Updated
Original VAYEMA symptom and impact self-check – not a validated scale
Cocaine use concerns
Answer the symptom statements below to see which experiences and areas of daily life you report as most affected. These are original VAYEMA questions, not a validated diagnostic scale. No clinical severity or probability score is calculated.
Answers are processed only in this page by this assessment. They are not submitted, monitored or automatically saved. No name, email or account is required. Use a private device and clear your answers when finished.
For adults aged 18 and over. This self-check cannot diagnose or rule out a condition. Concerns about a child require an age-appropriate professional assessment.
Thinking about the past four weeks, how well does each statement describe your experience?
Additional context – not included in any questionnaire score
These are original VAYEMA questions, not a diagnostic instrument or a validated severity scale. They summarise the experiences you select and do not predict a diagnosis or future harm. Background condition information; this source does not endorse this self-check.
Begin with what made you seek an assessment
You might be worried about losing control at weekends, feeling low afterwards, a physical symptom or the effect on someone close to you. Explain that starting point without needing to decide the diagnosis first. The assessment should be a place to understand the pattern and appropriate support, not an examination that determines whether your difficulties are serious enough to deserve attention.
The NHS cocaine guidance describes an individual assessment of health and substance use. You do not need to use daily to raise a concern. A useful professional conversation includes your goals, reservations and practical circumstances rather than ending with the same programme regardless of the answers. Ask what the appointment can cover and whether any medical needs require a different service.
Describe the pattern without reconstructing every event
The clinician may ask about frequency, approximate amounts, route, the length of periods of use and what tends to happen afterwards. Include whether a planned limit changes, whether use occurs alone or in particular settings and how recovery affects the next day. These details help with care planning; they are not instructions to monitor or test your own limits.
A representative example may be enough to begin. If your recollection is uncertain, say so. Do not exaggerate to secure treatment or minimise to obtain a preferred setting. The aim is an accurate working account, including gaps. You can share sensitive details through the clinical conversation rather than place a full history in a marketing form or an unmonitored online worksheet.
Control, craving and consequences matter more than one number
Assessment may explore strong urges, repeated unsuccessful attempts to reduce, time spent around use, continued use despite problems and the effect on important activities. A person may maintain work while losing time, money, confidence or relationships elsewhere. The apparent amount alone does not describe the whole clinical picture. One consequence or one questionnaire answer is not a stand-alone diagnosis.
The understanding guide explains these patterns. Consider what has changed from your usual life and what you would like to regain. That might be a reliable weekend, less secrecy or the ability to keep an intended decision. These are useful discussion points without requiring you to prove that your circumstances resemble someone else’s experience of addiction.
Physical symptoms need their own clinical attention
Cocaine can have serious effects on the heart, brain and other systems. Tell the clinician about chest symptoms, fainting, seizures, severe headaches, overheating, breathing problems or injuries. Nasal, respiratory or injection-related concerns may also be relevant. MedlinePlus describes the range of health effects. A psychological explanation should not replace investigation of a concerning physical symptom.
If a serious symptom is happening now, contact emergency services rather than save it for the assessment. Do not assume you are protected by age, fitness or previous uneventful use. Tell the receiving team about cocaine and other substances as accurately as possible. They need that information to assess the situation, not a definite diagnosis from you. Do not drive yourself while unwell or impaired.
The crash, sleep and mood are important parts of assessment
Ask about fatigue, low mood, loss of pleasure, sleep changes and craving after use or reduction. The clinician should consider how severe these experiences are and whether they create immediate safety concerns. MedlinePlus withdrawal guidance notes that serious distress can occur even without the dramatic physical signs associated with some other withdrawals.
Suicidal thoughts, severe agitation or inability to stay safe must be communicated directly to an appropriate professional. Do not assume they are only a comedown that must be endured without help. Mention any attempts to manage symptoms with alcohol, sleeping medicines or other substances. The assessment can consider a safer plan; the worksheet cannot interpret your mood or monitor changes after you leave the page.
Include all substances, prescriptions and relevant history
Alcohol, opioids, cannabis, other stimulants and prescribed medicines can change risk and treatment decisions. A clinician needs the whole picture, including recent starts, stops and missed prescriptions. You do not need to decide which substance is the main problem before being heard. Some combinations or simultaneous withdrawals may require specialist medical care rather than separate self-help plans.
Previous treatment is also useful: what approach was used, whether it addressed cocaine specifically, what helped and why it ended. A phrase such as counselling did not work can cover very different experiences. The assessor should explore the actual intervention and barriers rather than infer that all treatment is unsuitable. Relevant earlier records can help when available, but should not delay necessary medical attention.
Know what screening and drug tests can show
A screening questionnaire may organise selected information about substance use. Toxicology testing may indicate exposure within the limits of a particular test. Neither independently establishes the diagnosis, explains motivation or selects treatment. Results need interpretation alongside symptoms, prescriptions, timing and the clinical conversation. Ask what a proposed test is intended to clarify and how the result will affect your care.
This page does not reproduce a validated cocaine screening scale or provide a probability score. The original prompts are unscored preparation. A result from another website should not override concerning symptoms or decide that outpatient care is safe. The ASAM/AAAP guideline treats assessment, intoxication, withdrawal and continuing treatment as connected but distinct clinical tasks.
Ask about a cocaine-specific treatment recommendation
After assessment, you should understand the working conclusions, immediate priorities and proposed next step. Ask about behavioural care, including contingency management and CBT where appropriate and available. The professional should explain what sessions involve, which goals they address and how progress will be reviewed. A general statement that a clinic treats addiction is not a substitute for a concrete plan.
The treatment guide explains these approaches and the role of medical input. The recommended intensity should follow health, safety and practical needs. Individual outpatient sessions, more coordinated support or another service may be appropriate. A high self-test result should not automatically lead to residential treatment or a larger programme, and a lower result should not prevent a useful clinical conversation.
Keep preparation optional and private
The prompts can help you choose a few points to bring to the appointment. Leave anything blank, mark uncertainty and avoid identifying details about other people. The worksheet does not send answers, generate an inquiry or alert a clinician. It does not assign a diagnosis, assess the severity of intoxication or determine whether symptoms can safely wait. Current concerns need direct clinical communication.
You may review or deliberately download your notes. A downloaded file stays on your device and should be kept privately. Clear the page when finished, especially on a shared device. You can also attend without completing any questions. Preparation should reduce the burden of the appointment, not require an extensive history or repeated self-checking before a professional will help you consider the next step.
Agree practical arrangements and a review point
Discuss availability, treatment language, costs and appointment format before committing to care. Online or in-person sessions may have different practical requirements, and medical examination may still be needed. Ask who will coordinate information if several clinicians are involved and how questions are handled between appointments. Routine communication should have clear response arrangements rather than imply continuous monitoring.
VAYEMA’s assessment pathway can clarify suitable expertise or referral. Care coordination may support agreed handovers, while family support can address relatives’ concerns independently. The person should understand the next action and who is responsible. Emergency symptoms belong with local urgent services, not a website form or the next scheduled review.
Frequently asked questions about cocaine assessment
Is this a cocaine addiction test with a score?
No. It is an original, unscored preparation worksheet. It can help organise concerns for a clinician, but cannot confirm or rule out addiction, interpret a drug test or establish safety. A professional assessment considers the pattern, health and consequences together rather than making a decision from these prompts.
Can I ask for assessment if I do not use every day?
Yes. Daily use is not required for a pattern to become harmful or difficult to control. Explain what happens during periods of use and afterwards, including attempts to change. The assessment should consider your actual circumstances rather than require a particular frequency before support is offered.
What if I feel too ashamed to describe the amount?
You can say that the subject feels difficult and begin with your main concern. A respectful clinician should help you give an accurate account without humiliation. Estimates and uncertainty can be discussed. The purpose is safer planning, not proving that you are a good or bad person through a particular answer.
Should I wait until the comedown has passed?
Do not postpone medical help for serious symptoms or severe distress. Chest pain, collapse, seizures, dangerous agitation or inability to stay safe needs prompt or emergency care. A planned assessment can be arranged when appropriate, but an online timeline should not determine whether current symptoms are safe to ignore.
Can my partner attend without receiving all my clinical information?
Discuss the arrangement with the service. A trusted person can help with practical support or observations while you also have private time. Agree what can be shared and for what purpose. Their assistance or financial involvement should not be treated as automatic access to every assessment detail.
Will writing urgent symptoms here alert VAYEMA?
No. The worksheet is not transmitted or monitored. Use the actual routine inquiry route for appointment arrangements and direct medical or emergency services for urgent symptoms. An optional downloaded note is only a file under your control, not a clinical notification or proof that a professional has reviewed it.
Resources and references
[1] NHS: Cocaine addiction and getting help
[2] MedlinePlus: Cocaine health effects