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The major dependence drug producing like -
| 01. | Have you used drugs other than those needed for medical reasons? | Yes | No |
| 02. | Do you misuse more than one drug at a time? | Yes | No |
| 03. | Are you always able to stop using drugs? | Yes | No |
| 04. | Have you ever had blackouts or flashbacks as a result of drug use? | Yes | No |
| 05. | Do you ever feel bad or guilty about your drug use? | Yes | No |
| 06. | Does your spouse (or your parents) ever complain about your involvement with drugs? | Yes | No |
| 07. | Have you neglected your family because of your use of drugs? | Yes | No |
| 08. | Have you engaged in illegal activities in order to obtain drugs? | Yes | No |
| 09. | Have you ever experienced withdrawal symptoms (felt sick) when you stopped taking drugs? | Yes | No |
| 10. | Have you had medical problems as a result of your drug use (such as memory loss, hepatitis, convulsions, bleeding)? | Yes | No |
| 1. | Is most of your drinking done in private or when you are alone? | Yes | No |
| 2. | Is there a specific time each day that you crave an alcoholic drink? | Yes | No |
| 3. | Do you need a drink first thing in the morning in order to function? | Yes | No |
| 4. | Do you drink in order to forget about your troubles and worries? | Yes | No |
| 5. | Do you have troubles sleeping because of your drinking? | Yes | No |
| 6. | Since you have begun drinking, have you found your ambition has decreased? | Yes | No |
| 7. | Is life at home unhappy because of your drinking? | Yes | No |
| 8. | Are you careless of the welfare of your family when you are under the influence of alcohol? | Yes | No |
| 9. | Has your drinking caused financial problems for you and / or your family? | Yes | No |
| 10. | Do you feel remorseful after your drink? | Yes | No |
| 11. | Have you ever had a loss of memory as a result of drinking? | Yes | No |
| 12. | When with others, do you tend to drink because you are anxious? | Yes | No |
| 13. | When drinking, do you find yourself hanging out with individual who are not a good influence? | Yes | No |
| 14. | Has your reputation been directly affected by your drinking? | Yes | No |
| 15. | Are you missing your work because of your drinking? | Yes | No |
| 16. | Have you become less efficient because you started drinking? | Yes | No |
| 17. | Have you ever been in a hospital or institution on account of drinking? | Yes | No |
| 18. | Do you lose time from work due to drinking? | Yes | No |
| 19. | Do you drink booze or shy with other people? | Yes | No |
| 20. | Do you drink to build up your self confidence? | Yes | No |


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