Addiction Questionnaire

Addiction Questionnaire

Take your time, and answer each question carefully and honestly.


1). How often do you use drugs other than alcohol

NeverMonthly or less2-4 times a month2-3 times a week4 or more times a week

2). Do you use more than one type of drug on the same occasion?

NeverMonthly or less2-4 times a month2-3 times a week4 or more times a week

3). How many times do you take drugs on a typical day when you use drugs?

1 or 23 or 45 or 67 to 910 or more

4). How often are you heavily influenced by drugs?

NeverLess than monthlyMonthlyWeeklyDaily or almost daily

5). Over the past year, have you felt that your longing for drugs was so strong that you could not resist it?

NeverLess than monthlyMonthlyWeeklyDaily or almost daily

6). Has it happened, over the past year that you have not been able to stop taking drugs once you started?

NeverLess than monthlyMonthlyWeeklyDaily or almost daily

7). How often over the past year have you taken drugs and then not done something you should have done?

NeverLess than monthlyMonthlyWeeklyDaily or almost daily

8). How often over the past year have you needed to take a drug the morning after heavy drug use the day before?

NeverLess than monthlyMonthlyWeeklyDaily or almost daily

9). How often over the past year have you had guilt feelings or a bad conscience because you used drugs?

NeverLess than monthlyMonthlyWeeklyDaily or almost daily

10). Have you or anyone else been mentally/physically hurt because you used drugs?

NoYes, but not in the last yearYes, during the last year

11). Has a relative or a friend, a doctor or a nurse, or anyone else, been worried about your drug use or said to you that you should stop using drugs?

NoYes, but not in the last yearYes, during the last year



If you clicked yes to the previous question, please enter the email address would you like to be contacted at.