2720 E. Thomas Rd., Suite B-190
Phoenix, Arizona 85016
(tel) 602.535.6468
(fax) 602.595.8968
Phoenix, Arizona 85016
(tel) 602.535.6468
(fax) 602.595.8968
Drug Counselor Phoenix, Arizona
Drug Questionnaire
1) Have you used drugs other than those prescribed for medical reasons? ___yes ___no
2) Do you abuse more than one drug at a time? ___yes ___no
3) Are you unable to stop using drugs when you want to? ___yes ___no
4) Have you ever had blackouts or flashbacks as a result of drug use? ___yes ___no
5) Do you ever feel bad or guilty about your drug use? ___yes ___no
6) Does your partner (or parents) ever complain about your involvement with drugs? ___yes ___no
7) Have you neglected your family because of your use of drugs? ___yes ___no
8) Have you engaged in illegal activities in order to obtain drugs? ___yes ___no
9) Have you ever experienced withdrawal symptoms (felt sick) when you stopped taking drugs? ___yes ___no
10) Have you had medical problems as a result of your drug use? (e.g. memory loss, hepatitis, convulsions, bleeding)? ___yes ____no
Scoring
0 = No problems reported
1 to 2= Low level drug problem
3 to 5= Moderate level drug problem
6 to 8= Substantial level drug problem
9 to 10= Severe level drug problem
(Source: The Drug Abuse Screening Test (DAST)- 10 is a brief instrument for clinical screening and treatment evaluation and is designed to be used with adults and older youth)
If you or someone you know is struggling with a drug issue, please call Stonewall Institute at 602-535-6468