Online Self Assessment Quiz
Do you ever take medication in a larger dose than is prescribed by your doctor?
Yes
/ No
Do you ever take the medication more frequently than prescribed by your doctor?
Yes
/ No
Do you ever mix other drugs (including alcohol) with your prescribed medication without your doctors knowledge or approval?
Yes
/ No
Do you sometimes use mood-altering drugs that have been prescribed for someone else?
Yes
/ No
Do you ever use any other drugs that aren't prescribed for you by your doctor? (these might be medicines like diet pills, sleep aids, stay-awake pills or some of the herbal energy supplements that make you high or give you a buzz)
Yes
/ No
When you are using pain medication (including alcohol) and other drugs, do you ever put yourself in situations that raise your risk of getting hurt, having problems, or hurting others? (this includes things like driving while using prescriptions, alcohol, or other drugs; having sex without protection; getting into fights; skipping work; committing crimes; etc.)
Yes
/ No
Have you ever realized that you need to take more medication than you used to in order to get the pain relief you desire?
Yes
/ No
If you use the same amount of medication all the time, do you experience a reduction in your pain relief or are you tempted to increase the dose?
Yes
/ No
Have you ever been ashamed of your behavior while under the influence of your pain medication or of something that happened while you were taking it?
Yes
/ No
Have you ever felt sick or anxious (or experienced other withdrawal symptoms) when you suddenly stopped using your medication?
Yes
/ No
Have you ever used your medication or other drugs (including alcohol) to avoid withdrawal symptoms?
Yes
/ No
Have you ever hidden from (or not told one doctor what you have been given by another doctor) about the use of over the counter medication?
Yes
/ No
Have you ever done things while you were using pain medication, including alcohol and other drugs, that you regretted or that made you feel guilty or ashamed?
Yes
/ No
Have you had a persistent desire or made unsuccessful efforts to cut down or control your medication?
Yes
/ No
Have you ever used your medication (including alcohol) or other drugs to try to escape from or cope with a problem or situation that you didn't know any other way to deal with?
Yes
/ No
Do you use other drugs (including alcohol) when not taking your medication?
Yes
/ No
Do you spend a great deal of time seeing several doctors (doctor shopping), being under the influence, or recovering from the effects of your medication?
Yes
/ No
Has anyone else (a spouse, family member, boss, or friend) ever told you that they thought you might have a problem with your prescription drug use?
Yes
/ No
Have you continued to use your medication despite having persistent or frequent physical or psychological problems caused by the medication (for example, impaired liver functions or depression?)
Yes
/ No
Have you ever experienced legal problems due to substance related issues (such as forging prescriptions or driving while taking your mood altering medication)?
Yes
/ No
Have you ever used pain medication without really needing it for physical pain?
Yes
/ No
Have you ever used pain medication or other drugs (including alcohol) to cope with uncomfortable feelings or to manage stress?
Yes
/ No
Have you ever thought that you might have a problem with your prescription drug use?
Yes
/ No
Have you ever failed to finish home or work commitments because you were using pain medication (including alcohol) or drugs or were in withdrawal?
Yes
/ No
Have you ever seen a counselor or other professional for help about you prescription drug (or alcohol and/or other drug ) use?
Yes
/ No
Have you ever used more medication or used over a longer period of time than you originally intended?
Yes
/ No
Have you ever let other people down whom you cared about because you were using pain medication?
Yes
/ No
Have your family or friends ever been concerned about the amount of frequency of the pain medication you take?
Yes
/ No
Have you had arguments with your spouse or family members because of something that happened when you were using pain medication?
Yes
/ No
Have you ever been too sick to go to work as a result of using pain medication or other drugs? (This includes bad hangovers or withdrawal.)
Yes
/ No
Have you ever gotten physically sick as a result of taking your pain medication?
Yes
/ No
Have you ever continued using pain medication even though you knew they were causing problems or making you problems worse?
Yes
/ No
Has a doctor or counselor ever told you that he or she thought you had a serious problem with pain medication use?
Yes
/ No
Have you ever been a patient in a mental health clinic or hospital where using pain medication was at least a part of your problems?
Yes
/ No
Have you noticed a decrease in experiencing fun or pleasure as a result of taking the pain medication or recovering from its effects?
Yes
/ No
Have you experienced depression or even thoughts of suicide while taking pain medication?
Yes
/ No
Do you ever feel guilty or ashamed for taking pain medication?
Yes
/ No
Have you ever experienced the inability to remember events or blocks of time while under the influence of pain medication?
Yes
/ No
Have you ever been in a hospital as a direct (or indirect) result of taking pain medication?
Yes
/ No
Do you ever use your medication to feel high (euphoric)?
Yes
/ No
Have you ever lied to or mislead a doctor in order to receive more (or stronger) pain medication?
Yes
/ No
Do you panic when you cant get your pain medication as quickly as you would like (or get enough of your pain medication)?
Yes
/ No
Do you ever find yourself making excuses to use more medication than was prescribed by your doctor?
Yes
/ No
Did you feel uncomfortable or have the urge to lie (or rationalize/minimize) when answering any of the above questions?
Yes
/ No
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