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