1. Do you ever use more cocaine than you planned?

2. Has the use of cocaine interfered with your job?

3. Is your cocaine use causing conflict with your spouse or family?

4. Do you feel depressed, guilty, or remorseful after you use cocaine?

5. Do you use whatever cocaine you have almost continuously until the supply is exhausted?

6. Have you ever experienced sinus problems or nosebleeds due to cocaine use?

7. Do you ever wish that you had never taken that first line, hit, or injection of cocaine?

8. Have you experienced chest pains or rapid or irregular heartbeats when using cocaine?

9. Do you have an obsession to get cocaine when you don't have it?

10. Are you experiencing financial difficulties due to your cocaine use?

11. Do you experience an anticipation high just knowing you are about to use cocaine?

12. After using cocaine, do you have difficulty sleeping without taking a drink or another drug?

13. Are you absorbed with the thought of getting loaded even while interacting with a friend or loved one?

14. Have you begun to use drugs or drink alone?

15. Do you use larger doses of drugs or alcohol to get the same high you once experienced?

16. Have you tried to quit or cut down on your cocaine use only to find that you couldn't?

17. Have any of your friends or family suggested that you may have a problem?

18. Have you ever lied to or misled those around you about how much or how often you use?

19. Do you use drugs in your car, at work, in the bathroom, on airplanes, or other public places?

20. Are you afraid that if you stop using cocaine or alcohol your work will suffer or you will lose your energy, motivation, or confidence?

21. Do you spend time with people or in places you otherwise would not be around but for the availability of drugs?

22. Have you ever stolen drugs or money from friends or family?