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Answer the following questions as
honestly as possible.
Q: Have you used drugs other than those required for
medical reasons?
Q: Have you abused prescription drugs?
Q: Do you abuse more than one drug at a time?
Q: Do you use drugs more than once a week?
Q: Have you tried stop using drugs and were not able to
do so?
Q: Have you had blackouts or flashbacks as a result of
drug use?
Q: Do you ever feel bad or guilty about your drug use?
Q: Does your spouse -or parents - ever complain about
your involvement with drugs?
Q: Has drug abuse created problems between you and your
spouse or your parents?
Q: Have you lost friends because of your use of drugs?
Q: Have you neglected your family because of your use of
drugs?
Q: Have you been in trouble at work because of your use
of drugs?
Q: Have you lost a job because of drug abuse?
Q: Have you gotten into fights when under the influence
of drugs?
Q: Have you been arrested for possession of illegal
drugs?
Q: Have you been arrested for possession of illegal
drugs?
Q: Have you ever experienced withdrawal symptoms (felt
sick) when you stopped taking drugs?
Q: Have you had medical problems as a result of your
drug use - memory loss, hepatitis, convulsions,
bleeding, etc.?
Q: Have you gone to anyone for
help for a drug problem?
Q: Have you been involved in a treatment program
especially related to drug use?
If you answered "yes" to one or more questions, you
should contact your primary care physician, or an
addiction treatment center, for a complete assessment.
This does not mean you are an addict, only that it would
be wise to get a professional assessment.
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