Answer YES or NO to the following questions:

Have you used drugs other than those required for medical reasons?
Have you abused prescription drugs?
Do you abuse more than one drug at a time?
Do you use other drugs, meaning, do you use drugs other than those required for medical reasons?
Is it difficult for you to stop using drugs when you want to?
Do you abuse drugs on a continuous basis?
Do you try to limit your drug use to certain situations?
Have you had "blackouts" or "flashbacks" as a result of drug use?
Do you ever feel bad about your drug abuse?
Does your spouse (or parents) ever complain about your involvement with drugs?
Do your friends or relatives know or suspect you abuse drugs?
Has drug abuse ever created problems between you and your spouse?
Has any family member ever sought help for problems related to drug use?
Have you ever lost friends because of your use of drugs?
Have you ever neglected your family or missed work because of your use of drugs?
Have you ever been in trouble at work because of drug abuse?
Have you ever lost a job because of drug abuse?
Have you gotten into fights when under the influence of drugs?
Have you ever been arrested because of unusual behavior while under the influence of drugs?
Have you ever been arrested for driving while under the influence of drugs?
Have you engaged in illegal activities in order to obtain drugs?
Have you been arrested for possession of dangerous drugs?
Have you ever experienced withdrawal symptoms as a result of heavy drug intake?
Have you had medical problems as a result of your drug use (e.g., memory loss, hepatitis, convulsions,
bleeding, etc.)?
Have you ever gone to anyone for help for a drug problem?
Have you ever been in a hospital for medical problems related to drug use?
Have you ever been involved in a treatment program specifically related to drug care?
Have you been treated as an out-patient for problems related to drug use?

Your score is equal to the number of questions you answered YES to.
A score of five or less points indicates a Normal Score.
A score of six or more points indicates a Drug Problem.
http://www.projectcork.org/clinical_tools/pdf/DAST.pdf