UNCOPE Screening Tool UNCOPE Question 1 * Have you continued to use alcohol or drugs longer than you intended? Yes No UNCOPE Question 2 * Have you ever neglected some of your usual responsibilities because of alcohol or drug use? Yes No UNCOPE Question 3 * Have you ever wanted to cut down or stop using alcohol or drugs but couldn’t? Yes No UNCOPE Question 4 * Has your family, a friend, or anyone else ever told you that they objected to your alcohol or drug use? Yes No UNCOPE Question 5 * Have you ever found yourself preoccupied with wanting to use alcohol or drugs? Yes No UNCOPE Question 6 * Have you ever used alcohol or drugs to relieve emotional discomfort, such as sadness, anger, or boredom? Yes No Name * First Name Last Name Email * Phone * (###) ### #### Thank you! Our Intake and Compliance Specialist will contact you soon.
