Substance Abuse Scale
DAST-10
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Patient Name
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When completing this form please think about:
This is a list of questions concerning information for your potential involvement with drugs (excluding alcohol or tobacco use)
Have you used drugs other than those required for medical reasons?
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Yes
No
Do you abuse more than one drug at a time?
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Yes
No
Are you always able to stop using drugs when you want to? (if never use drugs answer "yes")
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Yes
No
Have you had "blackouts" or "flashbacks" as a result of drug use?
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Yes
No
Have you used drugs other than those required for medical reasons?
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Yes
No
Have you used drugs other than those required for medical reasons?
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Yes
No
Have you used drugs other than those required for medical reasons?
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Yes
No
Have you used drugs other than those required for medical reasons?
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Yes
No
Submit
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