Addiction Self Assessment

alcohol abuse treatment

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Is This You or Someone You Know?

The use of alcohol and other drugs is a normal part of most cultures, both in ceremony and as part of everyday social interaction. Many people use alcohol and drugs without developing physical or psychological symptoms. Those who abuse substances may also have underlying mental or physical problems. Substance abuse is continued use that has negative consequences but without necessarily losing control over the use.

Addiction Self-Assessment

Our brief assessment form is designed to evaluate the extent of your addiction and to suggest a potential treatment program. Please try to complete all of the information on this form.

To what extent do you agree with the following statements related to your addictions and mental health?

Please be as honest as possible when answering the questions below

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1. I have experienced periods of depression, anxiety, or other mental health conditions such as; Bipolar Disorder, Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, Personality Disorder, ADD, ADHD, etc
2. I have used alcohol or drugs because of emotional pain or stress.
3. I have at times missed work, appointments, or plans with family and friends due to my use.
4. I have tried to stop or control my using.
5. My use sometimes interferes with my sleeping, eating or other daily activities.
6. I have at times felt guilty or ashamed about my use.
7. My family, friends or coworkers have commented on my use.
8. I have used alone.
9. I occasionally have substituted one alcoholic drink/drug for another.
10. I have continued to use despite negative consequences. For example; health issues, relationship issues, occupational issues, legal issues, etc.
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