Addiction Awareness OSCA 11-036 response - REDACTED.pdf

What do you expect/need from treatment at this time?
SUBSTANCE USE IN THE PAST 30 DAYS (include script or OTC use):
Have you ever thought you should cut down
on your drinking and/or substance use?
Have people annoyed you by criticizing your
drinking or drug usage?
Have you ever felt “bad” or “guilty” about
your drinking or drug usage? Have you felt
remorse after drinking/using?
Have you ever had an “eye-opener” to steady
nerves in the a.m. after drinking or using?
Do you take prescribed medication beyond
doctor’s orders? Are your prescriptions
running out before the allotted time?
Do you find it hard to enjoy life without
drugs? Have you tried to quit using or
drinking but can’t?
Do you feel that your problems would go
away when you use or drink?
NEED FOR DETOX SERVICES:
SUBSTANCE USE & PSYCHIATRIC TREATMENT AND HISTORY:
1. In the last three months, have you felt you should cut down or stop drinking or using drugs?
Yes No
2. In the last three months, has anyone annoyed you or gotten on your nerves by telling you to
cut down
or stop drinking or using drugs?
Yes No
3. In the last three months, have you felt guilty or bad about how much you drink or use drugs?
Yes No
4. In the last three months, have you been waking up wanting to have an alcoholic drink or use
drugs?
Yes No
Each affirmative response earns one point. One point indicates a possible problem. Two points
indicate a probable problem
Do you have decreased ambition since started drinking, using, or gambling?
Do you crave drinking, using or gambling at a definite time of the day?
Do you drink, use or gamble alone?
Have you lost memory while drinking or using?