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Substance Addiction Screening and Brief Intervention Therapy
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* Indicates required question
Name
*
Your answer
Email ID
*
Your answer
WhatsApp/ Mobile number
Your answer
Types of substances used
*
Alcohol
Tobacco
Cannabis
Other psychoactive substances
How do you classify your substance use pattern
Social user
Occasional user
Daily user
Compulsive user
Clear selection
Have you ever experienced increased tolerance? (Needing more quantity of substance to get same pleasure):
Yes
No
Clear selection
Motivation to Screening
To understand the level of addiction in me
To understand the disease concept
To seek professional help for managing addiction
To decide if further treatment is required.
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Where did you hear about us? (If referred by someone, please add the name in the last input)
Instagram/ Facebook
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Webinars
Youtube
Other:
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