Substance Use Questionnaire

  • Substance Use Questionnaire

  • Do you struggle with limiting the length of time or limiting the amount of substance you use?
  • Do you struggle with stopping or reducing your substance use?
  • Do you spend a lot of time getting substances or recovering from the effects of substances (such as being hungover or sleeping)?
  • Do you experience an intense desire or craving to use the substance(s)?
  • Have you experienced difficulties taking care of responsibilities at work or in the home (such as keeping up with work tasks or housework or paying the bills)?
  • Have you experienced problems with family or friends because of your substance use?
  • Have you given up hobbies or activities you previously enjoyed because of your substance use?
  • Have you continued to use substances in physically harmful situations or engage in activities that could cause you harm (examples include, but are not limited to: theft, driving while under the influence, or sharing needles)?
  • Do you experience health-related problems (such as heart problems or tooth decay) that are caused or made worse by your substance use?
  • Do you experience mental health problems (such as depression or anxiety) that are caused or made worse by your substance use?
  • Do you find yourself having developed tolerance (either needing more of the substance to experience the same effect or experiencing less of the effect with the same amount)?
  • Do you experience withdrawal side effects when you are not using substances (such as moodiness, depression, anxiety, cravings, difficulty sleeping or eating)?

  • If this survey has helped you determine that you want to pursue substance-related Counseling, please contact us

    HERE 

    We look forward to hearing from you!

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