FOR DRUG & ALCOHOL ABUSE |
YES |
NO |
1. |
Have you ever decided to stop
your drug use or drinking and been unable to for any length
of time?
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2. |
Are other people bothered by your drugs
and alcohol consumption? Do they make comments or make it clear
that they are uncomfortable around you while you are using?
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3. |
Have you ever made an attempt to stop using
or drinking by switching from beer to liquor, liquor to beer,
heroin to pills or from hard drugs to pot and found that you
were unsuccessful?
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4. |
Do you ever wish that you could be like
others who drink and / or use and do not get in trouble?
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5. |
In the last year have you ever had a drink
or used drugs upon waking up to feel better from the previous
night?
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6. |
Have you recently found yourself in trouble
at school, work or with the law due to drinking or drug use?
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7. |
Has your drug use or drinking caused problems
at home with your family and loved ones?
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8. |
Do you ever sneak drinks or hide your drug
use at social gatherings?
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9. |
Do you tell yourself that you can quit anytime
but still get drunk and or high without intending to?
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10. |
Have you missed important commitments, such
as work, because you were high, hung-over or drunk?
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11. |
Do you ever have "blackouts," or
the inability to recall events, while using drugs or drinking?
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12. |
Have you ever felt that if only you could
quit using or drinking that your quality of life would increase? |
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