The following questions concern information about your potential involvement with drugs (not including alcoholic beverages) during the past 12 months. Carefully read each statement and decide if your answer is "yes" or "no". Write your answers down on a piece of paper.

In the statements, "drug abuse" refers to (1) the use of prescribed or over the counter drugs in excess of the directions and (2) any non-medicinal use of drugs. The various classes of drugs may include: cannabis (e.g. marijuana, hash), solvents, tranquilizers (e.g. Valium), barbiturates, cocaine, stimulants (e.g. speed), hallucinogens (e.g. LSD) or narcotics (e.g. heroin). Remember that the questions do not include alcoholic beverages.

Please answer every question. If you have difficulty with a statement, then choose the response that is mostly right.

These questions refer to the past 12 months - answer either yes or no to each.

© Copyright 1982, Ηarvey A. Skinner, PhD, and the Center for Addiction  and Mental Health, Toronto, Canada.