Central Connections – CAGE-AID Questions

Please complete this on your own.

Choose Yes, or No for each of the following questions.

*
1. Have you ever felt you ought to cut down on your drinking or drug use?
- Yes
- No
*
2. Have people annoyed you by criticizing your drinking or drug use?
- Yes
- No
*
3. Have you felt bad or guilty about your drinking or drug use?
- Yes
- No
*
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 (eye-opener)?
- Yes
- No
Name*
First Last
County of Residence*
Participant ID*
Signature*
Date*
Date Format: MM slash DD slash YYYY