CAGE-AID Questionnaire

Choices Mental Health Counseling PLLC

Narrowsburg, NY 12764
CAGE-AID Questionnaire
Your Name:
Today's Date:

MonthDayYear
Date
When thinking about drug use, include illegal drug use and the use of prescription drug use other than prescribed.
Questions:
YES NO
1. Have you ever felt that you ought to cut down on your drinking or drug use?

YesNo
2. Have people annoyed you by criticizing your drinking or drug use?

YesNo
3. Have you ever felt bad or guilty about your drinking or drug use?

YesNo
4. 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?

YesNo
Permission for use granted by Richard Brown, MD.
Should be Empty: