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The information you provide is completely confidential.

It’s your informational tool. If you decide help is needed, refer to this self-assessment when you consult a counselor and recovery center.

Question Yes No
1. Have you tried to stop using drugs or abusing alcohol — but couldn’t?
2. Do you avoid places and people that don’t approve of your drinking or using drugs?
3. Do you ever feel defensive, guilty or ashamed about using drugs or alcohol?
4. Have you substituted one drink or drug for another, thinking the switch would help you?
5. Do you drink or use drugs when you wake up or go to bed?
6. Does using or drinking interfere with sleeping or eating?
7. Have you lied about how much you drink or use?
8. Has your drinking or using drugs caused problems with your family or your work?
9. Is alcohol or drugs making life at home unhappy?
10. How many days of work or classes have your missed because of drinking or using?
11. Do you have blackouts or times you can’t remember when you’ve been drinking or using?
12. Do you get extra drugs or alcohol at a party, because you feel you haven’t had enough?
13. Have you ever thought you couldn’t fit it in or have a good time without drugs or alcohol?
14. Does the thought of running out of drugs or alcohol terrify you?
15. Do you ever question your own sanity?
16. Do you have irrational or indefinable fears?
17. Have you ever used drugs or alcohol because of emotional pain or stress?
18. Have you ever been arrested or medically treated for drinking or using?
19. Do you continue to drink or use despite negative consequences?

To get professional help from one of the most effective Drug/Alcohol Treatment Programs, call 1-877-711-4673.

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