1. Have you used drugs other than those required for medicinal reasons?
2. Have you used prescription drugs at higher doses than recommended or needed to obtain a new prescription before the due date?
3. Do you use more than one drug at a time?
4. Can you get through the week without using drugs?
5. Are you always able to stop using drugs when you want to?
6. Have you had "blackouts" or "flashbacks" as a result of drug use?
7. Do you ever feel bad or guilty about your drug use?
8. Does your spouse (or parents) ever complain about your involvement with drugs?
9. Has drug use created problems between you and your spouse or your parents?
10. Have you lost friends because of your use of drugs?
11. Have you neglected your family because of your use of drugs?
12. Have you been in trouble at work because of drug use?
13. Have you lost a job because of drug use?
14. Have you gotten into fights when under the influence of drugs?
15. Have you engaged in illegal activities in order to obtain drugs?
16. Have you been arrested for possession of illegal drugs?
17. Have you ever experienced withdrawal symptoms (felt sick) when you stopped taking drugs?
18. Have you had medical problems as a result of your drug use (e.g. memory loss, hepatitis, convulsions, bleeding, etc.)?
19. Have you gone to anyone for help for a drug problem?
20. Have you been involved in a treatment program specifically related to drug use?
Time's up
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