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The Cocaine Addiction Severity Test (CAST) and Cocaine Assessment Profile (CAP) were used to assess alcohol, tobacco & other drug use. Purposes 1. For greater awareness regarding drug abuse and drug issues 2. For earlier identification and resolution of problems 3. Designed to gather valuable information about areas of clients life that may contribute to their substance-abuse problems A. Cocaine Addiction Severity Test 1. Do you have trouble turning down cocaine when it is offered to you? 2. Do you tend to use up whatever supplies of cocaine you have on hand even though you try to save
some for another time?

3. Have you been trying to stop using cocaine but find that somehow you always go back to it? 4. Do you go on cocaine binges for 24 hours or longer? 5. Do you need to be high on cocaine in order to have a good time? 6. Are you afraid that you will be bored or unhappy without cocaine? 7. Are you afraid that you will be less able to function without cocaine? 8. Does the sight, thought or mention of cocaine trigger urges and cravings for the drug? 9. Does the sight, thought or mention of cocaine trigger urges and cravings for the drug? 10. Do you sometimes feel an irresistible compulsion to use cocaine? 11. Do you feel psychologically addicted to cocaine? 12. Do you feel guilty and ashamed of using cocaine and like yourself less for doing it? 13. Have you been spending less time with "straight" people since you've been using more cocaine? 14. Are you frightened by the strength of your cocaine habit? 15. Do you tend to spend time with certain people or go to certain places because you know that cocaine
will be available?

16. Do you use cocaine at work? 17. Do people tell you that your behavior or personality has changed even though they might not know
its due to drugs?

18. Has cocaine led you to abuse alcohol or other drugs? 19. Do you ever drive a car while high on cocaine, alcohol, or other drugs? 20. Have you ever neglected any significant responsibilities at home or at work due to cocaine use? 21. Have your values and priorities been distorted by cocaine use? 22. Do you deal cocaine in order to support your use? 23. Would you be using even more cocaine if you had more money to spend on it or otherwise had
greater access to the drug?

24. Do you hide your cocaine use from straight friends or filmily because you afraid of their reactions? 25. Have you become less interested in health-promoting activities (e.g. exercise, sports, diet, etc.) due to
cocaine use?

26. Have you become less involved in your job or career due to cocaine use? 27. Do you find yourself lying and making excuses because cocaine use? 28. Do you tend to deny and downplay the severity of your cocaine problem?

29. Have you been unable to stop using cocaine even though you know that it is having negative effects in
your life?

30. Has cocaine use jeopardized your job or career? 31. Do you worry whether you are capable of living a normal and satisfying life without cocaine? 32. Are you having financial problems due to cocaine use? 33. Are you having problems with your spouse or mate due to cocaine use? 34. Has cocaine use had negative effects on your physical health? 35. Is cocaine having a negative effect on your mood or mental state? 36. Has your sexual functioning been disrupted by cocaine use? 37. Have you become less sociable due to cocaine use? 38. Have you missed days of work due to cocaine use? B. Cocaine Assessment Profile 1. How long ago did you first try cocaine? 2. How did you use it the first time? 3. How long did you use cocaine on an "occasional" basis before your use became regular and

4. Have you ever freebased? 5. Have you ever injected cocaine? 6. Currently, what is your usual method of use? 7. On average, how many grams of cocaine do you use per week? 8. How much money do you spend on cocaine per week? 9. On average, how many days per week do you use cocaine? 10. Do you tend to go on "binges"? If yes, how long does the binge usually last? How many grams do you
use during a typical binge?

11. In what types of situations do you usually use cocaine? (check all that apply)

Alone With spouse/mate With friends Morning Afternoon

stop completely?

At parties At home At work Evening Late Night Hepatitis Other infections Heart "flutters"

With other sexual partner

12. During what portion of the day do you usually use cocaine? (check all that apply)

13. Since you first started using cocaine on a regular basis, what is the longest time you've been able to 14. Check below any physical problems caused by your cocaine use:

Low energy Sleep problems Hands tremble

Runny Nose Nasal sores, bleeding Sinus congestion Headaches Cough, sore throat Chest congestions

Nausea Chills Seizures with loss of consciousness Excessive weight loss Black phlegm Others (describe)

15. Check below any negative effects of cocaine on your mood or mental state: 16. Check any negative effects of cocaine on you relationships with other people:

Caused relationship to break up Caused arguments with spouse/mate Spouse/mate has threatened to leave Harmed sexual relationship Became socially isolated and withdrawn Harmed ability to talk openly and honestly with others
17. Check any negative effects of cocaine on your work or studies:

Arrive late to work/school Spend too much time on breaks Miss days of work/school Harmed relationship with boss Reduced productivity at work/school Got fired from a job
18. Check any negative effects of cocaine use on your financial situation:

Used up all money in bank Gotten in debt

Unable to keep up with bills No extra money

19. Check any legal consequences of your cocaine use:

Arrested for possession or sale of cocaine Arrested for other crime(s) related to cocaine sale/use
20. Has your cocaine use caused you to:

Have a car accident Have an unwanted sexual encounter Physically hurt someone Have a physical fight with someone Attempt suicide Deal drugs Steal from work, family, or friends

Analysis (CAST) If youre answer is YES to one or more question, you may have a problem with cocaine, alcohol, and/or other mind-altering substances. Severity ratings are base on the following: 0-1 no real problem, treatment not indicated 2-3 slight problem, treatment probably not necessary 4-5 moderate problem, treatment necessary 6-7 considerable problem, treatment necessary 8-9 extreme problem, treatment absolutely necessary *the severity ratings scale allows for the interviewer to determine the seriousness of a clients problem. The higher the score is, the greater the need for treatment in each area or immediate intervention. *CAP is used only for the assessment on how a person uses and is affected by cocaine.