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The following 10 questions concern information about your possible involvement with drugs not including alcoholic beverages during the past 12 months.
“Drug abuse” refers to (1) the use of prescribed or over‐the‐counter drugs in excess of the directions, and (2) any non-medical use of drugs.
The various classes of drugs may include cannabis (marijuana, hashish), solvents (e.g., paint thinner), tranquilizers (e.g., Valium), barbiturates, cocaine, stimulants (e.g., speed), hallucinogens (e.g., LSD) or narcotics (e.g., heroin). Remember that the questions do not include alcoholic beverages.
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Interpretation of Score
Score Degree of Problems Related to Drug Abuse Suggested Action 0 No problems reported None at this time 1‐2 Low level Monitor, re‐assess at a later date 3‐5 Moderate level Further investigation 6‐8 Substantial level Intensive assessment 9‐10 Severe level Intensive assessment
Question 1 of 10
Have you used drugs other than those required for medical reasons?
Question 2 of 10
Do you abuse more than one drug at a time?
Question 3 of 10
Are you able to stop abusing drugs when you want to?
Question 4 of 10
Have you ever had blackouts or flashbacks as a result of drug use?
Question 5 of 10
Do you ever feel bad or guilty about your drug use?
Question 6 of 10
Does your spouse (or parent) ever complain about your involvement with drugs?
Question 7 of 10
Have you neglected your family because of your drug use?
Question 8 of 10
Have you engaged in illegal activities in order to obtain drugs?
Question 9 of 10
Have you ever experienced withdrawal symptoms (felt sick) when you stopped taking drugs?
Question 10 of 10
Have you had medical problems as a result of your drug use (e.g. memory loss, hepatitis, convulsions, bleeding, etc.)?