Drug - The Alcohol & Drug service

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

YesNo

Do you use more than one drug at a time? *

YesNo

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

YesNo

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

YesNo

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

YesNo

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

YesNo

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

YesNo

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

YesNo

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

YesNo

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

YesNo

Drug screen test