I'm filling out this quiz for:
Myself My Child My Parent A Family Member A Friend A Business Associate

In the past three months, how often have you used drugs or alcohol?
Never Once or Twice Monthly Weekly Daily or Almost Daily

During the past three months, how often have you had a strong desire or urge to use?
Never Once or Twice Monthly Weekly Daily or Almost Daily

During the past three months, how often has your use led to health, social, legal or financial problems?
Never Once or Twice Monthly Weekly Daily or Almost Daily

During the past three months, how often have you failed to do what was normally expected of you because of your use?
Never Once or Twice Monthly Weekly Daily or Almost Daily

Has a friend or relative or anyone else ever expressed concern about your use?
No, Never Yes, but not in the past 3 months Yes, in the past 3 months

Have you ever tried and failed to control, cut down or stop using?
No, Never Yes, but not in the past 3 months Yes, in the past 3 months