Substance Use Craving Assessment Form
Please complete this assessment to help us understand your recent craving experiences and patterns related to substance use.
Which substance have you experienced cravings for most recently?
*
Please Select
Alcohol
Nicotine
Cannabis
Prescription medication (not as prescribed)
Stimulants (e.g., cocaine, amphetamines)
Opioids (e.g., heroin, fentanyl, painkillers)
Other
How intense was your strongest craving in the past week?
*
1
2
3
4
5
6
7
8
9
10
How often did you experience cravings in the past week?
*
Never
Once or twice
Several times
Daily
Multiple times per day
When are you most likely to experience cravings?
*
Morning
Afternoon
Evening
Night
Other
How long do your cravings typically last?
*
Less than 5 minutes
5–15 minutes
15–30 minutes
More than 30 minutes
In which situations do you most commonly experience cravings?
*
When alone
With certain people
At social events
When feeling stressed
After work or school
Other
Which feelings do you associate most with your cravings?
*
Stress
Anxiety
Happiness
Boredom
Loneliness
Other
How difficult is it for you to resist cravings when they occur?
*
Very easy
1
2
3
4
5
6
Very difficult
7
1 is Very easy, 7 is Very difficult
How often do you act on your cravings?
*
Never
Rarely
Sometimes
Often
Always
Please rate the following aspects of your recent craving experiences.
*
Rows
Frequency
Intensity
Duration
Low
1
2
3
Moderate
4
5
6
High
7
8
9
Submit Assessment
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