Using drugs and/or alcohol can impact your life in many different ways. The following questionnaire can help you assess your personal drug and/or alcohol use. In order for your score to be accurate you must answer all questions as honestly as you can. When you are finished click the submit button for the scoring key.

1. Have you started using more and more drugs or alcohol to get the effect(s) you want?

Yes No

2. Have you ever forgotten things after you drank or used drugs?

Yes No

3. Have family or friends ever commented on how much you drink and suggested you cut back?

Yes No

4. Ever experience an intense craving for alcohol or drugs?

Yes No

5. Does your behavior change when you are under the influence of alcohol or drugs making you do things you wouldn’t normally do like breaking the law, or having sex with someone?

Yes No

6. Do you ever feel “out of control” when drinking and drugging?

Yes No

7. Do friends say you become combative and argumentative when you drink and use drugs?

Yes No

8. Have you ever spent your rent or other bill money to buy drugs or alcohol?

Yes No

9. Have you accidentally hurt yourself or someone else while high on alcohol or drugs?

Yes No

10. Have you gotten into trouble at work or school because you used drugs or alcohol?

Yes No

11. Do you sometimes feel you can’t have “fun” unless drinking or doing drugs is a part of that “fun”?

Yes No

12. Have you driven a car while under the influence of drugs or alcohol?

Yes No

13. Is your performance at work or school being impacted by your use of alcohol or drugs?

Yes No

14. Have you had trouble getting along with your friends because of your alcohol or drug use?

Yes No

15. Do you ever feel addicted to alcohol or drugs?

Yes No