Drug (self) Questionnaire

Question

Frequently

Occasionally

Rarely

Never

1. Do you ever use any substance/alcohol? If no go to question 13

4

3

1

0

2. Do you ever use heroin, cocaine, crack or solvents?

10

10

10

0

3. Do you inject any substance?

10

10

10

0

4. Do you use more than one substance at a time? If you do, which do you use most often?

5

3

2

0

5. Do you use substances/alcohol when you are alone?

4

2

1

0

6. Do you use substances/alcohol because you are unhappy?

4

2

1

0

7. Does your substance/alcohol give you problems getting on with other people?

4

2

1

0

8. Do you get so off your head (intoxicated, stoned, mashed) that you do not know what you are doing?

6

3

2

0

9. Do you spend more on substances/alcohol than you can afford?

5

2

1

0

10. Does your substance/alcohol use affect your ability to cope with school or work?

3

2

1

0

11. Do you feel irritable or anxious if you do not use the substance/alcohol?

3

2

1

0

12. Are you concerned by your substance use?

3

2

1

0

13. Do you spend time with friends that use substances?

4

2

1

0

14. Do other people such as family and friends worry about your substance/alcohol use?

3

2

1

0

15. Do any close family members use substances/alcohol? If yes which do they use most often?

3

2

1

0

16. Has your drug use lead you to require medical attention, e.g GP or A&E?

10

5

3

0

Score (each column)

TOTAL SCORE