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.
CAGE-AID Score Interpreter
Score ≥2 warrants further clinical evaluation for a substance use disorder. This is a screen, not a diagnosis.
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. Educational reference only — not a diagnostic tool.
For reference only — not an assessment, diagnosis, or medical advice. This page provides scoring reference material; interpretation and clinical decisions rest with a qualified clinician.
What the CAGE-AID measures
The CAGE-AID (CAGE Adapted to Include Drugs) is a brief 4-item screening questionnaire that extends the original CAGE alcohol screener to cover all substance use, including illicit drugs and misused prescription medications. It was developed by Brown and Rounds in 1995 and is widely used in primary care, addiction medicine, and emergency settings.
Like the original CAGE, each item is answered Yes (1) or No (0). A score of 2 or higher is a positive screen for a possible substance use disorder and warrants a more full evaluation. The CAGE-AID takes less than 2 minutes to administer and requires no special training.
The CAGE-AID is particularly useful when a clinician suspects poly-substance use or when the original CAGE (alcohol only) may miss drug-related problems. For alcohol-specific screening, AUDIT or CAGE are more sensitive. For adolescent populations, the CRAFFT is preferred.
How to administer the CAGE-AID
The CAGE-AID can be administered in either format. It is short enough to be self-completed by patients during intake or used as part of a structured clinical interview. The original validation by Brown and Rounds (1995) used a clinician-administered format, while subsequent studies have examined both, including self-report and parent-report versions in adolescents (Couwenbergh et al., 2009).
For clinical use and educational reference only. A positive screen does not constitute a clinical evaluation. Clinical judgment is required.
CAGE-AID scoring and interpretation
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. A positive screen is not a diagnosis; clinical judgment is required before drawing any conclusions.
Psychometric properties
- Original validation. In 124 patients of 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 (Brown & Rounds, 1995).
- 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 (Couwenbergh et al., 2009).
- Northern Plains American Indians. In 50 adults with diabetes, reliability coefficients were above .90, with moderate correlations supporting concurrent and divergent validity (Leonardson et al., 2005).
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 (Brown & Rounds, 1995).
- Denial. Self-report screening depends on candour; denial may affect both the CAGE-AID and clinical interviews (Couwenbergh et al., 2009).
- 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, CAGE-AID adds drugs to each question.
You specifically need an alcohol use disorder screen and suspect no other substance involvement.
You need a combined alcohol and drug screen, the most efficient option for general substance use screening.
You need granular alcohol consumption data, hazardous vs harmful drinking distinction, or World Health Organization-standardized scoring.
Substance Use Screening in HiBoop
HiBoop does not offer the CAGE-AID; this page is reference material. For substance use, HiBoop offers the ASSIST, TAPS, DAST-10, and MAST, scored on submission and tracked over time.
HiBoop does not offer this scale. This page is reference material.This library is an academic and clinical reference. A scale described here is not necessarily offered in HiBoop; each page says whether it is.
Bill this assessment
In the US, the CAGE-AID: CAGE Adapted to Include Drugs is usually billed under these CPT codes. Payer rules vary.
Measurement-based care in practice
For clinicians
HiBoop does not offer this scale. For the scales it does offer, responses are scored on submission and tracked over time, and HiBoop automates delivery across your patient panel.
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.
Frequently Asked Questions
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 patient 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.
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
Last reviewed: Jun 3, 2026
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