Addiction Assessment

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TAKE THIS ADDICTION SELF-TEST

The purpose of this self-test is to give you some insight into whether or not you may have a problem with alcohol and/or drugs. This self-test is not intended to be used for the diagnosis or treatment of any medical or psychological condition. We advise you to consult your doctor about any concerns you may have regarding this questionnaire.

  1. Is alcohol or substance use making your home life unhappy?  YES   NO
  2. Does your alcohol or substance use make you careless of your family’s welfare?  YES   NO
  3. Do you use alcohol or substance because you are shy with other people?  YES   NO
  4. Does alcohol or substance use affect your reputation?  YES   NO
  5. Do you use alcohol or substances to escape from worries or troubles?  YES   NO
  6. Do you use alcohol or substances alone?  YES   NO
  7. Have you lost time from work due to your alcohol or substance use?  YES  NO
  8. Has your ambition decreased since you started using alcohol or substances?  YES   NO
  9. Has your efficiency decrease since you started using alcohol or substances?  YES   NO
  10. Is alcohol or substance use jeopardizing your job or business?  YES   NO
  11. Have you even felt guilty after using alcohol or substances?  YES  NO
  12. Are you struggling financially due to your alcohol or substance use?  YES   NO
  13. Do you turn to unhealthy relationships and/or environments when using alcohol or substances?  YES  NO
  14. Do you crave alcohol or substances at a specific time of day?  YES  NO
  15. Does alcohol or substance use cause you to have difficulty with sleep?  YES   NO
  16. Do you want to use alcohol or substances the next morning?  YES   NO
  17. Do you use alcohol or substances to build up your self-confidence?  YES   NO
  18. Have you ever had a complete loss of memory as a result of using alcohol or substances?  YES  NO
  19. Has your doctor ever treated you for alcohol or substance use?  YES   NO
  20. Have you ever been in a hospital or prison because of alcohol or substances?  YES   NO

If you answered YES to any one of these questions, that is a warning that you may have a substance use problem.
If you answered YES to any two or more, there is a chance you have a substance use problem.
If you answered YES to three or more, you have a substance use problem.

If you think you have a problem with addiction, please contact us for a confidential inquiry.