1. Do you avoid people or places that do not approve of you using drugs or substance?
2. Do you continue to use drugs or substance despite negative consequences?
3. Do you ever question your own sanity?
4. Do you ever use drugs or substance alone?
5. Do you feel it is impossible for you to live without drugs or substance?
6. Do you put the purchase of drugs or substance ahead of your financial responsibilities?
7. Do you regularly use a drug or substance when you wake up or when you go to bed?
8. Do you think a lot about drugs or substance?
9. Do you think you might have a drug or substance problem?
10. Does the thought of running out of drugs or substance terrify you?
11. Does using drug or substance interfere with your sleeping or eating?
12. Has using drug or substance affected your sexual relationship?
13. Has your job or school performance ever suffered from the effects of your drug or substance use?
14. Have you ever been arrested as a result of using drugs or substance?
15. Have you ever been in jail, hospital, or rehabilitation center because of your using drugs or substance?
16. Have you ever felt defensive, guilty, or ashamed about your using drugs or substance?
17. Have you ever lied about what or how much you use drug or substance?
18. Have you ever manipulated or lied to a doctor to obtain prescription drugs?
19. Have you ever overdosed on any drugs or substance?
20. Have you ever stolen drugs or substance or stolen to obtain drugs or substance?
21. Have you ever substituted one drug for another, thinking that one particular drug was the problem?
22. Have you ever taken drugs or substance you don't prefer?
23. Have you ever taken one drug or substance to overcome the effects of another?
24. Have you ever thought you couldn't fit in or have a good time without drugs or substance?
25. Have you ever tried to stop or control your using drugs or substance?
26. Have you ever used a drug or substance without knowing what it was or what it would do to you?
27. Have you ever used drugs or substance because of emotional pain or stress?
28. Have you had irrational or indefinable fears?
29. Is your drug or substance use making life at home unhappy?
30. Has any family member ever sought help for problems related to your drug use?
31. Have you ever neglected your family or missed work because of your use of drugs?
32. Has drug abuse ever created problems between you and your boyfriend/girlfriend or parents?
33. Does your boyfriend/girlfriend or parents ever complain about your involvement with drugs?
34. Have you ever lost friends because of your use of drugs?
35. Have you gotten into fights when under the influence of drugs?
36. Have you ever experienced withdrawal symptoms as a result of heavy drug intake?
37. Have you had medical problems as a result of your drug use (e.g., hepatitis, weight loss, or bleeding)?
38. Have you had medical problems as a result of your drug use (e.g., memory loss, convulsions, or hallucinatio)?
39. Have you abused prescription drugs?
40. Have you ever been in hospital for medical problems related to your drug use?
