MAP Substance Use Questionnaire
Substance use affects more than 21 million Americans, regardless of race, education or career path. If you are questioning your relationship with alcohol or other drugs, you are not alone. Use this questionnaire to reflect on your use of substances.
Note: This questionnaire is not meant to be diagnostic, but can be useful for your own introspection.
- Do you ever use substances for something other than a medical reason?
- When you use a substance, do you then want to use more than one drug a time?
- Do you find yourself using more and more drugs or alcohol in order to get the same feeling or high?
- Have you ever felt like you should cut back on your substance use?
- Have you ever tried to stop using substances but found you couldn’t despite your best efforts?
- Do you ever misuse substances while alone?
- Do you ever use substances to cope with negative feelings, stress, or other traumatic events?
- Have you ever misled someone about the extent of your substance use or hidden it from family or friends?
- Do you ever feel ashamed or guilty after using substances?
- Have your relationships with friends or family become distant or strained due to your substance use?
- Have your family or friends talked to you about your substance use?
- While under the influence of substances, have you gotten into arguments or fights with other people?
- Has your substance use caused problems or gotten you into trouble at your workplace?
- Have you ever engaged in risky or dangerous behavior due to your substance use?
- When you stop taking substances, do you experience any withdrawal symptoms or feel sick?
- Have you ever had medical problems such as blackouts, memory loss, hepatitis, convulsions, or bleeding as a result of your substance use?
- Are you unable to get through the week without using substances?
- Do you find yourself thinking a lot about how to obtain substances?
- Have you ever looked for or received help for a substance use issue?
Thank you for taking the time to explore and reflect on your substance use through this survey. The Member Assistance Program is here to support you and help you explore any questions or feelings you may have.
The Member Assistance Program is available Monday through Friday, from 10 a.m. to 6 p.m., and can be reached by phone at 212-701-9620, or by email at MAPrecovery@uft.org. All inquiries are confidential.