GAD-7 is a 7-question anxiety severity screener developed by Drs. Robert Spitzer, Kurt Kroenke, Janet Williams, and Bernd Löwe in 2006. Each item is scored 0–3 over a 2-week recall period. Total range 0–21. Bands: 0–4 minimal, 5–9 mild, 10–14 moderate, 15–21 severe. At cutoff ≥10 GAD-7 has 89% sensitivity and 82% specificity for generalized anxiety disorder. The US Preventive Services Task Force recommends GAD-7 for primary-care anxiety screening (B-grade, 2023). It is a screening, not a diagnosis — only a licensed clinician can diagnose anxiety disorder using DSM-5 criteria.
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Over the last 2 weeks, how often have you been bothered by the following problems?
What the GAD-7 measures and why USPSTF and SAMHSA endorse it
GAD-7 is a 7-item anxiety severity instrument developed by Drs. Robert L. Spitzer, Kurt Kroenke, Janet B. W. Williams, and Bernd Löwe and published in 2006 in Archives of Internal Medicine. Each item maps to one of the seven core anxiety symptom domains. Validation in over 2,740 primary-care patients showed sensitivity 89% and specificity 82% for generalized anxiety disorder at the cutoff score of 10 (Spitzer et al. 2006). The same study found GAD-7 also screens panic disorder (sensitivity 74%), social anxiety disorder (72%), and post-traumatic stress disorder (66%) with reasonable performance.
The US Preventive Services Task Force (June 2023) issued a B-grade recommendation for anxiety screening in adults under 65 — GAD-7 is the most-cited instrument in the recommendation. GAD-7 lives inside SAMHSA's SBIRT workflow alongside PHQ-9 (depression), AUDIT (alcohol), and DAST (drugs) as the standard anxiety screen for primary-care behavioral-health intersection.
The 7 items cover symptom domains: nervousness (Q1), uncontrollable worrying (Q2), excessive worry across topics (Q3), difficulty relaxing (Q4), restlessness (Q5), irritability (Q6), and fearful anticipation (Q7). Each is scored 0–3 on a 2-week recall ("not at all" / "several days" / "more than half the days" / "nearly every day"). Total range is 0–21. Unlike PHQ-9, GAD-7 does not include a suicidal-ideation item — anxiety severity does not correlate as directly with self-harm risk, though severe anxiety with co-occurring depression elevates risk.
GAD-7 is © Pfizer Inc. and free to reproduce in any format with no permission needed per phqscreeners.com, the same author group as PHQ-9. It appears in the NIMH Mental Health Outcomes set, USPSTF evidence reviews, the Kaiser Permanente Mental Health Integration model, and most major US EHR systems for primary-care anxiety screening.
What the 4 score bands mean
GAD-7 score interpretation comes directly from Spitzer et al.'s 2006 publication: 0–4 is "minimal anxiety," 5–9 is "mild," 10–14 is "moderate," and 15–21 is "severe." Each band below explains what the score reflects clinically, what guidance the GAD-7 authors attached to it, and how the band typically maps to anxiety treatment plus ASAM levels of care for co-occurring substance use disorder.
A GAD-7 score of 0 to 4 reflects symptom levels unlikely to indicate a clinical anxiety disorder for most adults. The instrument flagged none or very few of the seven anxiety symptom domains as bothering you most days over the past two weeks. GAD-7 has documented sensitivity 89% and specificity 82% for generalized anxiety disorder at cutoff 10, so a low score is a meaningful negative signal — but GAD-7 is a screener, not a diagnosis. Brief situational anxiety after a stressor, single-symptom worry, and concerns specific to phobia rather than generalized anxiety can still warrant a clinical conversation. If a specific event prompted you to take this screener, consider mentioning it at your next primary-care visit even with a 0–4 score.
A GAD-7 score of 5 to 9 indicates mild anxiety symptoms below Spitzer's clinical-action threshold of 10. At this band the standard recommendation is watchful waiting plus re-screen in 2 to 4 weeks, with attention to sleep, exercise, caffeine and stimulant intake, and any escalating life stressors. SAMHSA's primary-care SBIRT workflow typically triggers a brief educational conversation here, sometimes called "advice" rather than full brief intervention. Behavioral activation, relaxation training, and brief cognitive-behavioral techniques are evidence-based first-line approaches at this level. Re-take GAD-7 monthly while symptoms continue, and consider a clinical visit if symptoms persist beyond a month or begin affecting daily functioning.
A GAD-7 score of 10 to 14 is consistent with moderate generalized anxiety disorder by Spitzer's framework. Active treatment is indicated — not watchful waiting. First-line evidence-based options are cognitive-behavioral therapy (CBT), considered gold standard for GAD across 12+ structured sessions, OR SSRI antidepressants (sertraline, escitalopram first-line; venlafaxine SNRI also first-line), patient preference. Buspirone is an FDA-approved non-addictive anxiolytic specifically for GAD. For people with co-occurring substance use disorder, integrated dual-diagnosis treatment is recommended — addressing anxiety and substance use simultaneously, not sequentially — at ASAM Level 1.0 outpatient or Level 2.1 IOP. SAMHSA 1-800-662-4357 can route to integrated programs.
A GAD-7 score of 15 or higher indicates severe anxiety and triggers Spitzer's most urgent guidance. Best evidence supports combined CBT plus medication, often coordinated by a psychiatrist or behavioral-health team. SSRIs reach full effect over 4–6 weeks; consider augmentation with buspirone if partial response. Benzodiazepines (alprazolam, clonazepam, lorazepam) are NOT first-line for people with substance use disorder due to addiction risk — SSRIs and buspirone are preferred. Re-screen with GAD-7 every 2–4 weeks during titration. For co-occurring substance use disorder, ASAM Level 2.5 PHP or higher is typically appropriate, with anxiety treatment integrated into the SUD program. If severe anxiety is co-occurring with depression and you have any thoughts of self-harm, please call or text 988 immediately.
From a GAD-7 score to a real next step: CBT, SSRIs, buspirone, and integrated dual-diagnosis treatment
If your GAD-7 score is 10 or higher, Spitzer's guidance recommends active treatment. A GAD-7 score alone is not a treatment plan but a structured, evidence-based starting point. Here is how the instrument's recommendations translate to concrete actions in the United States today.
If you scored 10 or higher
- Talk to a primary-care clinician and bring your GAD-7 score. GAD-7 lives in primary-care SBIRT screening as the standard anxiety instrument that clinicians administer routinely; a 10+ score is a direct reason for longer conversation about treatment options including therapy and medication.
- Cognitive-behavioral therapy (CBT) is gold standard for generalized anxiety disorder — structured 12+ sessions delivering measurable symptom reduction in randomized controlled trials. Look for a therapist licensed in CBT (LCSW, LMFT, LPC, PsyD, PhD); the Anxiety & Depression Association of America (ADAA) directory lists ADAA-member CBT therapists.
- Medications work, especially in combination: SSRIs (sertraline, escitalopram) and SNRIs (venlafaxine) are first-line; buspirone is a non-addictive option specifically FDA-approved for GAD. SSRIs reach full effect over 4–6 weeks — do not stop early.
- Search SAMHSA's treatment locator by ZIP for behavioral-health providers, or browse our directory by state for integrated dual-diagnosis programs.
If you have co-occurring substance use
Anxiety disorders co-occur with substance use disorder in approximately 30 percent of cases (NESARC-III). The picture is complicated: stimulants (amphetamines, cocaine) directly induce anxiety; alcohol and benzodiazepine withdrawal produce severe anxiety; cannabis use can worsen anxiety in some people. Diagnostic interview separates substance-induced anxiety from primary anxiety disorder.
- Integrated treatment is the standard. Single program addressing both anxiety and SUD outperforms sequential treatment in outcomes (lower relapse, lower anxiety severity, lower drop-out). Ask explicitly about "dual-diagnosis" or "co-occurring disorders" capability when calling treatment centers.
- Avoid benzodiazepines if possible. Alprazolam, clonazepam, and lorazepam carry significant addiction risk. SSRIs, SNRIs, and buspirone are preferred for SUD-context anxiety. A clinician familiar with addiction medicine should make any benzo decision; if used, time-limited and supervised.
- Therapy stacks well. CBT for both anxiety and SUD; motivational interviewing for SUD ambivalence; mindfulness-based stress reduction (MBSR) for anxiety. A single therapist trained in both is ideal.
- Watch caffeine and stimulants. High caffeine intake (5+ coffees/day) commonly worsens anxiety; cocaine and methamphetamine directly induce GAD-like symptoms. Reducing stimulant intake often reduces GAD-7 score within 2–4 weeks.
If GAD-7 is not the right fit: PHQ-9, AUDIT-10, DAST-10, and CAGE-4
GAD-7 screens for anxiety severity over 2 weeks. If depression is your main concern (anxiety and depression co-occur in roughly 50% of cases), alcohol or drug use is a question, or you want a faster screen, the screeners below cover those distinct questions.
AUDIT-10 (Alcohol Use Disorders Identification Test)
10-question WHO-validated alcohol screener. Pair with PHQ-9 for a full alcohol-plus-depression picture — the combination is the standard primary-care SBIRT workflow.
DAST-10 (Drug Abuse Screening Test)
10-question Skinner-1982 drug-use screener (excluding alcohol and tobacco). Pair with PHQ-9 if substance use other than alcohol is a concern.
PHQ-9 (Patient Health Questionnaire-9)
9-question Kroenke-2001 depression severity screener. Depression co-occurs with substance use disorder in 30–40% of cases — integrated treatment is best evidence.
CAGE-4
4-question alcohol screener (Ewing JAMA 1984). Faster than AUDIT-10 but less sensitive. Public-domain. Cutoff ≥2 has 71% sensitivity / 90% specificity for AUD.
PHQ-2
2-item subset of PHQ-9 (anhedonia + depressed mood). Faster pre-screen used in primary care before triggering full PHQ-9.
ACE (Adverse Childhood Experiences)
10-question retrospective measure of childhood adversity (Felitti / CDC 1998). Public-domain. ACE ≥4 increases adult substance use disorder risk by 7×. Trauma-informed counterpart to current-symptom screeners.
PCL-5 (PTSD Checklist for DSM-5)
20-question current-symptom screener developed by VA National Center for PTSD (Weathers 2013). Public-domain. DSM-5-aligned with 4 cluster sub-scores. Pairs with ACE (past exposure + current symptoms = standard trauma workup). Cutoff ≥31 for probable PTSD.
WHO ASSIST
Longer 8-item WHO instrument covering alcohol, tobacco, cannabis, cocaine, stimulants, inhalants, sedatives, hallucinogens, opioids. For one-shot multi-substance screening. WHO ASSIST manual.
GAD-7 terms: CBT, SSRI, buspirone, DSM-5, SBIRT, integrated treatment
Six terms appear repeatedly across this page — the instrument itself (GAD-7), the gold-standard psychotherapy for anxiety (CBT), the most-prescribed first-line medications (SSRIs and buspirone), the diagnostic standard a clinician uses after the screen (DSM-5 GAD), the public-health workflow GAD-7 fits inside (SBIRT), and the evidence-based approach to anxiety-plus-SUD (integrated treatment). Plain definitions follow.
- GAD-7
- Generalized Anxiety Disorder 7-item screener. Developed by Drs. Robert L. Spitzer, Kurt Kroenke, Janet B. W. Williams, and Bernd Löwe and published in 2006 in Archives of Internal Medicine. Scores 0–21 across 4 severity bands. © Pfizer Inc., free to reproduce with no permission needed (same author group as PHQ-9).
- CBT · Cognitive-behavioral therapy
- Gold-standard psychotherapy for generalized anxiety disorder. Structured 12+ sessions delivering symptom reduction in randomized controlled trials. Combines cognitive restructuring (challenging anxious thought patterns) with behavioral techniques (exposure, relaxation training, problem-solving). Available in person, telehealth, and self-guided digital formats.
- SSRI · Selective serotonin reuptake inhibitor
- First-line antidepressant medication class also FDA-approved for anxiety disorders — sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil), fluoxetine (Prozac), citalopram (Celexa). Reach full clinical effect over 4–6 weeks. SNRIs (venlafaxine, duloxetine) are also first-line. Buspirone is a separate non-addictive anxiolytic specifically FDA-approved for GAD — useful when SUD context rules out benzodiazepines.
- DSM-5 generalized anxiety disorder
- Clinical criteria from the American Psychiatric Association: excessive anxiety and worry across most days for ≥6 months, difficulty controlling worry, plus ≥3 symptoms (restlessness, fatigue, concentration difficulty, irritability, muscle tension, sleep disturbance), causing functional impairment. GAD-7 items map to the symptom criteria. PHQ-9 screens depression; GAD-7 screens anxiety; both inform but do not establish DSM-5 diagnosis.
- SBIRT
- Screening, Brief Intervention, and Referral to Treatment — SAMHSA public-health workflow. GAD-7 + PHQ-9 + AUDIT-10 + DAST-10 are the standard SBIRT screening tools for primary-care behavioral-health intersection. Brief intervention is a 5–15 minute structured conversation triggered at moderate-band scores.
- Integrated treatment
- Best-evidence approach for anxiety plus co-occurring substance use disorder — addressing both diagnoses simultaneously in a single program rather than sequentially or in separate facilities. NIDA and SAMHSA recommend integrated dual-diagnosis programs over referring anxiety treatment out. Outcomes: lower relapse, lower anxiety severity, lower drop-out.
GAD-7 FAQ: anonymity, scoring, treatment, alternatives, co-occurring SUD
Ten common questions about GAD-7 — whether the quiz is truly anonymous, what specific scores mean clinically, how GAD-7 differs from DSM-5 generalized anxiety disorder diagnosis, when to use a different screener (PHQ-9 for depression, AUDIT-10 for alcohol, DAST-10 for drugs), and how anxiety intersects with substance use disorder including the special problem of benzodiazepines in SUD context.
Is this GAD-7 quiz anonymous?
Yes. Answers and scores are computed entirely in your browser. Nothing is sent to our servers. No email required. No account. No tracking of individual responses.
Is the GAD-7 a diagnosis?
No. GAD-7 is a screening tool, not a diagnosis. A score of 10 or higher indicates symptoms worth discussing with a clinician. Only a licensed healthcare professional can diagnose generalized anxiety disorder using DSM-5 criteria and a full clinical interview.
Who developed the GAD-7?
Drs. Robert L. Spitzer (Columbia, lead architect of DSM-III/IV), Kurt Kroenke (Indiana University / Regenstrief Institute), Janet B. W. Williams (Columbia), and Bernd Löwe developed GAD-7 as part of the PRIME-MD diagnostic suite. The original validation paper appeared in Archives of Internal Medicine 2006. Same author group as PHQ-9.
What does a GAD-7 score of 10 or higher mean?
A score of 10–14 is moderate, 15–21 is severe. At cutoff 10 GAD-7 has 89% sensitivity and 82% specificity for generalized anxiety disorder. Talk with a clinician about treatment options including CBT and medication. SAMHSA at 1-800-662-4357 can route to local clinicians. Call or text 988 if in crisis or 911 if in immediate danger.
How is GAD-7 different from PHQ-9?
GAD-7 measures anxiety severity (7 items, 0–21 score). PHQ-9 measures depression severity (9 items, 0–27 score). Both share the same author group and Likert scale. Anxiety and depression co-occur in roughly 50% of cases — primary-care clinicians often administer both together. GAD-7 also screens panic disorder (sensitivity 74%), social anxiety disorder (72%), and PTSD (66%) with reasonable performance.
Can this quiz replace a clinical evaluation?
No. A clinician will use GAD-7 results alongside a full clinical interview, medical history, and DSM-5 criteria. This screener is a useful starting point, not a substitute.
Is my data saved anywhere?
No. The quiz uses client-side JavaScript only. Questions and answers never leave the page. You can take a screenshot or print the page to share with a clinician, but nothing is stored on our servers.
How does anxiety connect to substance use?
Anxiety disorders co-occur with substance use disorder in approximately 30 percent of cases (NESARC-III). The picture is complicated: stimulants directly induce anxiety, alcohol and benzodiazepine withdrawal produce severe anxiety, and cannabis use can worsen anxiety in some people. Substance-induced anxiety vs primary anxiety disorder is separated by clinical interview. NIDA's research on comorbidity documents the evidence base. Call SAMHSA 1-800-662-4357 for integrated dual-diagnosis program referrals.
Are benzodiazepines a good treatment for anxiety with substance use disorder?
Generally no. Benzodiazepines (alprazolam, clonazepam, lorazepam, diazepam) carry significant addiction risk and are not first-line for people with substance use disorder. Best evidence supports cognitive-behavioral therapy (CBT) plus SSRIs (sertraline, escitalopram) or buspirone — non-addictive options. A clinician familiar with addiction medicine should make any benzo decision; if used, time-limited and supervised in a structured treatment setting.
Is this the same GAD-7 my primary-care doctor might use?
Yes, exactly the same 7 items with the same scoring. GAD-7 lives inside the USPSTF 2023 anxiety-screening recommendation, the SAMHSA SBIRT toolkit, the Kaiser Permanente Mental Health Integration model, and most major US EHR systems. It is the most-used anxiety screen in US primary care alongside PHQ-9 for depression.
GAD-7 primary sources: Spitzer 2006, USPSTF, SAMHSA, NIMH, NIDA, ADAA, Pfizer
Every fact and threshold on this page traces to one of the 10 sources below: Spitzer et al.'s 2006 publication in Archives of Internal Medicine, the USPSTF 2023 anxiety-screening recommendation, the SAMHSA helpline and SBIRT workflow, the NIMH anxiety reference, NIDA's research on comorbidity, the Anxiety & Depression Association of America directory, and Pfizer's phqscreeners.com.
- Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092-1097.
- USPSTF (2023). Anxiety Disorders in Adults: Screening — B-grade recommendation.
- 988 Suicide & Crisis Lifeline.
- SAMHSA National Helpline (1-800-662-4357).
- SAMHSA — Screening, Brief Intervention, and Referral to Treatment (SBIRT).
- NIMH — Anxiety Disorders (plain-language reference).
- NIDA — Comorbidity: Substance Use Disorders and Other Mental Illnesses.
- Anxiety & Depression Association of America (ADAA) therapist directory.
- Pfizer / phqscreeners.com — GAD-7 instrument library and reproduction permission.
- ASAM National Practice Guideline.
reviewedBy schema appears in the structured data, and this notice stays visible. We do not provide medical advice and we do not replace evaluation by a licensed clinician. Medical emergency: 911. Crisis: call or text 988. Free, confidential substance-use guidance 24/7: SAMHSA 1-800-662-4357. Behavioral-health and substance-use treatment records are protected under 42 CFR Part 2 and HIPAA.
