This Assessment is NO substitute for a more thorough assessment by a qualified addiction professional or drug rehab provider.
Please answer the questions to the best of your ability.
- Have you ever seen your loved one use drugs for reasons other than medical purposes?
Yes No Not Sure
- When using prescription drugs, does your loved one take more than the indicated dosage recommendations, or require abnormally frequent refills of medications?
Yes No Not Sure
- Does your loved one often need money and you are not sure for what purposes?
Yes No Not Sure
- Have you ever found drugs and/or paraphernalia related to drug use in your home?
Yes No Not Sure
- Have you witnessed a radical change in your loved one’s behavior and appearance that you feel is related to drug use?
Yes No Not Sure
- Have you noticed a change in friends, interests, and activities in your loved one that has you concerned?
Yes No Not Sure
- Have you criticized or gotten into arguments with your loved ones about their use/abuse of drugs?
Yes No Not Sure
- Has your loved one ever been arrested for reasons related to drugs?
Yes No Not Sure
- Have you ever had to make excuses for work or school to cover up your loved ones’ drug use/abuse?
Yes No Not Sure
- Has your loved one had medical complications as a result of drug use/abuse?
Yes No Not Sure