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Contact
About
Treatment
Medication Assisted Treatment
Our Story
Resources
FAQ
Statistics
GeneSight
Start the Process
How To Get Started
Individuals Checklist
Family Checklist
Codependency Checklist
Gallery
Menu
Contact
About
Treatment
Medication Assisted Treatment
Our Story
Resources
FAQ
Statistics
GeneSight
Start the Process
How To Get Started
Individuals Checklist
Family Checklist
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Individuals Checklist
Talk to a health care provider if you experienced two or more of these symptoms in the last year:
Individuals Checklist
Do you find yourself often taking more of the substance for a longer period than intended?
Yes
No
Do you find yourself having an ongoing desire or unsuccessful efforts to reduce use?
Yes
No
Do you find yourself having a great deal of time spent to obtain, use or recover from substance?
Yes
No
Do you find yourself having a great deal of time spent to obtain, use or recover from substance?
Yes
No
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Next
Do you find yourself failing to fulfill obligations at work, home or school as a result of continued use?
Yes
No
Do you continue to use despite ongoing social or relationship problems caused or worsened by use?
Yes
No
Do you find yourself giving up or reducing social, occupational or recreational activities because of use?
Yes
No
Do you find that repeated use in physically dangerous situations (like drinking or using other drugs while driving, or smoking in bed)?
Yes
No
Previous
Next
Do you continue to use despite repeated contact with law enforcement?
Yes
No
Do you find yourself developing tolerance (feeling less effect from the substance with continued use)?
Yes
No
Do you find yourself experiencing withdrawal symptoms after reducing use (symptoms vary by substance). Withdrawal does not happen with all substances; examples include inhalants and hallucinogens?
Yes
No
Previous
Next
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Do you find yourself often taking more of the substance for a longer period than intended?
Yes
No
Do you find yourself having an ongoing desire or unsuccessful efforts to reduce use?
Yes
No
Do you find yourself having a great deal of time spent to obtain, use or recover from substance?
Yes
No
Do you find yourself craving the substance?
Yes
No
Do you find yourself failing to fulfill obligations at work, home or school as a result of continued use?
Yes
No
Do you continue to use despite ongoing social or relationship problems caused or worsened by use?
Yes
No
Do you find yourself giving up or reducing social, occupational or recreational activities because of use?
Yes
No
Do you find that repeated use in physically dangerous situations (like drinking or using other drugs while driving, or smoking in bed)?
Yes
No
Do you continue to use despite repeated contact with law enforcement?
Yes
No
Do you find yourself developing tolerance (feeling less effect from the substance with continued use)?
Yes
No
Do you find yourself experiencing withdrawal symptoms after reducing use (symptoms vary by substance). Withdrawal does not happen with all substances; examples include inhalants and hallucinogens?
Yes
No
Submit Form
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