I'm filling out this quiz for: My Child My Parent A Family Member A Friend A Business Associate
In the past three months, how often has the addict used drugs or alcohol? Never Once or Twice Monthly Weekly Daily or Almost Daily
What addictive behaviors is the addict engaging in? Alcohol Cocaine (snorted) Cocaine (crack) Cocaine (shot) Heroin (snorted) Heroin (smoked) Heroin (shot) Methamphetamine (snorted) Methamphetamine (smoked) Methamphetamine (injected) Vicodin Oxycontin Prescription Amphetamines Prescription Pills Marijuana Huffing Compulsive sex (prostitutes, others) Compulsive sex (internet pornography) Compulsive Gambling Other, I don't Know Alcohol Cocaine (snorted) Cocaine (crack) Cocaine (shot) Heroin (snorted) Heroin (smoked) Heroin (shot) Methamphetamine (snorted) Methamphetamine (smoked) Methamphetamine (injected) Vicodin Oxycontin Prescription Amphetamines Prescription Pills Marijuana Huffing Compulsive sex (prostitutes, others) Compulsive sex (internet pornography) Compulsive Gambling Other, I don't Know Alcohol Cocaine (snorted) Cocaine (crack) Cocaine (shot) Heroin (snorted) Heroin (smoked) Heroin (shot) Methamphetamine (snorted) Methamphetamine (smoked) Methamphetamine (injected) Vicodin Oxycontin Prescription Amphetamines Prescription Pills Marijuana Huffing Compulsive sex (prostitutes, others) Compulsive sex (internet pornography) Compulsive Gambling Other, I don't Know
During the past three months, how often has the addict’s behavior led to health, social, legal or financial problems? Never Once or Twice Monthly Weekly Daily or Almost Daily
During the past three months, how often has the addict failed to do what was normally expected of them because of their addiction? Never Once or Twice Monthly Weekly Daily or Almost Daily
Has the addict ever tried and failed to control, cut down or stop their behavior? No, Never Yes, but not in the past 3 months Yes, in the past 3 months