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Alcohol and Drug Abuse
Assessment
|
||
|
CAGE-AID Questionnaire
|
Yes
|
No
|
|
Cut down: Have you ever felt that
you should cut down on your drinking or use of drugs?
|
1
|
0
|
|
Annoyed: Have you ever felt annoyed by being criticized about your drinking or use of drugs?
|
1
|
0
|
|
Guilty: Have you ever felt guilty about drinking or using drugs?
|
1
|
0
|
|
Eye opener: Have you
ever needed an eye opener (alcohol or drugs) after waking up to get rid of a hangover or calm your nerves?
|
1
|
0
|
|
Note: A total score of 2 or
greater is considered clinically significant and indicates a high likelihood
for alcoholism.
|
|
Total
|
|
RAFFT Questionnaire
|
Yes
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No
|
|
Relaxation: Do you ever
use drugs or drink alcohol in
order to relax or improve your self-esteem?
|
1
|
0
|
|
Alone: Do you ever use drugs or
drink alcohol while you
are alone?
|
1
|
0
|
|
Friends: Do you have any friends
who use drugs or have
a problem with alcohol?
|
1
|
0
|
|
Family: Does any of your close
family use drugs or have
a problem with alcohol?
|
1
|
0
|
|
Trouble: Have you ever gotten
into trouble because of
alcohol or drugs?
|
1
|
0
|
|
Note: Any positive answer
warrants further investigation
|
|
Total
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7/15/14
Alcohol and Drug Abuse Assessment
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