SDS Assessment Form
Client's First Name:
Client's Last Name:
1. Do you think your use of (drug) is out of control?
--None--
Never/almost never
Sometimes
Often
Always/nearly always
2. Did the prospect of missing a fix (or dose) make you anxious or worried?
--None--
Never/almost never
Sometimes
Often
Always/nearly always
3. Did you worry about your use of (drug)?
--None--
Never/almost never
Sometimes
Often
Always/nearly always
4. Did you wish you could stop?
--None--
Never/almost never
Sometimes
Often
Always/nearly always
5. How difficult did you find it to stop or go without (drug)?
--None--
Not difficult
Quite difficult
Very difficult
Impossible
Submit
