Has the
frequency of using drugs increased over the past year?
Yes
No
Do you have to
take larger amounts of a drug, than a year ago to
achieve a desired effect ?
Yes
No
Has your drug
taking caused problems in your family or place of work
?
Yes
No
Do other non
drug users tell you that your drug taking is a
problem?
Yes
No
Do you use
drugs to escape your problems in life?
Yes
No
Do you think
that stopping drugs is impossible?
Yes
No
Do you feel
you are more sociable more when you are using drugs ?
Yes
No
Have you ever
tried to stop taking drugs?
Yes
No
Have you ever
considered suicide because of your drug habit ?
Yes
No
Do you
continue to use drugs even though a partner has
promise to end the relationship?
Yes
No
Have you ever
attended a meeting of Narcotics Anonymous?
Yes
No
Do you suffer
any emotional effects after drug use like guilt,
shame, self hate or hopelessness ?
Yes
No
Have you ever
used drugs in order to relieve these feelings ?
Yes
No
