Substance Abuse

574-267-1700

joel@mcarthurcounselingcenter.com

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McArthur Counseling Center Drug Abuse Screening Form

This is a screening form for drug abuse. This does not include alcohol. Rate the person to be evaluated (over the last 12 months) on each of the questions listed below using the following scale: 10 questions.

1 yes 0 no

1* Have you used drugs other than those required for medical reasons?*
- 1 yes
- 0 no
2* Do you abuse more than one drug at a time?*
- 1 yes
- 0 no
3* Have you been in trouble at work or school because of drug abuse?*
- 1 yes
- 0 no
4* Have you had "blackouts" or "flashbacks" as a result of drug use?*
- 1 yes
- 0 no
5* Do you feel bad or guilty about your drug use?*
- 1 yes
- 0 no
6* Does your spouse (or parents) ever complain about your involvement with drugs?*
- 1 yes
- 0 no
7* Have you neglected your family because of your use of drugs?*
- 1 yes
- 0 no
8* Have you engaged in illegal activities in order to obtain drugs?*
- 1 yes
- 0 no
9* Have you ever experienced withdrawal symptoms (felt sick) when you stopped taking drugs?*
- 1 yes
- 0 no
10* Have you had medical problems as a result of your drug use (e.g. memory loss, hepatitis, convulsions, bleeding, etc.)?*
- 1 yes
- 0 no
Scoring Key:
To get your score, add up the figures and subtract 20.
Over 30 = A vulnerability to stress.
50-75 = Seriously vulnerable to stress.
Over 75 = Extremely vulnerable to stress.