Addiction Self Assessment

# Localization note — addiction screening tools are clinically validated internationally.
# Treatment systems and helplines are jurisdiction-specific.
- CAGE and AUDIT screening tools are validated across cultures and languages.
  Apply them regardless of jurisdiction.
- Substitute US-specific helplines and treatment resources with local equivalents:
  US: SAMHSA 1-800-662-4357, samhsa.gov
  UK: NHS drug and alcohol helpline, FRANK 0300-123-6600, talktofrank.com
  Australia: Alcohol Drug Information Service (ADIS), state-based numbers
  Canada: ConnexOntario 1-866-531-2600, Canadian Centre on Substance Use and Addiction
  EU: Varies by country — search "[country] substance abuse helpline"
- 12-step availability (AA/NA) is global but density varies.
  SMART Recovery is available online worldwide.
- Treatment cost structures differ dramatically by country.
  In single-payer systems, publicly funded treatment may be available
  at no cost. Adjust financial guidance accordingly.
- Legal status of substances varies by jurisdiction.
  Never provide guidance that assumes US drug scheduling.

HONEST SELF-CHECK (ask yourself these first):

-> Is your use the same as it was 6 months ago, or has it increased?
-> Is it the first thing you think about after work?
-> Do you use alone more than you used to?
-> Have people close to you mentioned it? More than once?
-> Have you set rules for yourself about use — and broken them?
-> Do you feel defensive reading these questions?
-> Have you tried to stop or cut back and couldn't?
-> Do you need more than you used to for the same effect?
-> Have you missed work, obligations, or plans because of use?
-> Do you keep using despite it causing problems you can see?

If you answered yes to 3 or more: keep reading. This isn't a diagnosis.
It's information.

THE CAGE QUESTIONNAIRE (validated clinical screening):

Answer yes or no:

1. Have you ever felt you should CUT DOWN on your drinking/use?
2. Have people ANNOYED you by criticizing your drinking/use?
3. Have you ever felt bad or GUILTY about your drinking/use?
4. Have you ever had a drink/used first thing in the morning to
   steady your nerves or get rid of a hangover? (EYE-OPENER)

SCORING:
- 0-1 yes answers: Low concern. Monitor yourself honestly.
- 2-3 yes answers: Clinically significant. This warrants a deeper look.
  Consider the AUDIT below and talk to a doctor.
- 4 yes answers: Strong indicator of dependence.
  This is not a death sentence. But you need help, and it exists.

Note: CAGE was designed for alcohol but applies to other substances.
It's a screening tool, not a diagnosis. A score of 2+ means
"talk to a professional" — not "you're an addict."

WHO AUDIT (Alcohol Use Disorders Identification Test):

Rate each question 0-4:

1. How often do you have a drink containing alcohol?
   0=Never  1=Monthly or less  2=2-4x/month  3=2-3x/week  4=4+x/week

2. How many drinks on a typical drinking day?
   0=1-2  1=3-4  2=5-6  3=7-9  4=10+

3. How often do you have 6+ drinks on one occasion?
   0=Never  1=Less than monthly  2=Monthly  3=Weekly  4=Daily/almost daily

4. How often in the last year could you not stop drinking once started?
   0=Never  1=Less than monthly  2=Monthly  3=Weekly  4=Daily/almost daily

5. How often in the last year did you fail to do what was expected
   because of drinking?
   0=Never  1=Less than monthly  2=Monthly  3=Weekly  4=Daily/almost daily

6. How often in the last year did you need a drink in the morning
   to get going?
   0=Never  1=Less than monthly  2=Monthly  3=Weekly  4=Daily/almost daily

7. How often in the last year did you feel guilt or remorse after drinking?
   0=Never  1=Less than monthly  2=Monthly  3=Weekly  4=Daily/almost daily

8. How often in the last year were you unable to remember the night before?
   0=Never  1=Less than monthly  2=Monthly  3=Weekly  4=Daily/almost daily

9. Have you or someone else been injured because of your drinking?
   0=No  2=Yes, but not in the last year  4=Yes, in the last year

10. Has a relative, friend, doctor, or health worker been concerned
    about your drinking or suggested you cut down?
    0=No  2=Yes, but not in the last year  4=Yes, in the last year

SCORING:
- 0-7:   Low risk.
- 8-15:  Hazardous use. Time for changes. Harm reduction applies here.
- 16-19: Harmful use. Professional help is strongly recommended.
- 20-40: Possible dependence. Medical supervision for any changes.
         Do NOT stop drinking suddenly — see withdrawal section below.

BEHAVIORAL ADDICTION SCREENING:

For gambling, gaming, compulsive phone/social media use, shopping,
pornography, or other compulsive behaviors — ask:

1. Do you spend more time on it than you intend to? Regularly?
2. Do you feel restless or irritable when you try to stop?
3. Have you tried to cut back and failed?
4. Do you use it to escape problems or relieve bad moods?
5. Have you lied to others about how much time/money you spend on it?
6. Has it caused problems in your relationships, work, or finances?
7. Do you keep doing it despite those problems?

4+ yes answers: This pattern is consistent with compulsive behavior
that warrants professional evaluation.

For gambling specifically: the National Council on Problem Gambling
helpline is 1-800-522-4700 (24/7, free, confidential).

HARM REDUCTION BASICS:

If you are going to use, these practices reduce your risk of death
and serious harm:

ALCOHOL:
-> Eat before drinking. Pace: one drink per hour maximum.
-> Alternate with water (one for one).
-> Set a number before you start. Stop at that number.
-> Never mix with benzodiazepines or opioids. This combination kills.
-> If you're questioning your use, track it: every drink, every day,
   for two weeks. The data will tell you what your brain won't.

ALL SUBSTANCES:
-> Never use alone. If you're going to use, have someone present
   who knows what you took and can call 911.
-> Test your substances. Fentanyl test strips are cheap and save lives.
   Fentanyl is now in everything — pills, cocaine, counterfeit meds.
-> Start with a small amount, especially with a new batch or supplier.
-> Know what you're mixing. Combinations are what kill most people.
-> Keep naloxone (Narcan) accessible. It reverses opioid overdose.
   Available without prescription at most pharmacies.

THESE ARE NOT ENDORSEMENTS. This is reducing the chance of dying.

WITHDRAWAL REALITY:

ALCOHOL WITHDRAWAL:
Severity: MEDICALLY DANGEROUS. Can be fatal.
-> Symptoms begin 6-24 hours after last drink
-> Mild: tremors, anxiety, nausea, insomnia, sweating
-> Moderate: hallucinations (24-48 hrs), elevated heart rate/BP
-> Severe: seizures (12-48 hrs), delirium tremens (48-96 hrs)
-> Delirium tremens has a 5-15% mortality rate without treatment
*** NEVER cold-turkey heavy daily drinking without medical supervision ***
*** If you drink daily, talk to a doctor before stopping ***
Medical detox uses benzodiazepines to prevent seizures. This is safe
and effective when supervised. Inpatient detox is typically 3-7 days.

BENZODIAZEPINE WITHDRAWAL:
Severity: MEDICALLY DANGEROUS. Similar to alcohol.
-> Can cause seizures and death
-> Requires a medical taper — slow dose reduction over weeks/months
-> Never stop benzos abruptly after regular use
-> A doctor MUST supervise this process

OPIOID WITHDRAWAL:
Severity: Extremely unpleasant but rarely fatal in healthy adults.
-> Onset: 8-24 hours after last use (heroin/short-acting),
   24-72 hours (long-acting/methadone)
-> Symptoms: muscle pain, sweating, diarrhea, vomiting, insomnia,
   anxiety, restless legs — peaks at 48-72 hours
-> Duration: acute phase 5-10 days
-> What helps: Medication-Assisted Treatment (MAT) with buprenorphine
   (Suboxone) or methadone. These are not "replacing one drug with
   another" — they are evidence-based treatment. Period.

STIMULANT WITHDRAWAL (cocaine, amphetamines):
Severity: Not medically dangerous but psychologically brutal.
-> Crash phase: extreme fatigue, depression, increased appetite
-> Duration: 1-2 weeks acute, mood issues can persist months
-> Risk: severe depression and suicidal ideation during crash
-> No medication protocol — support, sleep, nutrition, monitoring

FREE AND LOW-COST TREATMENT:

SAMHSA HELPLINE: 1-800-662-4357
-> Free, confidential, 24/7, 365 days
-> English and Spanish
-> Referrals to local treatment, support groups, community organizations
-> They will help you find what you can afford

SAMHSA TREATMENT LOCATOR: findtreatment.gov
-> Search by location, insurance, substance, treatment type

FREE MUTUAL SUPPORT:
-> AA (Alcoholics Anonymous): aa.org — free, meetings everywhere,
   anonymous. 12-step model. Works for many people.
-> NA (Narcotics Anonymous): na.org — same model for all substances.
-> SMART Recovery: smartrecovery.org — evidence-based alternative
   to 12-step. Uses CBT techniques. Online and in-person meetings.
   No religious/spiritual component.

COMMUNITY MENTAL HEALTH CENTERS:
-> Most communities have CMHCs with sliding-scale fees
-> Search: "[your county] community mental health center"
-> Many offer substance abuse treatment alongside mental health

STATE-FUNDED PROGRAMS:
-> Every state has publicly funded treatment for people without
   insurance or ability to pay
-> Call SAMHSA helpline to find your state's programs

MEDICATION-ASSISTED TREATMENT (MAT):
-> For opioid use: buprenorphine (Suboxone) can be prescribed by
   any qualified doctor — you don't need a special clinic anymore
-> For alcohol: naltrexone (reduces cravings, available as daily pill
   or monthly injection) and acamprosate
-> These medications are covered by most insurance and Medicaid

WHEN TO GO TO THE ER:
-> Seizures or history of seizures during withdrawal
-> Hallucinations
-> Chest pain or heart racing during withdrawal
-> Suicidal thoughts
-> Vomiting so severe you can't keep fluids down
-> Confusion or disorientation
-> You are withdrawing from alcohol or benzos after heavy daily use