| Section
#1 |
Yes |
No |
| 1. Do
you generally use alcohol or drugs more than once a week? |
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| 2. On
the days when you use (or used) alcohol or drugs, do you usually have
three drinks/doses or more? |
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| 3. Do
you use non-prescription drugs from time to time? |
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| 4. Do
you use prescription drugs so that you can change your mood or personality? |
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| 5. Do
you sometimes use more than the amount prescribed? |
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| 6. Do
you get (or have you gotten) intoxicated on alcohol or drugs more
than twice a year. (You're intoxicated if you use so much that you
can't function safely or normally or if other people think that you
can't function safely or normally.) |
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| 7. When
you're not using alcohol or drugs, do you ever put yourself in situations
that raise your risk of getting hurt or having problems? |
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| 8. Have
you ever felt like you should cut down on your drinking or drug use? |
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| 9. Have
other people ever criticized your drinking or drug use, or been annoyed
by it? |
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| 10.
Have you ever felt guilty about your drinking or drug use? |
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| 11.
Have you ever done things while you were using alcohol or drugs, that
you regretted, or that made you feel ashamed or guilty? |
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| 12.
Have you ever used alcohol or drugs first thing in the morning to
feel better, or get rid of a hangover? |
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| 13.
Have you ever thought that you might have a problem with your drinking
or drug use? |
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| 14.
Have you ever used alcohol or drugs in larger quantities than you
intended? For example, have you ever used more than you wanted to
or could afford to? |
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| 15.
Have you ever used alcohol or drugs more often than you intended?
For example, have you ever planned not to use that day but done it
anyway? |
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| 16.
Have you ever used alcohol or drugs for longer periods of time than
you intended? In other words have you ever not been able to stop when
you planned to? |
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| 17.
Have you ever had a desire to cut down on or control your alcohol
or drug use? |
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| 18.
Have you ever tried to cut down on or control your alcohol or drug
use? |
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| 19.
Do you spend a lot of time getting ready to use alcohol or drugs,
using, or recovering from using alcohol or drugs? |
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| 20.
Have you ever failed to meet a major life responsibility because you
were intoxicated, hung over, or in withdrawal? (having discomfort
when you stopped using) |
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| 21.
Have you given up any work, social, or recreational activities because
of alcohol or drug use? |
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| 22.
Have you had any physical, psychological, or social problems that
were caused by, or made worse by, your alcohol or drug use? |
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| 23.
Have you ever continued to use alcohol or drugs even though you knew
they were causing physical, psychological, or social problems, or
making those problems worse? |
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| 25.
Did your tolerance (your ability to use a lot of alcohol or drugs
without feeling intoxicated) increase since you first started using
alcohol or drugs? |
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| 25.
Do you ever get physically uncomfortable or sick the day after using
alcohol or drugs? |
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| 26.
Have you ever used alcohol or drugs to keep you from getting sick
the next day, or to make a hangover go away? |
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27. When you use
alcohol or drugs, what do you want those substances to do for you
that you believe that you can't do without them?
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28. When you use
alcohol or drugs, what do you want those substances to help you escape
from that you believe you can't escape from without them?
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