Drug Screening

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Drug Screening

Have you used drugs other than those required for medical reasons?	Yes	No
Have you abused prescription drugs?	Yes	No
Do you abuse more than one drug at a time?	Yes	No
Can you get through the week without using drugs (excluding those required for medical reasons)?	Yes	No
Are you always able to stop using drugs when you want to?	Yes	No
Do you abuse drugs on a continual basis?	Yes	No
Do you try to limit your drug use to certain situations?	Yes	No
Have you had "blackouts" or "flashbacks" as a result of drug use?	Yes	No
Do you ever feel bad about your drug abuse?	Yes	No
Does your spose (or parents) ever complain about your involvement with drugs?	Yes	No
Do your friends or relatives suspect you abuse drugs?	Yes	No
Has drug abuse ever created problems between you and your spouse?	Yes	No
Has any family member ever sought help for problems related to your drug use?	Yes	No
Have you ever lost friends because of your use of drugs?	Yes	No
Have you ever neglected your family or missed work because of your use of drugs?	Yes	No
Have you ever been in trouble at work because of your drug abuse?	Yes	No
Have you ever lost a job because of drug abuse?	Yes	No
Have you gotten into fights when under the influence of drugs?	Yes	No
Have you ever been arrested because of unusual behaviour while under the influence of drugs?	Yes	No
Have you ever been arrested for driving while under the influence of drugs?	Yes	No
Have you engaged in illegal activities to obtain drugs?	Yes	No
Have you ever been arrested for possession of illegal drugs?	Yes	No
Have you ever experienced withdrawal symptoms as a result of heavy drug intake?	Yes	No
Have you had medical problems as a result of your drug use (e.g., memory loss, hepatitis, convulsions, or bleeding)?	Yes	No
Have you ever gone to anyone for help for a drug problem?	Yes	No
Have you ever been in hospital for medical problems related to your drug use?	Yes	No
Have you ever been involved in a treatment program specifically related to drug use?	Yes	No
Have you been treated as an outpatient for problems related to drug abuse?	Yes	No