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Section 1 of 23
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Section 2 of 23
Section 3 of 23
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1.
I understand
2.
Option 2
3.
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Section 4 of 23
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Section 5 of 23
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Section 6 of 23
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Section 7 of 23
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Section 8 of 23
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Section 9 of 23
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Section 10 of 23
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Yes
Column 2
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Row 1
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Row 1
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Section 11 of 23
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Section 12 of 23
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My substance abuse is currently present or has been present in the past six months.
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add "Other"
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My substance abuse is currently present or has been present in the past six months.
I have been free of substance abuse in past six months or longer or have NEVER had a substance abuse problem
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add "Other"
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Section 13 of 23
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Section 14 of 23
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Strongly disagree
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add "Other"
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