Drugs Abuse Questionnaire

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Drugs Addiction Questionnaire

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Demographics

I am:

Male Female

Age:

1. Have you used drugs other than those prescribed by a doctor?

Yes No

2. Have you used prescription drugs in larger amounts or more often than they were prescribed?

Yes No

3. Do you use more than one drug at a time?

Yes No

4. Can you go a week without using any drugs?

Yes No

5. Are you able to stop using drugs when you want to?

Yes No

6. Have you ever had 'blackouts' or 'flashbacks' as a result of drug use?

Yes No

7. Do you ever feel guilty about your drug use?

Yes No

8. Does your family ever complain about your drug use?

Yes No

9. Has your drug use created problems in your family?

Yes No

10. Have you lost friends because of your drug use?

Yes No

11. Have you missed family events or spent less time with your family because of drug use?

Yes No

12. Have you been in trouble at work because of drug use?

Yes No

13. Have you lost a job because of drug use?

Yes No

14. Have you gotten into fights when you are under the influence of drugs?

Yes No

15. Have you done things that are against the law in order to get drugs?

Yes No

16. Have you been arrested for possession of illegal drugs?

Yes No

17. Have you ever felt sick (had withdrawal) when you stopped taking drugs?

Yes No

18. Have you had medical problems from using drugs (hepatitis, convulsions, infections, etc.)?

Yes No

19. Have you ever tried to get help to stop using drugs?

Yes No

20. Have you been in a drug abuse treatment program?

Yes No

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