Am
I Abusing Substances?
Check "Yes" or "No" to
the following items:
YES NO
____
____ 1. During the previous 12 month period, I have used
substances continually or recurrently, resulting in a failure to meet important
obligations at work, school or home, such as repeated absences, being late, having
to be counseled due to poor performance, neglect of work or family/household
responsibilities.
____
____ 2. During the previous 12 month period, I have used
substances continually or recurrently in situations in which it is physically
hazardous, such as driving an automobile or operating a machine while under the influence.
____
____ 3. During the previous 12 month period, I have
experienced persistent or recurrent substance-related legal problems, such as
DWI, public intoxication or disorderly conduct.
____
____ 4. During the previous 12 month period, I have
continued to use a substance despite persistent or recurrent
social or interpersonal problems caused or increased by the effects of the
substance, such as arguments with spouse/significant other about consequences
of intoxication or physical fights.
____
____ 5. During the previous 12 month period, my
tolerance for a substance has increased to the point where I need more of the
substance to achieve intoxication or desired effect, or I notice diminished
effect with continued use of the same amount of the substance.
____
____ 6. During the previous 12 month period, I have
experienced withdrawal from the substance or have taken the same or closely
related substance in order to relieve or avoid withdrawal symptoms such as sweating,
flu-like symptoms, headache, increased heart rate or elevated blood pressure.
____
____ 7. During the previous 12 month period, I have
often used the substance in larger amounts or over a longer period than was
intended.
____
____ 8. During the previous 12 month period, I have
experienced a persistent desire or unsuccessful effort to cut down or
control my use of a substance.
____
____ 9. During the previous 12 month period, I have
spent a great deal of time in activities necessary to obtain the substance, use
the substance or recovering from the effects of the substance use, such as
visiting multiple doctors, driving long distances, or using the substance too
much for too long.
____
____ 10. During the previous 12 month period, important
family, social, occupational, or recreational activities have been reduced or
given up because of my substance use.
____
____ 11. During the previous 12 month period, I have continued
use of the substance despite knowledge of having a persistent or recurrent
physical or psychological problem that is likely to have been caused
or exacerbated by the substance use, such as drinking despite recognition that
an ulcer or depression was made worse by alcohol consumption.
PLEASE REVIEW YOUR RESPONSES TO ITEMS #1
through #4: If you responded "Yes" to any one of items #1
throught #4, you may very possibly have a substance abuse problem.
PLEASE REVIEW YOUR RESPONSES TO ITEMS # 5
through #11: If you responded "Yes" to any three (3) of items
#5 through #11, you may very well possibly have a substance dependence problem.
Adapted from the Diagnostic and Statistical Manual of Mental
Disorders IV (DSM) is
published by the American Psychiatric Association