Drug and alcohol questionnaire

Are you at risk? Complete the self-assessment and find out for yourself...

You can download a printable version of this drugs and alcohol self-assessment tool or as a word document which you can edit and reuse.

Substance means any drug not prescribed by a doctor, including: alcohol; cocaine; ecstasy; crack; LSD; amphetamines; ketamine; solvents (gas/glues); heroin; poppers; tranquillisers/anti-depressants or legal/herbal highs.

  • Regularly means: three or more days a week.
  • Occasionally means: a few times each month.
  • Rarely means: less than once a month.

Need to know:

  1. Using any substance or alcohol can cause you problems if you do not know how the drug will affect you.
  2. Injecting any substance can make you dependent, increases the risk of overdose and can put you at risk of viruses carried in the blood such as hepatitis and HIV. If you are injecting get advice about how to inject safely
  3. Mixing substances is dangerous and can make you feel unwell or cause you to overdose. Mixing alcohol and cocaine produces a dangerous substance that can damage your liver and heart.
  4. Using substances when you are alone can mean that you are becoming dependent on the substance.
  5. Using substances when you are unhappy may seem helpful but it will only make matters worse. You cannot deal with problems when you are ‘off your face’. You may need to talk to someone.
  6. If substance use is affecting your school or home life, costs too much, gets you into trouble with the police, or makes you lose your friends, you need to think carefully about whether this is the life you want? Would you be better off stopping or cutting down your substance use?


York Family Information Service and Information Service for Young People

01904 554444 / 01904 555400


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