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In the past 12 months..
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1. Have you used drugs other than those required for medical reasons?
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2. Do you abuse more than one drug at a time?
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3. Are you always able to stop using drugs when you want to?
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4. Have you ever had blackouts or flashbacks as a result of drug use?
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5. Do you ever feel bad or guilty about your drug use?
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6. Does your spouse (or parents) ever complain about your drug use?
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7. Have you neglected your family because of drug use?
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8. Have you engaged in illegal activities in order to obtain drugs?
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9. Have you ever experienced withdrawal symptoms (felt sick) when you stopped using drugs?
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10. Have you had medical problems as a result of your drug use (e.g. memory loss, hepatitis, convulsions, bleeding)?
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Scoring: Score 1 point for each question answered "Yes," except for questions 3 for which a "No" receives 1 point.
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Score Interpretation:
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