For each substance you use, please put a checkmark in the box indicating how frequently you use the drug. For example, if you use cocaine once or twice per week, choose “Weekly”, while if you use cocaine 3-7 days per week choose “Daily".

DailyWeeklyMonthlyYearly
Alcohol
Cocaine
Ecstasy
Heroin
Marijuana
Methamphetamine
Oxycontin
Percocet
Ritalin
Tobacco
Valium
Vicodin
Xanax
YOUR TOTAL YEARLY SPENDING ON DRUGS
Select a Drug & a Time Frame to create a badge
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