|
“Substance” means any drug not prescribed by
a doctor including: cannabis, cocaine/crack, ecstasy, heroin,
tranquillisers/anti-depressants, amphetamines, LSD. poppers,
steroids, solvents (glues or gasses) and alcohol
REGULARLY = weekly or more
OCCASIONALLY = a few times each month
RARELY = less than once a month
|
R
E
G
U
L
A
R
L
Y |
O
C
C
A
S
I
O
N
A
L
L
Y |
R
A
R
E
L
Y |
N
E
V
E
R |
|
1. Do you ever use any substance/alcohol?
|
4 |
3 |
1 |
0 |
|
2. Do you use heroin, cocaine, crack or solvents?
|
16 |
16 |
3 |
0 |
|
3. Do you inject any substance?
|
12 |
10 |
5 |
0 |
|
4. Do you use more than one substance at a time?
|
5 |
3 |
2 |
0 |
|
5. Do you use substances when you are alone?
|
4 |
2 |
1 |
0 |
|
6. Do you use substances because you are unhappy or
it helps you cope?
|
4 |
2 |
1 |
0 |
|
7. Does your substance use give you problems in 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 than you can afford?
|
3 |
2 |
1 |
0 |
|
10. Does your substance 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?
|
3 |
2 |
1 |
0 |
|
12. Do you worry about your substance use?
|
3 |
2 |
1 |
0 |
|
13. Do other people such as family and friends worry
about your substance use?
|
3 |
2 |
1 |
0 |
|
SCORE (each column)
|
|
|
|
0 |
