with diabetes, reliability coefficients were above .90, with moderate correlations supporting concurrent and divergent validity [3].
Limitations
- Screening, not diagnosis. A positive screen signals elevated risk and should be followed by a comprehensive assessment.
- Lower specificity than the CAGE. Broadening the questions to drugs increases sensitivity at some cost to specificity [1].
- Denial. Self-report screening depends on candour; denial may affect both the CAGE-AID and clinical interviews [2].
- Small validation samples. The evidence base comes from modest samples, and more research is needed in other settings. For adolescents, the CRAFFT is more specifically developed for that age group.
CAGE vs CAGE-AID
The only difference is the scope: the CAGE-AID adds drugs to each question.
- Use the CAGE when you specifically need an alcohol use disorder screen and suspect no other substance involvement.
- Use the CAGE-AID when you need a combined alcohol and drug screen.
- Use the AUDIT when you need alcohol consumption detail, the hazardous vs harmful drinking distinction, or World Health Organization scoring.
For individuals: This page is a clinical reference, not a diagnostic tool. If you have concerns about your own symptoms, bring this information to a qualified mental health professional.
Billing
In the US, the CAGE-AID: CAGE Adapted to Include Drugs is usually billed under these CPT codes. Payer rules vary.
References
- 1.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.View source
- 2.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.View source
- 3.Leonardson GR, Kemper E, Ness FK, Koplin BA, Daniels MC, Leonardson GA. Validity and reliability of the AUDIT and CAGE-AID in Northern Plains American Indians. Psychol Rep. 2005;97(1):161-166.View source
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Related
Assessments
Common paths
- Cognitive Behavioural Therapy
CBT reduced alcohol and drug use more than minimal or non-specific treatment in a meta-analysis of 30 RCTs, and matched other specific therapies.
Magill M, et al. J Consult Clin Psychol. 2019;87(12):1093–105. - Motivational Interviewing
MI reduced substance use versus no intervention at short-term follow-up but differed little from usual care in a Cochrane review of 93 studies.
Schwenker R, et al. Cochrane Database Syst Rev. 2023;12(12):CD008063.
- Cognitive Behavioural Therapy
FAQ
How is the CAGE-AID scored?
Each of the 4 items is answered Yes (1) or No (0), giving a total score from 0 to 4. A score of 2 or higher is considered a positive screen and indicates that further clinical evaluation for a substance use disorder is warranted. Scores of 0 or 1 are considered a negative screen.
What does a positive CAGE-AID score mean?
A score of ≥2 is a positive screen, not a diagnosis. It signals that the client is at elevated risk for an alcohol or drug use disorder and should receive a more comprehensive assessment. Clinical judgment is required before drawing any conclusions.
Is the CAGE-AID self-report or clinician-administered?
The CAGE-AID can be administered in either format. It is short enough to be self-completed by clients during intake or asked as part of a structured clinical interview. Later studies have also examined self-report and parent-report versions in adolescents.
Can the CAGE-AID be used with adolescents?
Research has examined its use with adolescents, including a 2009 validation study that found excellent diagnostic accuracy in youth mental health care. However, for adolescent populations, screeners such as the CRAFFT are more specifically developed and widely recommended for that age group.
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