Instructions:

The following questions concern information about your potential involvement with drugs not including alcoholic beverages during the past 12 months. Carefully read each statement and decide if your answer is "Yes" or "No".

In the statements "drug abuse" refers to (1) the use of prescribed or over the counter drugs in excess of the directions and (2) any non-medical use of drugs. The various classes of drugs may include: cannabis (e.g.marijuana,hash), solvents, tranquilizers (e.g.Valium), barbiturates, cocaine, stimulants (e.g.speed), hallucinogens (e.g. LSD) or
narcotics (e.g.heroin). Remember that the questions do not include alcoholic beverages.  

These questions refer to the past 12 months. Please answer every question. If you have difficulty with a statement, then choose the response that is mostly right.

1. Your answers will remain confidential so please be honest. Select one box that best describes your answer to each question.

2. Choose a quiet place, while taking the test.

3. Answer all questions by selecting under the appropriate answer.