C.A.P. Pre-Survey

Identifying your level of dependence on cannabis

One of the first things that is useful in overcoming cannabis dependence is to understand the extent of your own dependence.

Please answer the following 5 questions thinking back over the last 3 months.

Question Title

* 1. Class Date

When class begins

Date

Question Title

* 2. Name

Question Title

* 3. Have you ever thought your use of cannabis was out of control?

Never or almost never (0)

Sometimes (1)

Often (2)

Always or nearly always (3)

Never or almost never (0)

Sometimes (1)

Often (2)

Always or nearly always (3)

Question Title

* 4. Did the possibility of missing a chance to smoke make you anxious or worried?

Never or almost never (0)

Sometimes (1)

Often (2)

Always or nearly always (3)

Never or almost never (0)

Sometimes (1)

Often (2)

Always or nearly always (3)

Question Title

* 5. Do you ever worry about your use of cannabis?

Not at all (0)

A little(1)

Quite a lot (2)

A great deal (3)

Not at all (0)

A little(1)

Quite a lot (2)

A great deal (3)

Question Title

* 6. Do you wish you could stop using marijuana?

Never or almost never (0)

Sometimes (1)

Often (2)

Always or nearly always (3)

Never or almost never (0)

Sometimes (1)

Often (2)

Always or nearly always (3)

Question Title

* 7. How difficult do you find it to stop or go without?

Not Difficult (0)

Quite Difficult (1)

Very Difficult (2)

Impossible (3)

Not Difficult (0)

Quite Difficult (1)

Very Difficult (2)

Impossible (3)