Substance Abuse Assessment Tool Welcome to your Substance Abuse Assessment Tool Full Name: Your Email: Phone number: 1. Have you ever abused substances while alone? Yes No None 2. Have friends and/or family members expressed concern about your substance use? Yes No None 3. Has your substance use been a source of conflict in your marriage or with your boyfriend/girlfriend? Yes No None 4. Have you lied to friends or family members about the amount and frequency of your substance use? Yes No None 5. Have you lied to a doctor in order to obtain prescription medications? Yes No None 6. Has your substance use negatively impacted your performance at work or school? Yes No None 7. Have you stolen substances, or stolen money or property in order to buy substances? Yes No None 8. Have you awakened after using substances with no memory about what you did while you were high? Yes No None 9. Have you used substances in order to wake up in the morning and/or to go to sleep at night? Yes No None 10. Have you used one substance in order to intensify the high from another substance? Yes No None 11. Have you used one substance in order to recover from using another substance? Yes No None 12. Have you used substances as a way of dealing with stress, pressure, and other negative experiences? Yes No None 13. Have you tried and failed to reduce the amount and/or frequency of your substance use? Yes No None 14. When you try to stop using, or when you can’t use, do you start to feel sluggish, sick, agitated, or depressed? Yes No None 15. Do you worry that you might have a substance abuse problem? Yes No None Time's up Leave a Reply Cancel replyCommentEnter your name or username to comment Enter your email address to comment Enter your website URL (optional) Save my name, email, and website in this browser for the next time I comment.
