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This questionnaire consists of twenty-eight questions about experiences that you may have in your daily life. We are interested in how often you have these experiences. It is important, however, that your answers show how often these experiences happen to you when you are not under the influence of alcohol or drugs.
To answer the questions, please determine to what degree the experience described in the question applies to you and circle the number to show what percentage of the time you have the experience.
| 0% | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100% |
| (never) |
| (always) |