Do
I Need Treatment?
- I drink or use drugs to relieve feelings of stress when I'm under pressure.
Yes
No
- Whenever I have a reason to celebrate—for example, a job promotion,
birthday, or anniversary—drinking or using drugs isone of the first things
I make a point of doing.
Yes
No
- I sometimes drink or use drugs heavily after a disappointment or rough day.
Yes
No
- I sometimes feel slightly guilty about my drinking or drug use.
Yes
No
- I experience memory blackouts during or after drinking or using drugs.
Yes
No
- When sober, I sometimes regret things I've said or done while intoxicated.
Yes
No
- I've often failed to keep promises about controlling my drinking or drug
use.
Yes
No
- I usually drink or use drugs after a confrontation or argument to relieve
my uncomfortable feelings.
Yes
No
- I sometimes have a drink or use a drug first thing in the morning to steady
my nerves or get rid of a hangover.
Yes
No
- I designate a set time of the day--for instance, anytime after 4:00 in the
afternoon--when it’s okay to begin drinking or using drugs.
Yes
No
- I sometimes stay drunk or high from drugs for more than a few days at a
time.
Yes
No
- When I start using, I'm in more of a hurry to get my first "fix"
than I used to be.
Yes
No
- I pretty much avoid going places where my drinking or drug use is not acceptable.
Yes
No
- Having a drink or using drugs isusually the first things I do when I come
home at the end of the day.
Yes
No
- I feel annoyed about comments on my alcohol or drug use.
Yes
No
- I feel guilt or shame about my use of alcohol or other drugs.
Yes
No
- I have been charged for Driving Under the Influence.
Yes
No
- I have experienced other legal problems and/or accidents as a result of
my use of alcohol or other drugs.
Yes
No
- I use alcohol or other drugs to build up my self-confidence.
Yes
No
- Alcohol or other drug use is jeopardizing my job or business.
Yes
No
- I have been to a hospital or other institution due to alcohol or other drug
use.
Yes
No
- I use alcohol or other drugs when I am alone.
Yes
No
- I socialize primarily with people who drink or use other drugs.
Yes
No
- I use substances at work or during school.
Yes
No
- I use a variety of drugs.
Yes
No
- I am losing friends because of my drug usage.
Yes
No
- I am at risk of losing my job or failing in school.
Yes
No
