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Self Assessment Form
 
The following quiz can help you determine whether you or someone you love has a drinking or drug problem, but please note: this quiz is not intended to be used to diagnose addictive illness, which can be done only by a qualified healthcare professional.
 
1. Do you need to drink or use drugs at a definite time everyday?     Yes    No
 
2. Do you prefer to drink or use drugs alone?     Yes    No
 
3. Do you lie about the amount of alcohol and/or drugs you use?     Yes    No
 
4. Is your drinking or drug usage hurting your family in any way?     Yes    No
 
5. Have you been giving up activities you used to do such as sports, homework, or hanging out with friends who don't use drugs or drink?     Yes    No
 
6. Do you lose time from work because of your drinking or drug usage?     Yes    No
 
7. Do you drink or use drugs to relieve anxiety?     Yes    No
 
8. Has your drinking or drug usage made you harder to get along with?     Yes    No
 
9. Is it making your home life unhappy?     Yes    No
 
10. Is it jeopardizing your schoolwork or hurting your business or career?     Yes    No
 
 
 
 
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