Please answer the questions below, rating yourself on each of the criteria shown using the scale on the right side of the page. As you answer each question, place an X in the box that best describes how you have felt and conducted yourself over the past 6 months. Please give this completed checklist to your healthcare professional to discuss during your appointment.

The CAGE Questionnaire Adapted to Include Drugs (CAGE-AID)

2/4 or greater = positive CAGE, further evaluation is indicated