Addiction Self-Assessment by Solace Asia

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Addiction Self-Assessment by Solace Asia

Addiction Self-Assessment by Solace Asia

Take the self-assessment below to find out if you are addicted to drugs or alcohol. Please think about your life in the past 12 months. Then go through the questions below and answer ‘YES’ or ‘NO’ for each one, in relation to your drug or alcohol use.

16Questions

1
Firstly, how can we address you?* This field is required.
First Name
Last Name
2
Email address* This field is required.All data is protected and will only be used for internal purposes.
example@example.com
3
Does using the same amount of the drug have less effect than it used to? Or do you have to use more to feel the effect you wanted?* This field is required.Please answer 'YES' if either question is true for you
YESNO
4
Do you have withdrawal symptoms when you weren’t using the drug? Or do you use the drug to avoid having these symptoms?* This field is required.Please answer 'YES' if either question is true for you
YESNO
5
Do you have times when you used the drug more or for longer than you wanted to?* This field is required.
YESNO
6
Do you want to cut back and stop using the drug, but can't? * This field is required.
YESNO
7
Do you spend a lot of time trying to get the drug, using the drug, or recovering from using it?* This field is required.
YESNO
8
Do you continue to use the drug even though you thought it might be causing mental or physical problems – or making them worse?* This field is required.
YESNO
9
Does using the drug make it harder for you to keep up with your responsibilities at work, school, or home?* This field is required.
YESNO
10
Do you resort to doing something dangerous more than once after using the drug – like drive a car or operate machinery?* This field is required.
YESNO
11
Do you use the drug even though you thought it might be causing problems with your family or other people?* This field is required.
YESNO
12
Do you have strong desires or craving for the drug?* This field is required.
YESNO
13
Do you spend less time working, enjoying hobbies, or being with others because of your use of the drug?* This field is required.
YESNO
14
Did you answer 'YES' to at least 2 of these questions? If you have, you may have an addiction towards drugs or alcohol.* This field is required.
YESNO
15
Would you like to schedule a hassle-free appointment to assess your addiction challenges with our clinical specialists?* This field is required.
YESNO
16
Please provide us your contact number so our clinical specialist can reach out with assistance. * This field is required.
Please enter a valid phone number.
Should be Empty:

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