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Start of Test |
YES NO
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| 1. |
Do I spend 50 Dollars or more on drugs or alcohol a Month? |
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| 2. |
Have you lost weight lately or are you under weight? |
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| 3. |
Have your daily habits changed? |
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| 4. |
Do your friends do drugs? |
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| 5. |
Are the majority of your friends mainly sober? |
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| 6. |
Do you sometimes feel depressed when you are out of drugs/alcohol? |
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| 7. |
Have you lost your job? |
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| 8. |
Do you enjoy life in general without drugs or alcohol? |
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| 9. |
Do you fly off the handle on occasion? |
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| 10. |
Have the use of drugs or alcohol adversely affected your life? |
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| 11. |
Did you spend a significant amount of time finding,
waiting or using drugs? |
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| 12. |
Can you abstain from drugs or alcohol for months/ years? |
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| 13. |
Has your habit significantly changed for the worse? |
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| 14. |
Do you want to quit but can't? |
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| 15. |
Do you feel the need to lie about your usage? |
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| 16. |
Have you been late or missed work entirely due to
drugs/alcohol? |
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| 17. |
Do you believe you don't have a drug problem? |
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| 18. |
Are the majority of your friends "user
friends"? |
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| 19. |
Do you feel helpless over drugs or alcohol? |
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| 20. |
Do you find yourself feeling depressed after a night
of usage about the money you spent? |
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| 21. |
Has the use of drugs or alcohol effected any aspect
of your life? |
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| 22. |
Do you plan your day around your drug or alcohol
habit? |
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| 23. |
Do you resent the efforts of others to tell you what to do? |
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| 24. |
Is it normally hard for you to "own up and take the
blame"? |
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| 25. |
Do you have a small circle of close friends, rather than a large
number of friends, speaking acquaintances? |
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| 26. |
Is your life a constant struggle for survival? |
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| 27. |
Do you often sing or whistle just for the fun of it? |
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| 28. |
Are you considered warm-hearted by your friends? |
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| 29. |
Do you steal for your habit
"drugs/alcohol"? |
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| 30. |
Is your life spiraling out of control? |
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| 31. |
Are you in denial? |
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| 32. |
Have you pawned your stuff or stuff that didn't
belong to you? |
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| 33. |
Do you make efforts to get others to laugh and smile? |
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| 34. |
Do you find it easy to express your emotions? |
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| 35. |
Do you wake up in the morning "ready to
go"? |
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| 36. |
Does it take drugs or alcohol to make you "
feel good" |
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| 37. |
Do you consider there are other people who are
definitely unfriendly toward you and work against you? |
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| 38. |
Did you feel compelled to lie on this test? |
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| 39. |
Do you have only a few people of whom you are really fond? |
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| 40. |
Are you rarely happy, unless you have a special reason? |
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