Have you used drugs other than those required for medical reasons?

No   Yes   

Have you abused prescription drugs?

No   Yes   

Do you abuse more than one drug at a time?

No   Yes   

Can you get through the week without using drugs (other than those required for medical reasons)?

No   Yes   

Are you always able to stop using drugs when you want to?*

No   Yes   

Have you had "blackouts" or "flashbacks" as a result of drug use?

No   Yes   

Do you ever feel bad about your drug abuse?

No   Yes   

Does your spouse (or parents) ever complain about your involvement with drugs?

No   Yes   

Has drug abuse ever created problems between you and your spouse?

No   Yes   

Have you ever lost friends because of your use of drugs?

No   Yes   

Have you ever neglected your family or missed work because of your use of drugs?

No   Yes   

Does your spouse (or parents) ever complain about your involvement with drugs?

No   Yes   

Have you ever lost a job because of drug abuse?

No   Yes   

Have you got into fights when under the influence of drugs?

No   Yes   

Have you engaged in illegal activities in order to obtain drugs?

No   Yes   

Have you ever been arrested for possession of illegal drugs?

No   Yes   

Have you ever experienced withdrawal symptoms as a result of heavy drug intake?

No   Yes   

Have you had medical problems as a result of your drug use (e.g. memory loss, hepatitis, convulsions, bleeding etc.)?

No   Yes   

Have you ever gone to anyone for help for a drug problem?

No   Yes   

Have you ever been involved in a treatment programme specifically related to drug use?

No   Yes