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Drug Screening Questionnaire (DAST)

Drug Screening Questionnaire (DAST) Using drugs can affect your health and some medications you may take. Please help us provide you with the best medical care by answering the questions below. P ati ent n m : Date of birth: Which recreational drugs have you used in the past year? (Check all that apply)

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The recommended behavior change is to abstain from use and accept the referral. More resources: www.sbirtoregon.org * Johnson J, Lee A, Vinson D, Seale P. “Use of AUDIT-Based Measures to Identify Unhealthy Alcohol Use and Alcohol Dependence in Primary Care: A Validation Study.” Alcohol Clin Exp Res, Vol 37, No S1, 2013: pp E253–E259

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