Yes

No

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Do you ever have trouble remembering things or concentrating on what you’re doing because you’re thinking about using?

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Have you ever broken promises because of your substance use?

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Have you ever done things when you were using that you wouldn’t normally do?

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Have you ever lost a job or had money troubles because of your use?

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Do you ever make excuses for your use or lie to hide it?

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Does someone make excuses for you when you’re hung over?

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Do others ever seem embarrassed about your use?

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Have your children ever asked you to stop using or been afraid of you when you're using?

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Has your spouse or a girlfriend or boyfriend ever left you because of your use?

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Have you ever had sexual problems that might be caused by your use?

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Have you ever had severe shaking, heard voices, or thought you were seeing things after you’ve been using?

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Have you noticed that you’ve gotten sick more often as you use more?

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Have you tried to quit but found you just couldn’t?