Comprehensive Health Assessment Page 5
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10Comprehensive Health Assessment
—continued
Not true/
Somewhat true/
Mostly true/
Very true/
Alcohol, Tobacco, and Other Drug Use
rarely
sometimes
usually
always
1. I abstain or drink in moderation when offered alcoholic
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4
beverages.
2. I abstain from using illegal psychoactive (mind-altering)
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4
drugs.
3. I do not consume alcoholic beverages or psychoactive
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4
drugs rapidly or in large quantities.
4. I do not use alcohol or psychoactive drugs in a way that
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4
causes me to behave inappropriately.
5. My use of alcohol or other drugs does not compromise my
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4
academic performance.
6. I refrain from drinking alcoholic beverages or using
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psychoactive drugs when engaging in recreational activities
that require strength, speed, or coordination.
7. I refrain from drinking alcoholic beverages while partici-
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pating in occupational activities, regardless of the nature
of those activities.
8. My use of alcohol or other drugs does not generate
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4
financial concerns for myself or for others.
9. I refrain from drinking alcohol or using psychoactive
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drugs when driving a motor vehicle or operating heavy
equipment.
10. I do not drink alcohol or use psychoactive drugs when
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I am alone.
11. I avoid riding with people who have been drinking alcohol
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or using psychoactive drugs.
12. My use of alcohol or other drugs does not cause family
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dysfunction.
13. I do not use marijuana.
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14. I do not use hallucinogens.
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15. I do not use heroin or other illegal intravenous drugs.
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4
16. I do not experience blackouts when I drink alcohol.
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17. I do not become abusive or violent when I drink alcohol or
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use psychoactive drugs.
18. I use potentially addictive prescription medication
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in complete compliance with my physician’s
directions.
19. I do not smoke cigarettes.
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20. I do not use tobacco products in any other form.
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21. I minimize my exposure to secondhand smoke.
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22. I am concerned about the effect that alcohol, tobacco,
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and other drug use is known to have on developing
fetuses.
23. I am concerned about the effect that alcohol, tobacco, and
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other drug use is known to have on the health of other
people.
24. I seek natural, health-enhancing highs rather than relying
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on alcohol, tobacco, and illegal drugs.
25. I take prescription medication only as instructed, and
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I use over-the-counter medication in accordance with
directions.
POINTS ________
Chapter One Shaping Your Health
23
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