Drug Use Screening
Are you worried about your or a loved one's drug use? If so, your
concern could indicate substance abuse. Please complete the short screening
below to assess further.
1. Have you or a loved one used drugs other than those
required for medical reasons?
Yes No
2. Have you or a loved one
abused prescription drugs?
Yes No
3. Do you or a loved one abuse
more than one drug at a time?
Yes No
4. Can you or a loved one
get through the week without using drugs (other than those required for medical
reasons)?
Yes No
5. Are you or a loved one always able to stop
using drugs when you/they want to?
Yes No
6. Do you or a loved
one abuse drugs on a continuous basis?
Yes No
7. Do you or a
loved one try to limit the drug use to certain situations?
Yes No
8. Have you or a loved one had "blackouts" or "flashbacks" as a result
of drug use?
Yes No
9. Do you or a loved one ever feel bad about
the drug abuse?
Yes No
10. Does your or a loved one's spouse (or
parents) ever complain about your involvement with drugs?
Yes No
11. Do your or a loved one's friends or relatives know or suspect you/they abuse
drugs?
Yes No
12. Has drug abuse ever created problems between
you and your spouse?
Yes No
13. Has any family member ever sought
help for problems related to your drug use?
Yes No
14. Have you
ever lost friends because of your use of drugs?
Yes No
15. Have
you ever neglected your family or missed work because of your use of drugs?
Yes No
16. Have you ever been in trouble at work because of drug
abuse?
Yes No
17. Have you ever lost a job because of drug abuse?
Yes No
18. Have you gotten into fights when under the influence
of drugs?
Yes No
19. Have you ever been arrested because of
unusual behavior while under the influence of drugs?
Yes No
20. Have you ever been arrested for driving while under the influence of drugs?
Yes No
21. Have you engaged in illegal activities to obtain drugs?
Yes No
22. Have you ever been arrested for possession of illegal
drugs?
Yes No
23. Have you ever experienced withdrawal symptoms
as a result of heavy drug intake?
Yes No
24. Have you had medical
problems as a result of your drug use (e.g., memory loss, hepatitis,
convulsions, or bleeding)?
Yes No
25. Have you ever gone to
anyone for help for a drug problem?
Yes No
26. Have you ever been
in hospital for medical problems related to your drug use?
Yes No
27. Have you ever been involved in a treatment program specifically
related to drug use?
Yes No
28. Have you been treated as an
outpatient for problems related to drug abuse?
Yes No
Total points:
Each "yes"
equals 1 point. If the points add up to 3 or more, this is cause for possible
concern and requires further professional evaluation. If 6 or more, this
indicates harmful drug use that requires immediate professional attention. Drug
abuse leads to health and family problems, loss of control, jobs, and
relationships, and often progresses to serious injury and/or other personal
crisis.
Farnham Family Services has helped many recover
from addiction and substance abuse. Contact us today to learn how we can help you.
Make an Appointment