Cocaine Addiction Quiz - Affordable Drug Rehab

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Cocaine Addiction Quiz

While not a substitute for professional diagnosis, completing a quiz can help clarify the severity of the situation and encourage individuals to seek further support if needed.

Fill Out Information Below

Cocaine Addiction Quiz

Fill out the quiz below to get an assessment if you or someone you care about is suffering

Name

Email

Phone

Do you frequently use cocaine in large amounts whenever it is available?

Yes

No

None

Do you find yourself doing more cocaine in order to achieve the same high you had reached in prior experiences?

Yes

No

None

Do you experience withdrawals such as fatigue, sleep disturbances, anxiety or depression when you stop using cocaine?

Yes

No

None

Do you find yourself unable to stop using cocaine once you’ve started?

Yes

No

None

Have you been unable to successfully quit cocaine despite your best efforts?

Yes

No

None

Have you ever consulted a healthcare professional to help you quit?

Yes

No

None

Have you ever continually neglected any family responsibility or other obligation because of cocaine?

Yes

No

None

Have you ever lost a job or friends because of cocaine?

Yes

No

None

Have you ever committed a crime (aside from purchasing or possessing the drug) to obtain cocaine?

Yes

No

None

Have you ever been arrested for using or possessing cocaine?

Yes

No

None

Do you use cocaine more than once a week?

Yes

No

None

Since using cocaine, have you experienced paranoia, hallucinations, delusions or seizures?

Yes

No

None

Since using cocaine, have you had an issue with weight loss?

Yes

No

None

Since using cocaine, have you had any problems with your heart, gastrointestinal tract or kidneys?

Yes

No

None

Since using cocaine, have you had any problems with nasal perforations or your respiratory system?

Yes

No

None

Have you ever gone to the hospital because of cocaine?

Yes

No

None

Time's up

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