Substance Abuse Self Assessment

  • Do you drink or use to overcome shyness or to feel more confident?
    • Yes
    • No
  • Are you having money troubles because of drinking or using?
    • Yes
    • No
  • Do you ever stay home from work because of drinking or using?
    • Yes
    • No
  • Is drinking or using causing trouble in your family?
    • Yes
    • No
  • Is drinking or using giving you a bad reputation?
    • Yes
    • No
  • Have you lost a job or a business because of drinking or using?
    • Yes
    • No
  • Do you drink or use to escape your problems?
    • Yes
    • No
  • Do you drink or use when you are alone?
    • Yes
    • No
  • Do you have blackouts? (Loss of memory for events that happened or of actions you performed while drinking or using?)
    • Yes
    • No
  • Do you feel remorse after drinking or using?
    • Yes
    • No
  • Do you need a drink at a definite time every day?
    • Yes
    • No
  • Do you drink in the morning?
    • Yes
    • No
  • Have you ever been in a hospital because of drinking or using?
    • Yes
    • No
  • Has a doctor ever treated you for your drinking or using?
    • Yes
    • No
  • Do you drink or use too much at the wrong time?
    • Yes
    • No
  • Do you make promises to yourself or others about your drinking or using?
    • Yes
    • No
  • Do you have to keep on drinking or using once you have started?
    • Yes
    • No
  • Is drinking or using making it hard for you to sleep?
    • Yes
    • No
  • Have you had an accident because of drinking or using?
    • Yes
    • No
  • Do you drink or use to relieve the painfulness of living?
    • Yes
    • No
  • Do you have trouble disposing of cans or bottles?
    • Yes
    • No
  • Are you less particular about people you are with and the places you go when you are drinking or using?
    • Yes
    • No
  • Have you been arrested more than once for drunk driving or driving under the influence of drugs?
    • Yes
    • No
  • Has drinking or using affected your health?
    • Yes
    • No

 

If you answered “Yes” to 1 of these questions, please have awareness over your use moving forward. You could develop a dependence or addiction in the future.

If you answered “yes” to 2 or more of these questions, please contact me as you may have an issue with substances, and I’d like to help.

 

Source: Cottonwood, Tuscon