Does your family member suffer from addiction?

Do you ever use alone?

Yes

No

Have you ever substituted one drug for another, thinking that one particular drug was the problem?

Yes

No

Have you ever manipulated or lied to a doctor to obtain prescription drugs?

Yes

No

Have you ever stolen drugs or stolen to obtain drugs?

Yes

No

Do you regularly use a drug when you wake up or when you go to bed?

Yes

No

Have you ever taken one drug to overcome the effects of another?

Yes

No

Do you avoid people or places that do not approve of you using drugs?

Yes

No

Has your job or school performance ever suffered from the effects of your drug use?

Yes

No

Have you ever lied about what or how much you use?

Yes

No

Do you put the purchase of drugs ahead of your financial responsibilities?

Yes

No

Does using interfere with your sleeping or eating?

Yes

No

Is your drug use making life at home unhappy?

Yes

No