Self Quiz
Are you an alcohol or other drug user? Find out if you’re at risk of health consequences, developing a pattern of dependence or abuse by completing this sample pre-screening survey:Pre-screen questions
- Have you smoked cigarettes or used other tobacco products in the past three years?
a. Yes b. No - On average, how many days a week do you drink alcohol? ____________
- On a typical day when you drink, how many drinks do you have? ____________
- What is the maximum number of drinks you had on any given day in the past month? __________
- Do you use prescription drugs for reasons other than prescribed, more frequently than prescribed, or any illicit drugs?
a. Yes b. No
- A “yes” answer to questions 1 or 5 is a positive screen.
- Add scores on quantity and frequency for questions 2, 3, 4 and if they exceed the limits for men/women they are a positive screen.
- WOMEN: three per day/seven per week
- MEN: four per day/14 per week

