LEVEL 2—Substance Use—Adult*
*Adapted from the NIDA-Modified ASSIST
PLEASE TYPE YOUR "FIRST INITIAL AND LAST NAME " ONLY!
PLEASE BE HONEST!
IT DOESN'T HELP YOU OR I IF YOU LIE! I'M NOT HERE TO JUDGE! I'M HERE TO HELP!
During the past TWO (2) WEEKS, about how often did you use any of the following medicines ON YOUR OWN, that is, without a doctor’s prescription, in greater amounts or longer than prescribed?
Not at all
One or two days
More than half the days
Painkillers (like Vicodin)
Stimulants (like Ritalin, Adderall)
Sedatives or tranquilizers (like sleeping pills or Valium)
Cocaine or crack
Club drugs (like ecstasy)
Hallucinogens (like LSD)
Inhalants or solvents (like glue)
Methamphetamine (like speed)
Should be Empty:
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