Cocaine Addiction Quiz 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 Victoria Club Drugs Addiction Quiz Alcoholism Quiz
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