Drug Use Screening


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.

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