1. Have you ever tried to stop or cut back your drug use and not been able to?
2. Have your family or friends ever commented on your drug use or asked you to cut back?
3. Have you neglected friends and family or hobbies and past-times as a result of your drug use?
4. Have you “blacked out” or experienced "flashbacks" as a result of your drug use?
5. Have you ever experienced feelings of guilt or shame about your drug use or done something that you later regret?
6. Do you hide your drug use from friends, family and those in authority?
7. Have you missed family or professional commitments because of drugs?
8. Have you ever engaged in any illegal activity, either as a result of drug use, or in order to obtain drugs?
9. Have you ever experienced any withdrawal symptoms when you have stopped taking drugs?
10. Do you combine drugs or medicines with drinking alcohol to enhance the effects?
11. Have you had medical problems as a result of your drug use (e.g., memory loss, hepatitis, convulsions, bleeding, etc.)?