Alcohol and Drug Use Self Assessment

Yes

No

1.

Have you hurt someone (either physically or emotionally) by your alcohol or drug use behavior?

2.

Are people ever afraid to be around you when you are using alcohol or drugs because of the possibility of verbal or physical abuse?

3.

Do you have money problems because of your use of alcohol or drugs?

4.

Do you tell lies to cover up for your alcohol or drug use?

5.

Do you blame your companions for your behavior while using alcohol or drugs?

6.

Do you make threats, such as "If you stop my drinking or using drugs, I'll leave you"?

7.

Have you ever asked someone to "cover up" for an alcohol or drug episode by calling your employer, or telling others that you are feeling "sick?"

8.

Have you not had social invitations extended out of fear or anxiety about you?

9.

Do you think that if you stopped drinking or using drugs, your other problems would be solved?

10.

Have you ever had alcohol hidden from you?

11.

Do you ever ask others to buy alcohol for you?

Alcohol and Drug Use Self Assessment

Alcohol Use Self Assessment Tool

Section 2

Yes	No
		1.	Do you drive while intoxicated or high?
		2.	Have you or someone else been injured as a result of drinking or using drugs?
		3.	Are you having problems with work, school, or family as a result of drinking or using drugs?
		4.	Do you get angry if anyone mentions your substance use or expresses concerns about your use?
		5.	Have you broken promises because of drinking or using drugs?
		6.	Are plans frequently upset, canceled or delayed because of alcohol or drug use?
		7.	Has your drinking or drug use caused family, job or legal problems?
		8.	Can you handle more alcohol or drugs now than a few years ago?
		If you answered Yes to any of the questions in Section 1, your friend or family member may have an alcohol problem. The time to seek expert help and guidance is now. Please allow us to send you our brochure to examine in the privacy of your home or office. Or call 877.627.4389 right now to speak with one of our caring staff and take the first step -- The Right Step today. 1 "Yes" answer indicates a possible alcohol problem. The time to seek expert help and guidance is now. Please allow us to send you our brochure to examine in the privacy of your home or office. Or call 877.627.4389 right now to speak with one of our caring staff and take the first step -- The Right Step today. 2 or more "Yes" answers indicates that a problem is likely to exist. The time to seek expert help and guidance is now. Please allow us to send you our brochure to examine in the privacy of your home or office. Or call 877.627.4389 right now to speak with one of our caring staff and take the first step -- The Right Step today.