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The Science of Drug Abuse and Addiction from the National Institute on Drug Abuse

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Note: This website collects no personally identifiable information and does not store your responses to any of the following questions.

Instructions: In response to each question, mark affirmative answers when appropriate (the default setting is a negative response). At the end of the survey, the screening tool will tally the responses to generate a substance involvement score, determine risk and recommended level of intervention, and provide additional resources.

Screening for Drug Use in General Medical Settings*

Pre-screening Question

In your life, which of the following substances have you ever used?
Please report nonmedical use only: Do not record medications that are used as prescribed by your doctor.

Drug Type	Yes	No
Tobacco products (cigarettes, chewing tobacco, cigars, etc.)	Yes	No
Alcoholic beverages (beer, wine, liquor, etc.)	Yes	No
Cannabis (marijuana, pot, grass, hash, etc.)	Yes	No
Cocaine (coke, crack, etc.)	Yes	No
Prescription stimulants (Ritalin, Concerta, Dexedrine, Adderall, diet pills, etc.)	Yes	No
Methamphetamine (speed, crystal, ice, etc.)	Yes	No
Inhalants (nitrous oxide, glue, gas, paint thinner, etc.)	Yes	No
Sedatives or sleeping pills (Valium, Serepax, Ativan, Xanax, Librium, Rohypnol, GHB, etc.)	Yes	No
Hallucinogens (LSD, acid, mushrooms, PCP, Special K, Ecstasy, etc.)	Yes	No
Street opioids (heroin, opium, etc.)	Yes	No
Prescription opioids (fentanyl, oxycodone [OxyContin, Percocet], hydrocodone [Vicodin], methadone, buprenorphine, etc.)	Yes	No
Other: Other:	Yes	No

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*This screening tool was adapted from the World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) Version 3.0, developed and published by the WHO.

Note: This website collects no personally identifiable information and does not store your responses to any of the following questions.

The National Institute on Drug Abuse (NIDA) is part of the National Institutes of Health (NIH) , a component of the U.S. Department of Health and Human Services. Questions? See our Contact Information. Last updated on Thursday, September 17, 2009.