Cocaine Addiction Questionnaire

Is cocaine costing you more than just money? Use our cocaine addiction questionnaire below to help identify the severity of your cocaine binges. Once cocaine addiction starts to take hold the consequences can affect every aspect of a persons life. As the habit progresses  they will isolated through guilt and shame, but still continue to use. Promises to self and others are broken. As an experienced addiction counsellor I can help you change your behaviour.

The cocaine addiction questionnaire below will help you objectively measure your use. Pay close attention to the cocaine test results when you have completed. Take the advised action before cocaine removes everything you care about. Call us on 01227 290 098 for an appointment with a qualified addiction counsellor. For information about our cocaine addiction counselling click here

Please answer every question. Contact us here.

Your advice is shown here once you have completed the cocaine addiction questionnaire submitted your answers.

1. Have you used drugs other than those required for medical reasons?
2. Do you abuse more than one drug at a time?
3. Are you always able to stop using the drug when you want to?
4. Have you had “blackouts” or “flashbacks” as a result of drug use?
5. Have you neglected work or missed days due to drug use?
6. Do you ever feel bad or guilty about your drug use?
7. Does your spouse or loved one ever complain about your involvement with drugs?
8. Have you neglected your family because of your use of drugs?
9. Have you engaged in illegal activities in order to obtain drugs?
10. Have you ever experienced withdrawal symptoms when you stopped taking drugs?
11. Have you had medical problems as a result of your drug use (e.g., sinus issues, memory loss, hepatitis, convulsions, bleeding etc)?