Self Test

This self-test should not be taken as a diagnosis or treatment of any medical or emotional condition. We advise you to consult your doctor about any concerns you may have regarding this questionaire.

The purpose of this survey is to help you decide whether or not you may have a problem with Alcohol and/or Drugs. Answer each question honestly.

Do you lose time from work due to your drinking or drugging?		YES	NO
Is your drinking/drugging making your home life unhappy?		YES	NO
Do you drink or drug because you are shy with other people?		YES	NO
Is drinking or drugging affecting your reputation?		YES	NO
Have you ever felt remorse after drinking or drugging?		YES	NO
Have you gotten into financial difficulties because of your drinking or drugging?		YES	NO
Do you turn to lower companions and inferior environment when drinking or drugging?		YES	NO
Does your drinking or drugging make you careless of your family's welfare?		YES	NO
Has your ambition decreased since drinking or drugging?		YES	NO
Do you crave a drink or a drug at a definite time daily?		YES	NO
Do you want a drink or drug the next morning?		YES	NO
Does drinking or drugging cause you difficulty in sleeping?		YES	NO
Has your efficiency decreased since drinking or drugging?		YES	NO
Is drinking or drugging jeopardizing your job or business?		YES	NO
Do you drink or drug to escape from worries or troubles?		YES	NO
Do you drink or drug alone?		YES	NO
Have you ever had a complete loss of memory as a result of your drinking or drugging?		YES	NO
Has your physician ever treated you for drinking or drugging?		YES	NO
Do you drink or drug to build up your self confidence?		YES	NO
Have you ever been in a hospital or institution on account of drinking or drugging?		YES	NO

If you have answered YES to any one of the questions, there is a definite warning that you may have a problem with alcohol or drugs.

If you answered YES to two or more of the questions, it is advisable that you contact a qualified drug/alcohol practitioner to review your drug and
alcohol use.

(The above test questions are used by Johns Hopkins University Hospital, Baltimore MD., In deciding whether or not a patient is alcoholic.)

If you would like some literature sent to you or if you would like to talk to us about how we can help, please call us at (303) 825-8113.