Addiction Quiz
This self-test is not intended to be used
for the diagnosis or treatment of any medical or emotional condition.
We advise you to consult your doctor about any concerns you may have
regarding this questionnaire.
The purpose of this survey is to give
you some insight into whether or not you may have a problem with Alcohol
and/or Drugs. Your responses are completely confidential and anonymous.
See the privacy policy for more information.
1. Do you lose time from work due to your drinking or
drugging? ___Yes ___No
2. Is your drinking/drugging making your home life unhappy?
___Yes ___No
3. Do you drink or drug because you are shy with other
people?___Yes ___No
4. Is drinking or drugging affecting your reputation?
___Yes ___No
5. Have you ever felt remorse after drinking or drugging?
___Yes ___No
6. Have you gotten into financial difficulties because
of your drinking or drugging? ___Yes ___No
7. Do you turn to lower companions and inferior environment
when drinking or
drugging? ___Yes ___No
8. Does your drinking or drugging make you careless of
your family’s welfare?
___Yes ___No
9. Has your ambition decreased since dinking or drugging?
___Yes ___No
10. Do you crave a drink or a drug at a definite time
daily? ___Yes ___No
11. Do you want a drink or drug the next morning? ___Yes
___No
12. Does drinking or drugging cause you difficulty in
sleeping? ___Yes ___No
13. Has your efficiency decreased since drinking or drugging?
___Yes ___No
14. Is drinking or drugging jeopardizing your job or business?
___Yes ___No
15. Do you drink or drug to escape from worries or troubles?
___Yes ___No
16. Do you drink or drug alone? ___Yes ___No
17. Have you ever had a complete loss of memory as a result
of drinking or
drugging? ___Yes ___No
18. Has your physician ever treated you for drinking or
drugging? ___Yes ___No
19. Do you drink or drug to build up your self-confidence?
___Yes ___No
20. Have you ever been in a hospital or institution on
account of drinking or
drugging? ___Yes ___No
The purpose of this survey is to
give you some insight into whether or not you may have a problem with
Alcohol and/or Drugs. This test is used as a screening tool by John
Hopkins Hospital.
For additional information or referrals,
submit the confidential inquiry.
