SELF ASSESSMENT: DRUGS
INSTRUCTIONS: Carefully consider each question and answer either “YES ”or ”NO”.
The use of the word “DRUG” refers to:                          
A) Non-medical usage:
1) Solvents (inhaled)
2) Cannabis (eg. hashish; pot; marijuana)
3) Cocaine (powder or crack)
4) Stimulates (eg. speed; amphetamines; crystal; crank)
5) Narcotics (heroin; smack)
6) Tranquilizers
7) Barbiturates
B) Usage of over the counter or prescribed medication in excess of directions.

Yes	NO
		Have you abuse prescription drugs?
		Have you abused more than one drug at a time?
		Have you ever used drugs other than for medical purposes?
		Can you be without drugs for more than a week?
		While under the influence of drugs, have you gotten into physical confrontations?
		Has your drug usage caused problems between you and family or close relationships?
		Are you always able to stop drug usage when you want?
		Has marital issues been caused by your drug usage?
		Have you experienced “flashbacks” or ”blackouts ”from drugs?
		Have you felt guilty or bad over your drug usage?
		Have you lost employment due to drug usage?
		Has there ever been trouble at work from your drug usage?
		Has your drug usage caused you to neglect your family obligations?
		Have you lost friendships because of drug usage?
		Have you experienced withdrawal symptoms (sickness) when you stopped using?
		Has medical problems resulted from your drug use? (Hepatitis; memory loss; bleeding; digestive; convulsions; etc)
		Have you ever resorted to illegal activities to obtain drugs?
		Has legal issues ever arise from your involvement with drugs?
		Have you ever sought help for your drug problems?
		Have you ever been in a treatment program where recovery from drugs was it’s focus?

Your Score

If Your Score Is	It means...
7 OR MORE	DEPENDENT
5 to 6	DEPENDENCY MAY BE INDICATED
1 to 4	ABUSE INDICATED / NONDEPENDENT