addiction-self-assessment

What this skill does

# Addiction & Substance Self-Assessment

This is not a lecture. Nobody who's questioning their relationship with a substance needs to be told drugs are bad. You already know something is off or you wouldn't be here. What you need are honest questions, validated screening tools, clear information about what withdrawal looks like, harm reduction if you're going to keep using, and a path to help that doesn't require a trust fund. That's what this is.

```agent-adaptation
# Localization note — addiction screening tools are clinically validated internationally.
# Treatment systems and helplines are jurisdiction-specific.
- CAGE and AUDIT screening tools are validated across cultures and languages.
  Apply them regardless of jurisdiction.
- Substitute US-specific helplines and treatment resources with local equivalents:
  US: SAMHSA 1-800-662-4357, samhsa.gov
  UK: NHS drug and alcohol helpline, FRANK 0300-123-6600, talktofrank.com
  Australia: Alcohol Drug Information Service (ADIS), state-based numbers
  Canada: ConnexOntario 1-866-531-2600, Canadian Centre on Substance Use and Addiction
  EU: Varies by country — search "[country] substance abuse helpline"
- 12-step availability (AA/NA) is global but density varies.
  SMART Recovery is available online worldwide.
- Treatment cost structures differ dramatically by country.
  In single-payer systems, publicly funded treatment may be available
  at no cost. Adjust financial guidance accordingly.
- Legal status of substances varies by jurisdiction.
  Never provide guidance that assumes US drug scheduling.
```

## Sources & Verification

- **CAGE Questionnaire** -- Ewing, J.A. (1984). "Detecting Alcoholism: The CAGE Questionnaire." JAMA. Validated four-question screening tool.
- **AUDIT Tool** -- World Health Organization. Alcohol Use Disorders Identification Test. 10-question validated screening. [who.int](https://www.who.int/publications/i/item/audit-the-alcohol-use-disorders-identification-test-guidelines-for-use-in-primary-health-care)
- **SAMHSA** -- Substance Abuse and Mental Health Services Administration. [samhsa.gov](https://www.samhsa.gov/). Free 24/7 helpline: 1-800-662-4357.
- **NIDA** -- National Institute on Drug Abuse. [nida.nih.gov](https://nida.nih.gov/). Research-based information on substance use disorders.
- **SMART Recovery** -- Evidence-based mutual support alternative to 12-step. [smartrecovery.org](https://www.smartrecovery.org/)
- **Harm Reduction International** -- Principles and evidence base for harm reduction approaches. [hri.global](https://www.hri.global/)

## When to Use

- User is questioning whether their drinking has become a problem
- Someone wants an honest self-assessment of their substance use
- User mentions they're using more than they used to, or using alone
- Someone is worried about a family member's substance use
- User asks about withdrawal symptoms or detox safety
- Someone wants to cut back but doesn't know where to start
- User needs affordable or free treatment options
- Someone mentions compulsive behaviors (gambling, gaming, phone use) that feel out of control

## Instructions

### Step 1: Start with honest questions — not judgment

**Agent action**: Ask these questions directly. Don't soften them, don't hedge. The user came here because they want honesty.

```
HONEST SELF-CHECK (ask yourself these first):

-> Is your use the same as it was 6 months ago, or has it increased?
-> Is it the first thing you think about after work?
-> Do you use alone more than you used to?
-> Have people close to you mentioned it? More than once?
-> Have you set rules for yourself about use — and broken them?
-> Do you feel defensive reading these questions?
-> Have you tried to stop or cut back and couldn't?
-> Do you need more than you used to for the same effect?
-> Have you missed work, obligations, or plans because of use?
-> Do you keep using despite it causing problems you can see?

If you answered yes to 3 or more: keep reading. This isn't a diagnosis.
It's information.
```

### Step 2: Clinical screening — the CAGE questionnaire

**Agent action**: Walk the user through CAGE. Four questions, yes/no. Score it honestly.

```
THE CAGE QUESTIONNAIRE (validated clinical screening):

Answer yes or no:

1. Have you ever felt you should CUT DOWN on your drinking/use?
2. Have people ANNOYED you by criticizing your drinking/use?
3. Have you ever felt bad or GUILTY about your drinking/use?
4. Have you ever had a drink/used first thing in the morning to
   steady your nerves or get rid of a hangover? (EYE-OPENER)

SCORING:
- 0-1 yes answers: Low concern. Monitor yourself honestly.
- 2-3 yes answers: Clinically significant. This warrants a deeper look.
  Consider the AUDIT below and talk to a doctor.
- 4 yes answers: Strong indicator of dependence.
  This is not a death sentence. But you need help, and it exists.

Note: CAGE was designed for alcohol but applies to other substances.
It's a screening tool, not a diagnosis. A score of 2+ means
"talk to a professional" — not "you're an addict."
```

### Step 3: The AUDIT tool — deeper alcohol screening

**Agent action**: If the user's concern is specifically alcohol, walk through the full AUDIT. Score each question 0-4.

```
WHO AUDIT (Alcohol Use Disorders Identification Test):

Rate each question 0-4:

1. How often do you have a drink containing alcohol?
   0=Never  1=Monthly or less  2=2-4x/month  3=2-3x/week  4=4+x/week

2. How many drinks on a typical drinking day?
   0=1-2  1=3-4  2=5-6  3=7-9  4=10+

3. How often do you have 6+ drinks on one occasion?
   0=Never  1=Less than monthly  2=Monthly  3=Weekly  4=Daily/almost daily

4. How often in the last year could you not stop drinking once started?
   0=Never  1=Less than monthly  2=Monthly  3=Weekly  4=Daily/almost daily

5. How often in the last year did you fail to do what was expected
   because of drinking?
   0=Never  1=Less than monthly  2=Monthly  3=Weekly  4=Daily/almost daily

6. How often in the last year did you need a drink in the morning
   to get going?
   0=Never  1=Less than monthly  2=Monthly  3=Weekly  4=Daily/almost daily

7. How often in the last year did you feel guilt or remorse after drinking?
   0=Never  1=Less than monthly  2=Monthly  3=Weekly  4=Daily/almost daily

8. How often in the last year were you unable to remember the night before?
   0=Never  1=Less than monthly  2=Monthly  3=Weekly  4=Daily/almost daily

9. Have you or someone else been injured because of your drinking?
   0=No  2=Yes, but not in the last year  4=Yes, in the last year

10. Has a relative, friend, doctor, or health worker been concerned
    about your drinking or suggested you cut down?
    0=No  2=Yes, but not in the last year  4=Yes, in the last year

SCORING:
- 0-7:   Low risk.
- 8-15:  Hazardous use. Time for changes. Harm reduction applies here.
- 16-19: Harmful use. Professional help is strongly recommended.
- 20-40: Possible dependence. Medical supervision for any changes.
         Do NOT stop drinking suddenly — see withdrawal section below.
```

### Step 4: Behavioral addiction screening

**Agent action**: For non-substance compulsive behaviors, use this framework.

```
BEHAVIORAL ADDICTION SCREENING:

For gambling, gaming, compulsive phone/social media use, shopping,
pornography, or other compulsive behaviors — ask:

1. Do you spend more time on it than you intend to? Regularly?
2. Do you feel restless or irritable when you try to stop?
3. Have you tried to cut back and failed?
4. Do you use it to escape problems or relieve bad moods?
5. Have you lied to others about how much time/money you spend on it?
6. Has it caused problems in your relationships, work, or finances?
7. Do you keep doing it despite those problems?

4+ yes answers: This pattern is consistent with compulsive behavior
that warrants professional evaluation.

For gambling specifically: the National Council on Problem Gambling
helpline is 1-800-522-4700 (24/7, free, confidential).
```

### Step 5: Harm r