List the places where you are most likely to use cocaine / drugs / alcohol:

List the people with whom you are most likely to use cocaine / drugs / alcohol:

List and times or days when you are more likely to use cocaine / drugs / alcohol:

List any activities that make it more likely that you will use cocaine / drugs / alcohol:

Do you think that you use cocaine / drugs / alcohol when you are feeling certain ways?

Read through the following list and mark the ones that are relevant to you. For those you have marked, list specific examples from your own experience:
 
at the end of (or during) a tense day

when faced with something you fear or are anxious about

when you've failed to accomplish something you'd planned

when you feel you have been taken advantage of

when you are bored

when you are in a social situation

when you feel bad about yourself

when you are depressed

when you want to feel energized or high

when you are faced with a tough problem

when you want to be friendly

when you wish your personality was different

others not listed here
 

List the places where you are unlikely to use cocaine / drugs / alcohol:

List the people with whom you are unlikely to use cocaine / drugs / alcohol:

List the times or days when you are unlikely to use cocaine / drugs / alcohol:

List the activities you engage in when you are unlikely to use cocaine / drugs / alcohol: