Question 1(of 10)

Have you used drugs other than those required for medical reasons?

Question 2(of 10)

Do you use more than one drug at a time?

Question 3(of 10)

Are you always able to stop using drugs when you want to?

Question 4(of 10)

Have you had “blackouts” or “flashbacks” as a result of drug use?

Question 5(of 10)

Do you ever feel bad or guilty about your drug use?

Question 6(of 10)

Does your spouse (or parent) ever complain about your involvement with drugs?

Question 7(of 10)

Have you neglected your family because of your use of drugs?

Question 8(of 10)

Have you engaged in illegal activities in order to obtain drugs?

Question 9(of 10)

Have you ever experienced withdrawal symptoms (felt sick) when you stopped taking drugs?

Question 10(of 10)

Have you had medical problems as a result of your drug use (e.g., memory loss, hepatitis, convulsions, bleeding etc...)?