Drug Abuse Assessment

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1-888-687-7332

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Please complete the following form and click Submit. We will contact you as soon as possible regarding the results. Your information is confidential and will only be seen by the River Source staff. Fields marked * are required.

Name: *

(At least your first name is required)

Email Address: *

Phone Number:

Are you unhappy with the way your life is going?:

Yes

Do you feel you may have a problem with drugs?:

Yes

Are you preoccupied with thoughts of using drugs?:

Yes

Can you stop using drugs on your own?:

Yes

Do you use drugs continuously?:

Yes

Do you use more than one drug at a time?:

Yes

Are using drugs causing problems with your job?:

Yes

Have your relationships been negatively affected?:

Yes

Do you refuse to go places where you cannot use drugs?:

Yes

Do you need to use drugs to have fun socially?:

Yes

Do you do things that are illegal to get drugs?:

Yes

Do you lie about using drugs?:

Yes

Do you use drugs to escape your problems?:

Yes

Have you had medical problems from using drugs?:

Yes

Has drug use resulted in legal problems?:

Yes

Do you worry that friends or family know you use drugs?:

Yes

Do you have withdrawal when you cannot get drugs?:

Yes

Do you ever crave drugs?:

Yes

Do you use drugs to cope with fear or anger or depression?:

Yes

Are you willing and able to get treatment at The River Source?:

Yes

Testimonials

"My mother found the River Source online and I am so happy she did! It had great reviews, Daniel was instrumental in getting me to come for a tour. When I took the tour it seemed like a clean, safe place and everyone was really welcoming—staff and clients. My experience was amazing! I am a completely different person from when I checked in. River Source helped me grow spiritually and exposed me to a fellowship that is truly lifesaving! My life is exciting and I am full of hope! I have..."

Aaron C. - November 2011

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