ASSESSMENTS

The Alcohol Use Disorders Identification Test (AUDIT), developed in 1982 by the World Health Organization, is a simple way to screen and identify people at risk of alcohol problems.

How often do you have a drink containing alcohol?

Never (Skip to question 9-10)
Monthly or less
2 to 4 times a month
2 to 3 times a week
4 or more times a week

How many drinks containing alcohol do you have on a typical day when you are drinking?

1 or 2
3 or 4
5 or 6
7, 8, or 9
10 or more

How often do you have six or more drinks on one occasion?

Never
Less than monthly
Monthly
Weekly
Daily or almost daily

How often during the last year have you found that you were not able to stop drinking once you had started?

Never
Less than monthly
Monthly
Weekly
Daily or almost daily

How often during the last year have you failed to do what was normally expected from you because of drinking?

Never
Less than monthly
Monthly
Weekly
Daily or almost daily

How often during the last year have you been unable to remember what happened the night before because you had been drinking?

Never
Less than monthly
Monthly
Weekly
Daily or almost daily

How often during the last year have you needed an alcoholic drink first thing in the morning to get yourself going after a night of heavy drinking?

Never
Less than monthly
Monthly
Weekly
Daily or almost daily

How often during the last year have you had a feeling of guit or remorse after drinking?

Never
Less than monthly
Monthly
Weekly
Daily or almost daily

Have you or someone else been injured as a result of your drinking?

No
Yes, but not in the last year
Yes, during the last year

Has a relative, friend, doctor, or another health professional expressed concern about your drinking or suggested you cut down?

No
Yes, but not in the last year
Yes, during the last year

Add up the points associated with these answers.
A total score of 8 or more indicates harmful drinking behavior.

Using drugs can affext your health and some medications you may take. Please help us provide you witht he best medical care by answering the questions below.

Methamphetamines(speed, crystal)
Cannabis(marijuana, pot)
Inhalants(paint thinner, aerosol, glue)
Tranqualizers(valium)
Cocaine
Narcotics (heroin, oxycodone, methadone, etc.)
Hallucinogens(LSD, Mushrooms)
Other

How ofthen have you used these drugs?

Monthly or less
Weekly
Daily or almost daily

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

No
Yes

Do you abuse more than one drug at a time?

No
Yes

Are you unable to stop using drugs when you want to?

No
Yes

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

No
Yes

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

No
Yes

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

No
Yes

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

No
Yes

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

No
Yes

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

No
Yes

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

No
Yes

Have you ever injected drugs?

Never
Yes, in the past 90 days
Yes, more than 90 days ago

Have you ever been in treatment for substance abuse?

Never
Currently
In the past