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Name_______ |
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Date_______ |
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Score_______ |
1. |
Have you used drugs other than those required for medical reasons? |
Yes No |
2. |
Have you abused prescription drugs? |
Yes No |
3. |
Do you abuse more than one drug at a time? |
Yes No |
4. |
Can you get through the week without using drugs (other than those required for medical reasons)? |
Yes No |
5. |
Are you always able to stop using drugs when you want to? |
Yes No |
6. |
Do you abuse drugs on a continuous basis? |
Yes No |
7. |
Do you try to limit your drug use to certain situations? |
Yes No |
8. |
Have you had "blackouts" or "flashbacks" as a result of drug use? |
Yes No |
9. |
Do you ever feel bad about your drug abuse? |
Yes No |
10. |
Does your spouse (or parents) ever complain about your involvement with drugs? |
Yes No |
11. |
Do your friends or relatives know or suspect you abuse drugs? |
Yes No |
12. |
Has drug abuse ever created problems between you and your spouse? |
Yes No |
13. |
Has any family member ever sought help for problems related to your drug use? |
Yes No |
14. |
Have you ever lost friends because of your use of drugs? |
Yes No |
15. |
Have you ever neglected your family or missed work because of your use of drugs? |
Yes No |
16. |
Have you ever been in trouble at work because of drug abuse? |
Yes No |
17. |
Have you ever lost a job because of drug abuse? |
Yes No |
18. |
Have you gotten into fights when under the influence of drugs? |
Yes No |
19. |
Have you ever been arrested because of unusual behavior while under the influence of drugs? |
Yes No |
20. |
Have you ever been arrested for driving while under the influence of drugs? |
Yes No |
21. |
Have you engaged in illegal activities to obtain drugs? |
Yes No |
22. |
Have you ever been arrested for possession of illegal drugs? |
Yes No |
23. |
Have you ever experienced withdrawal symptoms as a result of heavy drug intake? |
Yes No |
24. |
Have you had medical problems as a result of your drug use (e.g., memory loss, hepatitis, convulsions, or bleeding)? |
Yes No |
25. |
Have you ever gone to anyone for help for a drug problem? |
Yes No |
26. |
Have you ever been in hospital for medical problems related to your drug use? |
Yes No |
27. |
Have you ever been involved in a treatment program specifically related to drug use? |
Yes No |
28. |
Have you been treated as an outpatient for problems related to drug abuse? |
Yes No |
Gavin DR; Ross HE; Skinner HA. Diagnostic validity of the Drug Abuse Screening Test in the assessment of DSM-III drug disorders. British Journal of Addiction 84(3): 301-307, 1989. (23 refs.)
