Drug Test — Still Here

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 parents) ever complain about your involvement with drugs?
Yes No

Have you neglected your family because of your drug use?
Yes No

Have you engaged in illegal activities 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)?
Yes No

DAST-10: Drug Abuse Screening Test