Kenneth Minkoff, M.D.
PMB 319
100 Powdermill Road
Acton, MA 01720

MENTAL ILLNESS DRUG & ALCOHOL SCREENING
MIDAS
Each question refers to the past six months	YES	NQ
1. Do you feel that you have a problem with your use of drugs and/or alcohol and/or gambling?	YES	NO
2. Do you use drugs, alcohol or gambling even though your doctor or other treaters recommend that you do not?	YES	NO
3. Is your family concerned about your drugs and/or alcohol or gambling?	YES	NO
4. Are your treaters concerned about your drugs and/or alcohol or gambling?	YES	NO
5. Have you had legal problems or engaged in illegal activity (other than using drugs) due to drugs and/or alcohol or gambling?	YES	NO
6. Have your had medical problems related to, or worsened by, drugs and/or alcohol or gambling?	YES	NO
7. Do you use drugs and alcohol or gambling to relieve mental health symptoms?	YES	NO
8. Do you find that using drugs and/or alcohol or gambling worsens your mental health symptoms?	YES	NO
9. Do you have problems taking your psychiatric medication as prescribed because of drug and/or alcohol use or gambling?	YES	NO
10. Have you gotten in trouble, including getting in trouble at a mental health treatment program, because of drug and/or alcohol use or gambling?	YES	NO
11. Have you had ER visits or psychiatric hospitalizations that were connected to drug and/or alcohol use or gambling?	YES	NO
12. Do you ever feel guilty about your drug and/or alcohol use or gambling?	YES	NO
13. Have you experienced withdrawal symptoms or intense cravings to	YES	NO

use drugs or alcohol or to gamble? 14. Have you attended self-help (e.g.., 12 Step) meetings relating to drug	YES	NO
and/or alcohol addiction or gambling? 15. Have you received any addiction treatment, including	YES	NO
detoxification? 16. Have you felt unable to control your use of any drug or alcohol or	YES	NO
gambling? 17. Do you consider yourself to be an alcoholic or drug addict or	YES	NO
gambling addict?
Scoring: Any YES answer on questions 1-12 indicates probable abuse. Any YES answer on questions 13-17 indicates probable dependence.
Clinician should rate his/her perception of the client's reliability and commitment to answering the
questions: High, Moderate, Low.
NB: Total score may be an indicator of severity, but even a low score can indicate probable
substance abuse or dependence.
Inconsistent or scattered scores are likely indicators of denial, defensiveness, or minimization.