ASSIST - Peer Assistance Services

Cocaine

Based on your answers, you may be at high risk of dependence or you may be dependent on substance(s) and are probably experiencing health, social, financial, legal and relationship problems as a result of your use. It is recommended to abstain from drugs (including misused prescription medication) as there are no known safe levels of use. Meeting with a counselor can help you to get the support needed to improve health outcomes and develop a treatment plan. We strongly encourage you to discuss the results of your screening with your healthcare provider.

Risk Level
High

Amphetamine

Risk Level
High

Opioids

Risk Level
High

Inhalants

Risk Level
High

Alcohol

Based on your answers, you may be at high risk of dependence or you may be dependent on alcohol and are probably experiencing health, social, financial, legal and relationship problems as a result of your use. By abstaining from alcohol, you may be able to eliminate some of the associated health risks.

Men, age 21 to 65, should have no more than 4 standard drinks per day and no more than 14 in a week.

Women, and men over 65, should have no more than 3 standard drinks per day and no more than 7 within a week.

Avoid alcohol, if you:

Are pregnant, may become pregnant, or breastfeeding.
Are taking prescription or over-the-counter medications that can interact with alcohol.
Have a health condition that can be made worse by alcohol.
Will be driving or operating machinery, or doing any other activity that requires coordination.

Risk Level
High

Cannabis

Risk Level
High

Sedatives

Risk Level
High

Tobacco

Based on your answers, you scored in the high risk category; there are no safe levels of smoking or using smokeless tobacco. It is advised that you consider quitting or cutting back your use. We strongly encourage you to talk with your healthcare provider about tobacco cessation options or call 1-800-Quit-Now to participate in a tobacco cessation program.

Risk Level
High

Hallucinogens

Risk Level
High

Injection Drugs

Based on your answers, you may be at high risk for developing a severe substance use disorder due to the drugs you are using by injection. Use of injection drugs may lead to, health, social, legal, and financial problems. Use of injection drugs increases your risk for health problems such as HIV, sexually transmitted infections, Hepatitis C, Hepatitis B, skin infections, heart disease and other cardiovascular problems, and other serious health problems. Meeting with a counselor can help you to get the support needed to improve health outcomes and develop a treatment plan. We strongly encourage you to discuss the results of your screening with your health care provider. If you continue to use injection drugs, you can take steps to reducing your risk of developing infections. For those living outside of the Denver area, see: www.detoxlocal.com/needle-exchanges/colorado to find a harm reduction center in your area. If you reside in Denver, contact the Harm Reduction Action Center in Denver here: harmreductionactioncenter.org for needle exchange and testing.

Risk Level
High

Other

Risk Level
High

Cocaine

Based on your answers, you have been using drugs and scored in the moderate high risk level. It is recommended to abstain from drugs (including misused prescription medication) as there are no known safe levels of use. By not using drugs, you will be able to reduce some of the negative health consequences as well as legal, financial and relationship difficulties with friends and family. Meeting with a substance treatment provider may help you to get the support needed to improve your health. We encourage you to discuss the results of your screening with your healthcare provider.

Risk Level
Moderate High

Amphetamine

Based on your answers, you have been using drugs and scored in the moderate-high risk level. It is recommended to abstain from drugs (including misused prescription medication) as there are no known safe levels of use. By not using drugs, you will be able to reduce some of the negative health consequences as well as legal, financial and relationship difficulties with friends and family. Meeting with a substance treatment provider may help you to get the support needed to improve your health. We encourage you to discuss the results of your screening with your healthcare provider.

Risk Level
Moderate High

Opioids

Risk Level
Moderate High

Inhalants

Risk Level
Moderate High

Alcohol

Based on your answers, you are drinking above the recommended drinking guidelines and scored in the moderate-high risk level. It is recommended you take steps to reduce or abstain from consuming alcohol. By reducing your drinking, you may be able to eliminate some of the associated health risks.

Men, age 21 to 65, should have no more than 4 standard drinks per day and no more than 14 in a week.

Women, and men over 65, should have no more than 3 standard drinks per day and no more than 7 within a week.

Avoid alcohol, if you:

Are pregnant, may become pregnant, or breastfeeding.
Are taking prescription or over-the-counter medications that can interact with alcohol.
Have a health condition that can be made worse by alcohol.
Will be driving or operating machinery, or doing any other activity that requires coordination.

Risk Level
Moderate High

Cannabis

Risk Level
Moderate High

Sedatives

Risk Level
Moderate High

Tobacco

Based on your answers, you scored in the moderate-high risk category; there are no safe levels of smoking or using smokeless tobacco. It is advised that you consider quitting or cutting back your use. We encourage you to talk with your healthcare provider about tobacco cessation options or call 1-800-Quit-Now to participate in a tobacco cessation program.

Risk Level:
Moderate High

Hallucinogens

Risk Level
Moderate High

Injection Drugs

Based on your answers, you may be at risk for negative health problems due to injection drug use even though you have not used injection drugs in the past three months It is recommended that you continue to abstain from injection drug use. If you have not already, it is also recommended that you see a healthcare provider to be tested for infections such as, HIV, Hepatitis B, Hepatitis C, and other infections that may occur if you have used injection drugs even one time in the past

Risk Level
Moderate High

Other

Risk Level
Moderate High

Cocaine

Based on your answers, you scored in the moderate-low risk level. If you continue to use at this level, you may be at risk of developing negative health, social, legal and financial problems. It is recommended to abstain from drugs (including misused prescription medication) as there are no known safe levels of use.

Risk Level
Moderate Low

Amphetamine

Risk Level
Moderate

Opioids

Risk Level
Moderate Low

Inhalants

Risk Level
Moderate Low

Alcohol

Based on your answers, you scored in the moderate-low risk level. If you continue to drink at this level, you may be at risk of experiencing negative health and social consequences.

Men, age 21 to 65, should have no more than 4 standard drinks per day and no more than 14 in a week.

Women, and men over 65, should have no more than 3 standard drinks per day and no more than 7 within a week.

Avoid alcohol, if you:

Are pregnant, may become pregnant, or breastfeeding.
Are taking prescription or over-the-counter medications that can interact with alcohol.
Have a health condition that can be made worse by alcohol.
Will be driving or operating machinery, or doing any other activity that requires coordination.

Risk Level
Moderate Low

Cannabis

Based on your answers, you scored in the moderate-low risk level. If you continue to use at this level, you may be at risk for developing negative health, social, legal and financial problems in the future. The best recommendation for health and other reasons is to abstain from all drug use, including taking another person’s prescription medications or your own prescription medications in ways they were not prescribed.

Risk Level
Moderate Low

Sedatives

Risk Level
Low Moderate

Tobacco

Based on your answers, you scored in the moderate-low risk category; there are no safe levels of smoking or using smokeless tobacco. It is advised that you consider quitting or cutting back your use. We encourage you to talk with your healthcare provider about tobacco cessation options or call 1-800-Quit-Now to participate in a tobacco cessation program.

Risk Level:
Moderate Low

Hallucinogens

Risk Level
Low Moderate

Other

Risk Level
Moderate Low

Cocaine

Based on your responses, you may be at a low risk of experiencing negative health and social consequences from your use. It is recommended to abstain from drugs (including misused prescription medication) as there are no known safe levels of use. Abstaining from all illegal and illicit substances is the best choice to protect your health and other areas of your life.

Risk Level
Low

Amphetamine

Risk Level
Low

Opioid

Risk Level
Low

Inhalants

Risk Level
Low

Alcohol

Based on your responses, you may be at a low risk of experiencing negative health and social consequences from your use.

Men, age 21 to 65, should have no more than 4 standard drinks per day and no more than 14 in a week.

Women, and men over 65, should have no more than 3 standard drinks per day and no more than 7 within a week.

Avoid alcohol, if you:

Are pregnant, may become pregnant, or breastfeeding.
Are taking prescription or over-the-counter medications that can interact with alcohol.
Have a health condition that can be made worse by alcohol.
Will be driving or operating machinery, or doing any other activity that requires coordination.

Risk Level:
Low

Cannabis

Risk Level
Low

Sedatives

Risk Level
Low

Tobacco

There are no safe levels of smoking or using smokeless tobacco. If you use tobacco, it is advised that you consider quitting or cutting back on your use. Please talk to your healthcare provider about tobacco cessation options or call 1-800-Quit-Now to participate in a tobacco cessation program.

Risk Level:
Low

Hallucinogens

Risk Level
Low

Injection Drugs

Your answers indicated that you are at low risk of experiencing or developing negative health, social, legal and financial problems due to injection drug use. The best recommendation for health and other reasons is to continue abstaining from all injection drug use and use of any illegal and illicit substances.

In your life, which of the following substances have you ever used?

a. Tobacco products (cigarettes, chewing tobacco, cigars, etc.)

b. Alcoholic beverages (beer, wine, spirits, etc.)

c. Cannabis (marijuana, pot, grass, hash, etc.)

d. Cocaine (coke, crack, etc.)

e. Amphetamine type stimulants (speed, diet pills, ecstasy, etc.)

f. Inhalants (nitrous, glue, petrol, paint thinner, etc.)

g. Sedatives or Sleeping Pills (Valium, Serepax, Rohypnol, etc.)

h. Hallucinogens (LSD, acid, mushrooms, PCP, Special K, etc.)

i. Opioids (heroin, morphine, methadone, codeine, etc.)

j. Other (please specify)

In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?

a. Tobacco products (cigarettes, chewing tobacco, cigars, etc.)

b. Alcoholic beverages (beer, wine, spirits, etc.)

c. Cannabis (marijuana, pot, grass, hash, etc.)

d. Cocaine (coke, crack, etc.)

e. Amphetamine type stimulants (speed, diet pills, ecstatsy, etc.)

f. Inhalants (nitrous, glue, petrol, paint thinner, etc.)

g. Sedatives or Sleeping Pills (Valium, Serepax, Rohypnol, etc.)

h. Hallucinogens (LSD, acid, mushrooms, PCP, Special K, etc.)

i. Opioids (heroin, morphine, methadone, codeine, etc.)

j. Other

During the past three months, how often have you had a strong desire or urge to use (first drug, second drug, etc)?

a. Tobacco products (cigarettes, chewing tobacco, cigars, etc.)

b. Alcoholic beverages (beer, wine, spirits, etc.)

c. Cannabis (marijuana, pot, grass, hash, etc.)

d. Cocaine (coke, crack, etc.)

e. Amphetamine type stimulants (speed, diet pills, ecstasy, etc.)

f. Inhalants (nitrous, glue, petrol, paint thinner, etc.)

g. Sedatives or Sleeping Pills (Valium, Serepax, Rohypnol, etc.)

h. Hallucinogens (LSD, acid, mushrooms, PCP, Special K, etc.)

i. Opioids (heroin, morphine, methadone, codeine, etc.)

j. Other

During the past three months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems?

a. Tobacco products (cigarettes, chewing tobacco, cigars, etc.)

b. Alcoholic beverages (beer, wine, spirits, etc.)

c. Cannabis (marijuana, pot, grass, hash, etc.)

d. Cocaine (coke, crack, etc.)

e. Amphetamine type stimulants (speed, diet pills, ecstasy, etc.)

f. Inhalants (nitrous, glue, petrol, paint thinner, etc.)

g. Sedatives or Sleeping Pills (Valium, Serepax, Rohypnol, etc.)

h. Hallucinogens (LSD, acid, mushrooms, PCP, Special K, etc.)

i. Opioids (heroin, morphine, methadone, codeine, etc.)

j. Other

During the past three months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)?

a. Tobacco products (cigarettes, chewing tobacco, cigars, etc.)

b. Alcoholic beverages (beer, wine, spirits, etc.)

c. Cannabis (marijuana, pot, grass, hash, etc.)

d. Cocaine (coke, crack, etc.)

e. Amphetamine type stimulants (speed, diet pills, ecstasy, etc.)

f. Inhalants (nitrous, glue, petrol, paint thinner, etc.)

g. Sedatives or Sleeping Pills (Valium, Serepax, Rohypnol, etc.)

h. Hallucinogens (LSD, acid, mushrooms, PCP, Special K, etc.)

i. Opioids (heroin, morphine, methadone, codeine, etc.)

j. Other

Has a friend or relative or anyone else ever expressed concern about your use of (first drug, second drug, etc)?

a. Tobacco products (cigarettes, chewing tobacco, cigars, etc.)

b. Alcoholic beverages (beer, wine, spirits, etc.)

c. Cannabis (marijuana, pot, grass, hash, etc.)

d. Cocaine (coke, crack, etc.)

e. Amphetamine type stimulants (speed, diet pills, ecstasy, etc.)

f. Inhalants (nitrous, glue, petrol, paint thinner, etc.)

g. Sedatives or Sleeping Pills (Valium, Serepax, Rohypnol, etc.)

h. Hallucinogens (LSD, acid, mushrooms, PCP, Special K, etc.)

i. Opioids (heroin, morphine, methadone, codeine, etc.)

j. Other

Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?

a. Tobacco products (cigarettes, chewing tobacco, cigars, etc.)

b. Alcoholic beverages (beer, wine, spirits, etc.)

c. Cannabis (marijuana, pot, grass, hash, etc.)

d. Cocaine (coke, crack, etc.)

e. Amphetamine type stimulants (speed, diet pills, ecstasy, etc.)

f. Inhalants (nitrous, glue, petrol, paint thinner, etc.)

g. Sedatives or Sleeping Pills (Valium, Serepax, Rohypnol, etc.)

h. Hallucinogens (LSD, acid, mushrooms, PCP, Special K, etc.)

i. Opioids (heroin, morphine, methadone, codeine, etc.)

j. Other

Have you ever used any drug by injection? (non-medical use only)