Free Confidential Substance Abuse Assessment

1. Have you ever abused substances while alone?

2. Have friends and/or family members expressed concern about your substance use?

3. Has your substance use been a source of conflict in your marriage or with your boyfriend/girlfriend?

4. Have you lied to friends or family members about the amount and frequency of your substance use?

5. Have you lied to a doctor in order to obtain prescription medications?

6. Has your substance use negatively impacted your performance at work or school?

7. Have you stolen substances, or stolen money or property in order to buy substances?

8. Have you awakened after using substances with no memory about what you did while you were high?

9. Have you used substances in order to wake up in the morning and/or to go to sleep at night?

10. Have you used one substance in order to intensify the high from another substance?

11. Have you used one substance in order to recover from using another substance?

12. Have you used substances as a way of dealing with stress, pressure, and other negative experiences?

13. Have you tried and failed to reduce the amount and/or frequency of your substance use?

14. When you try to stop using, or when you can’t use, do you start to feel sluggish, sick, agitated, or depressed?

15. Do you worry that you might have a substance abuse problem?

Thank you for taking Cross Creek Hospital’s Addiction Screening.

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