Substance Use Self-Assessment Tool Welcome to your Substance Use Self-Assessment Tool Full Name: Your Email: Phone number: 1. Has someone raised concern about your drinking or drugging? Yes No None 2. Have you ever stayed away from school, work, college, or university due to drinking or drugging? Yes No None 3. Is your drinking or drugging affecting your relationships? Yes No None 5. Do you drink or drug to escape your worries or troubles? Yes No None 4. Have you ever felt guilty about your behaviour when drinking or drugging? Yes No None 6. Have you ever gotten into financial difficulties because of drinking or drugging? Yes No None 7. Has your ambition or drive decreased since drinking or drugging? Yes No None 8. Is drinking or drugging jeopardising your job or business? Yes No None 9. Have you ever had memory loss due to drinking or drugging? Yes No None 10. Do you drink/take drugs to build up your self- confidence? Yes No None 11. Have you ever tried to control, reduce, or stop your drinking or drugging? Yes No None 12. Have you come into contact with the police/legal services due to your drinking or drugging? Yes No None 13. Have you needed to increase your drinking or drug quantity to achieve the desired effect? Yes No None 14. Have you continued to use alcohol or drugs in situations where it puts yourself/others at risk e.g. whilst driving? 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.
