SUBSTANCE ABUSE ASSESSMENT This online addiction screening is strictly for general information purposes and is not a substitute for an in-person clinical evaluation. The screening is free & completely anonymous if you choose. The online screening takes about 5 minutes and provides general feedback when completed. Please discuss any questions you may have with your physician or an addiction treatment professional. If you need help finding the right treatment professional or center, please call us. Do you find yourself sad, anxious, irritable, or worried most days of the week for long periods of time? Yes No Do you have trouble falling asleep or staying asleep? Yes No Do you feel fatigued or lethargic most of the time, no matter how much sleep you get? Yes No Do you ever feel like you are being watched, fearful that someone is constantly out to get you? Yes No Do you continually experience racing, intrusive thoughts that you can’t seem to quiet? Yes No Do you ever feel a sensation of deep euphoria for no apparent reason, almost as if you could conquer anything? Yes No Do you ever compulsively engage in behaviors that you later regret or could compromise your safety (e.g. gambling, over-spending, shoplifting, or risky sexual behavior)? Yes No Do you ever feel unable to relax if things aren’t exactly symmetrical, perhaps engaging in habitual counting or reordering of objects? Yes No Have you ever heard a voice or seen something that you later realized was not really there or was not observed by others? Yes No Do you ever feel unable to leave your home, even when you have work, school, or social responsibilities? Yes No Do you ever restrict your food intake or overeat to the point of sickness? Yes No Do you struggle to control your temper, often feeling high levels of rage? Yes No Do you regularly use substances like alcohol or illicit drugs, often feeling unable to function without them? Yes No Do you ever have thoughts of harming others, and have you ever made a plan to do so? Yes No Thank you for taking the time to complete the assessment. Please enter your information below so we can correspond with you about your results. First Name Last Name Email Address Phone Time's up
