Questionnaire

Do You or Your Loved One Have a Problem?

1. Has your personality changed since you began using drugs or alcohol?
2. Have you ever experienced any legal consequences for your use of drugs or alcohol (i.e. DUI, possession, public intoxication, etc.)?
3. Has your use had any negative effects on your work or school performance?  (Have you been late to work, been absent, not completed tasks in a timely manner, had poor performance, etc.?)
4. Has anyone close to you expressed a concern about your use of drugs or alcohol?
5. Do you think about drugs or alcohol during your day?
6. Do you find thoughts about drugs or alcohol intrusive? (Do you think about it when you do not want to?)
7. Have you ever tried to stop using drugs or alcohol?
8. Do you think of ways to make time to use drugs or alcohol?
9. Do you look forward to getting finished at work or the weekend so that you may use drugs or alcohol?
10. Have you ever drank or used when you did not want to?
11. Have you ever drank or used more than you wanted to?
12. Have you ever overdosed?
13. Have you ever blacked out while under the influence?
14. Have you ever behaved in a manner outside of your moral code while under the influence (i.e. sexual indiscretion, driving under the influence, stealing, etc.)?
15. Has your tolerance changed? (Can you consume more or less than you used to?)
16. Have you ever felt that you needed to drink or use to get started in your day?
17. Have you ever used drugs or alcohol to “get through a tough time”?
18. Have you ever had to explain your drug or alcohol use to others?
19. Have you experienced any medical problems related to your use of drugs or alcohol?  (This could include injuries that occur while under the influence.)
20. Do you have friends and family that use alcohol?
21. Have your friends (that you drink or use with) ever commented that your use is worse than theirs?
22. Do you have any non-using friends that you associate with regularly?
23. Do family members or friends avoid you because of your use?
24. Have you ever lost a relationship because of your use (i.e. divorce, separation, estrangement, etc.)?
25. Have you ever used money to purchase drugs or alcohol that should have been spent attending to other financial responsibilities?
26. Have you ever had to borrow money from someone to pay your bills because you have used your money to purchase drugs or alcohol?

If you answered “Yes” to 5 questions or more, this is a strong indicator that you or your loved one may have a problem with drug or alcohol addiction. 

For further information, please contact us at 800-684-6614, 24 hours a day/7 days a week.