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Do you abuse drugs?
(If your answer is NO please skip to Q.2)
 
Yes
 
No
 
 
How long have you been taking drugs?
 
1 year
 
2 year
 
More than 2 years
 
 
How frequently do you take drugs?
 
Daily
 
Weekly
 
Monthly
 
Other
 
 
 
What is the reason that you started taking drugs?
 
Peer pressure
 
Family conflicts
 
Curiosity
 
Other
 
 
 
How do you feel when you are on drugs?
 
Very Unsatisfied
 
Unsatisfied
 
Neutral
 
Satisfied
 
Very Satisfied
 
Other
 
 
 
Where do you buy / get them?
 
Friends
 
Dealers
 
Other
 
 
 
Are you addicted? Do you want to quit the habit?
 
Yes
 
No
 
Other
 
 
 
Have you ever tried drugs?
 
Yes
 
No
 
 
Do you have friends who take drugs?
 
Yes
 
No
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