28 QUESTIONS ABOUT DRUG USE

The following questions concern information about your involvement and abuse of drugs. Drug abuse refers to:

1. The use of prescribed or “over the counter” drugs in excess of the directions AND/OR
2. Any non-medical use of drugs.
3. The questions DO NOT include alcoholic beverages.

The questions refer to the past 12 months. Carefully read each statement and decide whether your answer is yes or no. Please give the best answer or the answer that is right most of the time.

1. Have you used drugs other than those required for medical reasons?
2. Have you abused prescription drugs?
3. Do you abuse more than one drug at a time?
4. Can you get through the week without using drugs (other than those required for medical reasons)?
5. Are you always able to stop using drugs when you want to?
6. Do you abuse drugs on a continuous basis?
7. Do you try to limit your drug use to certain situations?
8. Have you had “blackouts” or “flashbacks” as a result of drug use?
9. Do you ever feel bad about your drug abuse?
10. Does your spouse (or parents) ever complain about your involvement with drugs?
11. Do your friends or relatives know or suspect you abuse drugs?
12. Has drug abuse ever created problems between you and your spouse?
13. Has any family member ever sought help for problems related to your drug use?
14. Have you ever lost friends because of your use of drugs?
15. Have you ever neglected your family or missed work because of your use of drugs?
16. Have you ever been in trouble at work because of drug abuse?
17. Have you ever lost a job because of drug abuse?
18. Have you gotten into fights when under the influence of drugs?
19. Have you ever been arrested because of unusual behavior while under the influence of drugs?
20. Have you ever been arrested for driving while under the influence of drugs?
21. Have you engaged in illegal activities to obtain drugs?
22. Have you ever been arrested for possession of illegal drugs?
23. Have you ever experienced withdrawal symptoms as a result of heavy drug intake?
24. Have you had medical problems as a result of your drug use (e.g., memory loss, hepatitis, convulsions, or bleeding)?
25. Have you ever gone to anyone for help for a drug problem?
26. Have you ever been in hospital for medical problems related to your drug use?
27. Have you ever been involved in a treatment program specifically related to drug use?
28. Have you been treated as an outpatient for problems related to drug abuse?

1. Do you lose time from work due to your drinking?
2. Is drinking making your home life unhappy?
3. Do you drink because you are shy with other people?
4. Is drinking affecting your reputation?
5. Have you ever felt remorse after drinking?
6. Have you gotten into financial difficulties as a result of your drinking?
7. Do you turn to lower companions and an inferior environment when drinking?
8. Does your drinking make you careless of your family’s welfare?
9. Has your ambition decreased since drinking?
10. Do you crave a drink at a definite time daily?
11. Do you want a drink the next morning?
12. Does drinking cause you to have difficulty in sleeping?
13. Has your efficiency decreased since drinking?
14. Is drinking jeopardizing your job or business?
15. Do you drink to escape from worries or troubles?
16. Do you drink alone?
17. Have you ever had a complete loss of memory as a result of your drinking?
18. Has your physician ever treated you for drinking?
19. Do you drink to build up your self-confidence?
20. Have you ever been in a hospital or institution on account of drinking?

Take the Cigarette / Nicotine Addiction Test:

• stop smoking for just one day
• continue the process for 3 days
• monitor the process along the way
• look for behavior changes and withdrawal symptoms
• make a note of any behavior changes and withdrawal symptom

Here’s what happens when you stop smoking:

• your body cleanses itself of the impurity (i.e: tobacco, nicotine and other toxic substances found in cigarettes)
• cleansing may cause side effects such as withdrawal symptoms, mood swings, etc.

Fortunately, in most cases, all this, if it occurs at all, is usually mild and lasts from between 3 days to several months. Note: Side effects aren’t a serious problem for most people trying to quit.

Did you experience any of the following when trying to quit:

• mood swings
• dizziness
• fatigue
• constipation
• trouble sleeping
• headaches
• anxiety
• irritability
• tremors
• difficulty concentrating
• dry mouth
• hunger
• cravings for tobacco

If you answered “YES” to more than three of the above symptoms, you may be addicted to nicotine. You may wish to seek guidance for the best way to quit smoking.

1. Did you ever lose time from work or school due to gambling?
2. Has gambling ever made your home life unhappy?
3. Did gambling affect your reputation?
4. Have you ever felt remorse after gambling?
5. Did you ever gamble to get money with which to pay debts or otherwise solve financial difficulties?
6. Did gambling cause a decrease in your ambition or efficiency?
7. After losing did you feel you must return as soon as possible and win back your losses?
8. After a win did you have a strong urge to return and win more?
9. Did you often gamble until your last dollar was gone?
10. Did you ever borrow to finance your gambling?
11. Have you ever sold anything to finance gambling?
12. Were you reluctant to use “gambling money” for normal expenditures?
13. Did gambling make you careless of the welfare of yourself or your family?
14. Did you ever gamble longer than you had planned?
15. Have you ever gambled to escape worry or trouble?
16. Have you ever committed, or considered committing, an illegal act to finance gambling?
17. Did gambling cause you to have difficulty in sleeping?
18. Do arguments, disappointments or frustrations create within you an urge to gamble?
19. Did you ever have an urge to celebrate any good fortune by a few hours of gambling?
20. Have you ever considered self destruction or suicide as a result of your gambling?