Lawrence Peltz Ph.D., MFT
Office: (415)
472-5688
Fax: (630) 839-6371
Northgate Medical Center · 750 Las Gallinas Ave., Suite #200 ·
San Rafael, CA 94903
Screening Tests
Please choose either item below.
Drug
Abuse Screening Test (DAST)
The purpose of the Alcohol Self Screening
Test is to help you discover:
- The pattern of your use of alcohol
- The extent of its effect on your social and family relationships
- The extent of its effect on your job or school performance
- Whether problems with tolerance or withdrawal exist
If you answer "yes" to one or more of the following questions, you may be experiencing some symptoms of alcohol abuse or dependency.
Please note that accurate screening and diagnosis for Alcohol Dependence requires the following:
A complete physical examination to identify physical concerns that may cause symptoms in common with mental disorders.
An in-person diagnostic interview conducted by a licensed mental health professional who is expert in mental health diagnosis.
This test is offered as a self-help aid and is not a substitute for expert clinical judgment by a licensed mental health professional. By using this test, you hereby agree to these terms and limitations.
1. In your opinion, was there ever a time when you tended to drink too much?
2. Did anyone ever voice concern about your drinking?
3. Did alcohol ever cause any problems for you?
4. Have you ever drunk much more than usual in order to get the same effect?
5. Did you ever get sick or get the shakes when you tried to cut down on your drinking?
6. Did you ever take a drink to get rid of the shakes or to cope with other symptoms of withdrawal?
7. Have you often drunk much more than you planned to?
8. Did you ever fail to cut down or stop drinking despite your best efforts?
9. Was there ever a time when you spent a lot of time drinking, drunk or hung over?
10. Have you given up or cut back on important activities because of your drinking? Examples include sports, work/school, and time with friends and family.
11. Have you continued to drink, even though you experienced any of the following problems: Depression, memory blackouts, undue suspiciousness or lack of motivation?
12. Have you continued to drink, even though you experienced physical problems from drinking? Some examples include liver problems, seizures and physical injuries.
Drug Abuse Screening Test (DAST)
Use this Drug Abuse Screening Test (DAST) to check
out possible problems with drug abuse. The test has been designed to help
decide if you, or someone you know, has characteristics and behaviors of
addiction.
This test is reprinted from: ADDICTIVE BEHAVIORS, Vol 7(4), 1982, pp 363-371, Skinner, "Drug Abuse Screening Test" with permission from Elsevier Science. It is offered as a self-help aid and is not a substitute for expert clinical judgement by a licensed mental health professional. By using this program, you hereby agree to these terms and limitations.
1. Have you used drugs other than those required for medical reasons?
2. Have you abused prescription drugs?
3. Do you abuse more than one drug at a time?
4. *Can you get through the week without using drugs (other than those
required for medical reasons)?5. *Are you always able to stop using drugs when you want to?
6. Do you abuse drugs on a continuous basis?
7. *Do you try to limit your drug use to certain situations?
8. Have you had "blackouts" or "flashbacks" as a result of drug use?
9. Do you ever feel bad about your drug abuse?
10. Does your spouse (or parents) ever complain about your involvement with drugs?
11. Do your friends or relatives know or suspect you abuse drugs?
12. Has drug abuse ever created problems between you and your spouse?
13. Has any family member ever sought help for problems related to your drug use?
14. Have you ever lost friends because of your use of drugs?
15. Have you ever neglected your family or missed work because of your use of drugs?
16. Have you ever been in trouble at work because of drug abuse?
17. Have you ever lost a job because of drug abuse ?
18. Have you gotten into fights when under the influence of drugs?
19. Have you ever been arrested because of unusual behavior while under the
influence of drugs?20. Have you ever been arrested for driving while under the influence of drugs?
21. Have you engaged in illegal activities to obtain drugs?
22. Have you ever been arrested for possession of illegal drugs?
23. Have you ever experienced withdrawal symptoms as a result of heavy drug intake?
24. Have you had medical problems as a result of your drug use (e.g., memor loss, hepatitis, convulsions, or bleeding)?
25. Have you ever gone to anyone for help for a drug problem?
26. Have you ever been in hospital for medical problems related to your drug use?
27. Have you ever been involved in a treatment program specifically related to drug use?
28. Have you been treated as an outpatient for problems related to drug abuse?
Scoring: Each positive response yields a point of 1, except for questions denoted with an asterisk. *Items 4, 5, and 7 are scored in the "no" or false direction.
A score of greater than five requires further evaluation for substance abuse problems.
Copyright © 2000 Lawrence Peltz, Ph.D.