Self-Assessment for Drug and Alcohol Problems

Have you ever done something that you regretted under the influence of drugs or alcohol?
Yes   No

Have you ever lied to anyone about your drug use?
Yes   No

Do you feel the need to be under the influence of drugs and/or alcohol during normal activities?
Yes   No

Have you ever experienced blackouts or periods of memory loss from drugs or alcohol?
Yes   No

Do you rely on drugs and alcohol for confidence in social situations?
Yes   No

Have you ever been arrested or almost arrested, gotten a DWI, MIP, or a ticket for drugs, alcohol or paraphernalia?
Yes   No

Does it take more drugs or alcohol than it used to for you to get high or drunk?
Yes   No

Have you ever overdosed or had alcohol poisoning?
Yes   No

Do you spend a lot of time planning, talking about, thinking about, or trying to get drugs and alcohol?
Yes   No

Have you ever tried a drug that you said you wouldn’t?
Yes   No

Has your school or work performance declined?
Yes   No

Has your relationship with your parents changed since you started using drug and or alcohol?
Yes   No

Have you ever promised yourself or someone else that you would stop using or cut down and not followed through?
Yes   No

Has drinking or drug use caused arguments or problems between you and your family, friends, school or work?
Yes   No

Have you ever lost friends or romance due to your drinking or using?
Yes   No

Have you engaged in risky sexual behavior while on drugs or alcohol?
Yes   No

Have you ever missed an important event because of your drinking or using?
Yes   No

Have you stolen from anyone including friends or family to support your alcohol/ drug use?
Yes   No

Have you ever sought out help, voluntarily or forced, because of your drinking or drug use? (Counselors, A.A., N.A., or treatment for drugs and alcohol)
Yes   No

Do you drink or use more than you intended to or at times when you know you shouldn’t?
Yes   No