If you are in a state of crisis or need immediate help for any reason, please refrain from filling out this assessment and call 911. If you feel that you are a danger to yourself, please refrain from filling out this assessment and contact the National Suicide Prevention Lifeline at 1-800-273-8255.

This online Prescription Drug Addiction assessment takes approximately five minutes and will provide general feedback when completed. Please note that this assessment is not a formal diagnostic tool and should not be interpreted as such. This assessment is free and can be taken anonymously, if you choose.

If you answer “yes” to any of the questions provided, it is highly recommended that you contact the staff at The Refuge – A Healing Place or another qualified healthcare provider. If you would prefer to be contacted by the staff at The Refuge – A Healing Place, please leave your contact information in the space provided at the end of this assessment. Please note that by leaving your information, you consent to allow The Refuge – A Healing Place to use this information to contact you. Any information provided will remain confidential. If you choose to not leave your information, the staff at The Refuge – A Healing Place will not contact you.

If you answer “no” to the questions provided, you are still encouraged to reach out to the staff at The Refuge – A Healing Place or another qualified healthcare provider for a detailed evaluation of your risk for Prescription Drug Addiction.

1. Have you ever had problems in school, at work, or in social settings related to your use of prescription drugs?

Yes No

2. Do you need prescription drugs to get going in the morning, or to relax at night?

Yes No

3. Have you ever had legal problems related to your prescription drug use, such as being cited for driving while impaired?

Yes No

4. Do you use prescription drugs in an attempt to cope with stress, pressure, and other negative experiences?

Yes No

5. Have you used a prescription drug in larger quantities, more frequently, or for a longer period of time than directed by your doctor or pharmacist?

Yes No

6. Have you ever borrowed or stolen drugs that were prescribed to someone else?

Yes No

7. Have you ever exaggerated or lied about symptoms to a doctor in order to get a prescription for the drug that you have been using?

Yes No

8. Have you ever visited multiple doctors, or claimed that you lost a prescription, in order to get more of the drug that you have been using?

Yes No

9. Have you ever lied to or otherwise attempted to deceive friends, family members, or colleagues about your prescription drug use?

Yes No

10. Do you feel as though you need to use prescription drugs in order to enjoy yourself at parties, sporting events, or other social gatherings?

Yes No

11. Have you ever tried and failed to reduce the amount or frequency of your prescription drug use?

Yes No

12. When you’re not able to take a prescription drug when you want one, or when you’re trying to cut down or stop your prescription drug use, do you begin to feel anxious, agitated, physically ill, or otherwise not right?

Yes No

13. Have friends or loved ones ever expressed concern to you about your prescription drug use?

Yes No

14. Are you worried that you might have a problem with prescription drugs?

Yes No

Thank you for taking The Refuge's Drug Screening.

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Disclaimer: The Refuge – A Healing Place disclaims any liability, loss, or risk sustained as a consequence, directly or indirectly, of the use and application of these assessments.

Free Confidential Prescription Drug Addiction Assessment

1. Have you ever had problems in school, at work, or in social settings related to your use of prescription drugs?

2. Do you need prescription drugs to get going in the morning, or to relax at night?

3. Have you ever had legal problems related to your prescription drug use, such as being cited for driving while impaired?

4. Do you use prescription drugs in an attempt to cope with stress, pressure, and other negative experiences?

5. Have you used a prescription drug in larger quantities, more frequently, or for a longer period of time than directed by your doctor or pharmacist?

6. Have you ever borrowed or stolen drugs that were prescribed to someone else?

7. Have you ever exaggerated or lied about symptoms to a doctor in order to get a prescription for the drug that you have been using?

8. Have you ever visited multiple doctors, or claimed that you lost a prescription, in order to get more of the drug that you have been using?

9. Have you ever lied to or otherwise attempted to deceive friends, family members, or colleagues about your prescription drug use?

10. Do you feel as though you need to use prescription drugs in order to enjoy yourself at parties, sporting events, or other social gatherings?

11. Have you ever tried and failed to reduce the amount or frequency of your prescription drug use?

12. When you’re not able to take a prescription drug when you want one, or when you’re trying to cut down or stop your prescription drug use, do you begin to feel anxious, agitated, physically ill, or otherwise not right?

13. Have friends or loved ones ever expressed concern to you about your prescription drug use?

14. Are you worried that you might have a problem with prescription drugs?

Thank you for taking The Refuge's Drug Screening.