Programs & Services
Self-Assessment Form
According to the National Institute on Drug Abuse (NIH) there were an estimated 23.1 million (8.9 percent) Americans in need of treatment for a problem related to drugs or alcohol, but only about 2.5 million people (1 percent) received treatment at a specialty facility.

 
Programs & Services > Self-Assessment Form
 
Self-Assessment Form
The following self-assessment tool was developed to determine whether or not you or a loved one might have a drug or alcohol problem. For more information, please contact us at (800) 223-6410.

Do you have unstoppable cravings for drugs or alcohol?


While under the influence, have you ever hurt yourself or others?


If you have caused harm to people, have you ever promised not to do it again but been unable to keep the promise?


Have people ever made comments about your drug or alcohol use?


Does your drinking or using drugs negatively affect the way you perform at work or school?


Do you drink or use drugs to numb your feelings?


Do you drink or use drugs because you feel insecure or self-conscious about yourself?


Have you been in trouble with the law or any other authority because of the amount you drink or use drugs?


Have you tried to stop using drugs or drinking but found that you are unable?


Have you lost or damaged relationships because of the way you use drugs and drink?


Have you started to drink or use drugs alone because you are ashamed or because you do not want to share what you have with others?


Do you feel the desire to constantly be drunk or "high"?


Have you ever been arrested for a DUI, DWI or any drug-related offense?


Are you unable to have good time with people at places such as parties or clubs if you are not under the influence of drugs or alcohol?


Have you ever woken up the next morning after drinking or using drugs and been unable to remember what happened the night before?


Do you ever tell yourself you will just have one or two drinks but find you have several more than you planned?


Do you socialize with individuals who use drugs and drink the way you do?


Have you ever stayed drunk or "high" for multiple days at a time?


Do you find that you are defensive about what people say concerning your drinking and drug use?


If so, do you drink and use drugs more because they made you upset?