1 Hello, What's your name?
 2 How old are you?
3Â Select Your State
4
Do you take substances in larger amounts ORÂ for longer periods of time than you intended?
5
Do you want to cut down or stop using the substance(s) but are struggling to do so?
6
Do you spend a great deal of time acquiring, doing, or being intoxicated by the substance(s)?
7
Do you have frequent strong cravings and/or urges to use the substance(s)?
8
Are you neglecting your work, home, or school because of substance use?
9
Do you continue to use despite the negative impact on your peers, professional, family, or romantic relationships?
10
Do you give up or cancel important plans or activities because of substance use?
11
Do you use it even when it puts you in danger (DWI/DUI, Frequent Overdose, Infections, organ failure, etc.)?
12
Do you use even though the substance(s) negatively impact your physical or psychological wellness?
13
Do you need more of the substance(s) to get the effect you want (tolerance)?
14
Do you have withdrawal symptoms that can be relieved by taking more of the substance(s)?
