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Drug Abuse Screening Test (DAST-10) (NM800037)

Drug Abuse Screening Test (DAST-10) (NM800037) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Questionnaires



Patient Name

DOB:

MR #


NM#800037 (Rev. 06/05/17) Worksheet Only – Not a Medical Record Document
UW Health uwhealth.org
(University of Wisconsin Hospitals and Clinics Authority)
DRUG USE QUESTIONNAIRE (DAST-10)






DRUG USE QUESTIONNAIRE (DAST-10)

The following questions concern information about your possible involvement with drugs not including alcoholic beverages
during the past 12 months. Carefully read each statement and decide if your answer is “Yes” or “No”. Then, circle the
appropriate response beside the question.

In the statements “drug abuse” refers to (1) the use of prescribed or over the counter drugs may include: cannabis (e.g.
marijuana, hash), solvents, tranquilizers (e.g. Valium), barbiturates, cocaine, stimulants (e.g. speed), hallucinogens (e.g.
LSD) or narcotics (e.g. heroin). Remember that 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.

These questions refer to the past 12 months. Circle Your
Response
1. Have you used drugs other than those required for medical reasons? Yes No
2. Do you abuse more than one drug at a time? Yes No
3. Are you always able to stop using drugs when you want to? Yes No
4. Have you had “blackouts” or “flashbacks” as a result or drug use? Yes No
5. Do you ever feel bad or guilty about your drug use? Yes No
6. Does your spouse (or parents) ever complain about your involvement Yes No
with drugs?

7. Have you neglected your family because of your use of drugs? Yes No
8. Have you engaged in illegal activities in order to obtain drugs? Yes No
9. Have you ever experienced withdrawal symptoms (felt sick) when you Yes No
stopped taking drugs?

10. Have you had medical problems as a result of your drug use Yes No
(e.g. memory loss, hepatitis, convulsions, bleeding, etc.)?


© Copyright 1982 by Harvey A. Skinner, PhD and the Centre for Addiction and Mental Health, Toronto, Canada. You may
reproduce this instrument for non-commercial use (clinical, research, training purposes) as long as you credit the author Harvey
A. Skinner, Department of Public Health Sciences, University of Toronto.