Drug Screening

Have you used drugs other than those required for medical reasons?

Yes
No

Do you abuse more than one drug at a time?

Yes
No

Are you always able to stop using drugs when you want to?

Yes
No

Have you had “blackouts” or “flashbacks” as a result of drug use?

Yes
No

Do you ever feel bad or guilty about your drug use?

Yes
No

Does your spouse (or parent) ever complain about your involvement with drugs?

Yes
No

Have you neglected your family because of your use of drugs?

Yes
No

Have you engaged in illegal activities in order to obtain drugs?

Yes
No

Have you ever experienced withdrawal symptoms (felt sick) when you stopped taking drugs?

Yes
No

Have you had medical problems as a result of your drug use (e.g., memory loss, hepatitis, convulsions, bleeding etc…)?

Yes
No

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Score

Score 0 No problem reported Score 1-2 Low level of problem use Score 3-5 Moderate level of problem use Score 6-8 Substantial level of problem use Score 9-10 Severe level of problem use

The Drug Abuse Screening Test (DAST)

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