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Test PAGE 2

Test PAGE 2

Medically Reviewed by Lisa Tomsak, DO

•

08/24/2023

•

3 minute read

•

Medically Reviewed by Lisa Tomsak, DO

test 1

"*" indicates required fields

Are you worried about yourself or a loved one?*

Myself

Loved one

1. Do you or your loved often use drugs or alcohol in larger amounts or over a longer period of time than you or they intended?*

Yes

No

2. Have you or your loved for a while now wanted to cut back on drugs or alcohol or made unsuccessful attempts to do so?*

Yes

No

3. Do you or your loved spend a great deal of time finding, using, or recovering from drugs or alcohol?*

Yes

No

4. Do you or your loved have strong urges or powerful cravings to use drugs or alcohol?*

Yes

No

5. Has your or loved one's use of drugs or alcohol resulted in your inability to meet your or their obligations at work, home, or school?*

Yes

No

6. Have you or your loved had to cut back on or abandon social, professional, or recreational activities due to your or their use of drugs or alcohol?*

Yes

No

7. Have you or your loved repeatedly used drugs or alcohol when it was hazardous to do so, such as while driving a car or operating machinery?*

Yes

No

8. Have you or your loved experienced social or relationship problems due to your or their use of drugs or alcohol and kept using anyway?*

Yes

No

9. Have you or your loved kept using drugs or alcohol knowing that it has caused or worsened physical or mental health issues?*

Yes

No

10. When you or your loved attempt to cut back on or stop your use of drugs or alcohol, have you or do they experienced uncomfortable physical or mental health symptoms (withdrawal)?*

Yes

No

test 2

"*" indicates required fields

Are you worried about yourself or a loved one?*

Myself

Loved one

1. Do you or your loved often use drugs or alcohol in larger amounts or over a longer period of time than you or they intended?*

Yes

No

2. Have you or your loved for a while now wanted to cut back on drugs or alcohol or made unsuccessful attempts to do so?*

Yes

No

3. Do you or your loved spend a great deal of time finding, using, or recovering from drugs or alcohol?*

Yes

No

4. Do you or your loved have strong urges or powerful cravings to use drugs or alcohol?*

Yes

No

5. Has your or loved one's use of drugs or alcohol resulted in your inability to meet your or their obligations at work, home, or school?*

Yes

No

6. Have you or your loved had to cut back on or abandon social, professional, or recreational activities due to your or their use of drugs or alcohol?*

Yes

No

7. Have you or your loved repeatedly used drugs or alcohol when it was hazardous to do so, such as while driving a car or operating machinery?*

Yes

No

8. Have you or your loved experienced social or relationship problems due to your or their use of drugs or alcohol and kept using anyway?*

Yes

No

9. Have you or your loved kept using drugs or alcohol knowing that it has caused or worsened physical or mental health issues?*

Yes

No

10. When you or your loved attempt to cut back on or stop your use of drugs or alcohol, have you or do they experienced uncomfortable physical or mental health symptoms (withdrawal)?*

Yes

No

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