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Toll Free 24 Hour Assistance 1-888-988-2288 |
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Agency for Community Treatment Services, Inc. |
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Drug Use Questionnaire Check the one response to each item that best describes how you have felt over the past 12 months. 1. Have you ever used drugs other than those required for medical treatment? 2. Have you abused prescription drugs? Yes 3. Do you abuse more than one drug at a time? Yes 4. Can you get through the week without using drugs? Yes 5. Are you always able to stop using drugs when you want to? Yes 6. Have you had "blackouts" or "flashbacks" as a result of drug use? Yes 7. Do you feel guilty of your drug use? Yes 8. Does your spouse (or parents) ever complain about your involvement with drugs? Yes 9. Has drug abuse created problems between you and your spouse or parents? Yes 10. Have you lost friends because of your use of drugs? Yes 11. Have you neglected your family because of your use of drugs? Yes 12. Have you been in trouble at work because of your use of drugs? Yes 13. Have you lost a job because of drug abuse? Yes 14. Have you gotten into fights when under the influence of drugs? Yes 15. Have you engaged in illegal activities in order to obtain drugs? Yes 16. Have you been arrested for possession of illegal drugs? Yes 17. Have you ever experienced withdrawal symptoms (felt sick) when you stopped taking drugs? Yes 18. Have you had medical problems as a result of your drug use (e.g. memory loss, hepatitis, convulsions, bleeding, etc.)? Yes 19. Have you gone to anyone for help for a drug problem? Yes 20. Have you been involved in a treatment program especially related to drug use? Yes According to the Vanderbilt University Addiction Center, the level of advisability of seeking drug treatment is based on the number of "Yes" answers you gave.
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