1. How often do you use drugs other than alcohol?
Never
Monthly or less
2-4 times per month
2-3 times per week
4+ times per week
2. How many times do you take drugs on a typical day when you use drugs?
0
1-2
3-4
5-6
7+
3. How often during the past year have you found that you were not able to stop using drugs once you had started?
Never
Less than monthly
Monthly
Weekly
Daily or almost daily
4. How often during the past year have you neglected your family because of drug use?
Never
Less than monthly
Monthly
Weekly
Daily or almost daily
5. How often during the past year have you engaged in illegal activities in order to obtain drugs?
Never
Less than monthly
Monthly
Weekly
Daily or almost daily
6. How often during the past year have you had problems at work or studies because of drug use?
Never
Less than monthly
Monthly
Weekly
Daily or almost daily
7. How often during the past year have you had to use drugs in the morning to get yourself going after a heavy drug session the day before?
Never
Less than monthly
Monthly
Weekly
Daily or almost daily
8. How often during the past year have you had guilt or remorse after drug use?
Never
Less than monthly
Monthly
Weekly
Daily or almost daily
9. Have you or someone else been injured as a result of your drug use?
No
Yes, but not in the past year
Yes, during the past year
10. Has a relative, friend, doctor, or other health worker been concerned about your drug use or suggested you cut down?
No
Yes, but not in the past year
Yes, during the past year
11. Have you ever tried to cut down or stop using drugs but failed?
No
Yes, but not in the past year
Yes, during the past year