CAGE-AID

CAGE-AID
Patient's Name *

First Name Last Name
Date *

Month Day Year
Date
Instructions: Answer Yes or No to each of the following questions:
1. Have you ever felt you ought to cut down on your drinking or drug use? *

Yes (1) No (0)
2. Have people annoyed you by criticizing your drinking or drug use? *

Yes (1) No (0)
3. Have you ever felt bad or guilty about your drinking or drug use? *

Yes (1) No (0)
4. Have you ever had a drink or used drugs first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)? *

Yes (1) No (0)
Total Score (For the total score, add the numerical value of each answer):
A score of 2 or more may indicate clinically significant alcohol or drug problems.

Reprinted with permission from the Wisconsin Medical Journal Brown, R.L. and Rounds, LA Conjoint screening questionnaires for alcohol and drug abuse. Wisconsin Medical Journal 94:135-140, 1995.
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