James Fitzgerald Therapy, PLLC James Fitzgerald, MS, NCC, AAP, Psychotherapist Strengthening Your Conscious Self © 2022 Client Assessments Drug Abuse Screening Test (DAST 10) Please enable JavaScript in your browser to complete this form.General Instructions"Drug use" refers to (1) the use of prescribed or over‐the‐counter drugs in excess of the directions, and (2) any nonmedical use of drugs. The various classes of drugs may include cannabis (marijuana, hashish), solvents (e.g., paint thinner), tranquilizers (e.g., Valium), barbiturates, cocaine, stimulants (e.g., speed), hallucinogens (e.g., LSD) or narcotics (e.g., heroin). The questions do not include alcoholic beverages. Please answer every question. If you have difficulty with a statement, then choose the response that is mostly right. LayoutUser ID (number)DateThese questions refer to drug use within the past 12 months. Please answer no or yes. 1. Have you used drugs other than those required for medical reasons?NoYes2. Do you use more than one drug at a time?NoYes3. Are you always able to stop using drugs when you want to? NoYes4. Have you had "blackouts" or "flashbacks" as a result of drug use?NoYes5. Do you ever feel bad or guilty about your drug use?NoYes6. Does your spouse (or parents) ever complain about your involvement with drugs?NoYes7. Have you neglected your family because of your use of drugs?NoYes8. Have you engaged in illegal activities in order to obtain drugs? NoYes9. Have you ever experienced withdrawal symptoms (felt sick) when you stopped taking drugs? NoYes10. Have you had medical problems as a result of your drug use (e.g., memory loss, hepatitis, convulsions, bleeding, etc.)?NoYesCommentsIs there anything else you think your therapist should know about your drug use.Skinner HA (1982). The Drug Abuse Screening Test. Addictive Behavior. 7(4):363-371. Yudko E, Lozhkina O, Fouts A (2007). A comprehensive review of the psychometric properties of the Drug Abuse Screening Test. Journal of Substance Abuse Treatment. 32:189-198. SubmitSave and Resume Later Your form entry has been saved and a unique link has been created which you can access to resume this form. Enter your email address to receive the link via email. Alternatively, you can copy and save the link below. Please note, this link should not be shared and will expire in 30 days, afterwards your form entry will be deleted. Copy Link Email * Send Link