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Alcohol and Drug Screening

Your answers on this form are confidential.

Alcohol

One drink = 12 oz. beer, 5 oz. wine or 1.5 oz. liquor (one shot)
How many times in the past year have you had 4 or more drinks in a day?*

Drugs

Recreational drugs include methamphetamines (speed, crystal) cannabis (marijuana, pot), inhalants (paint thinner, aerosol, glue), tranquilizers (Valium), barbiturates, cocaine, ecstasy, hallucinogens (LSD, mushrooms), or narcotics (heroin).
How many times in the past year have you used a recreational drug or used a prescription medication for non-medical reasons?*