Self Assessment
The following is a mergence of the two most widely used
questionnaires used to asses if a drug or alcohol problem exists.
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1. Is your use affecting your relationships with
friends or family?
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2. Have you ever regretted something you did while
under the influence?
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3. Has your drinking or
drug use ever affected your work performance?
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4. Have you ever missed
work due to your use?
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5. Has your use ever
caused financial troubles?
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6. Have you lied about
your use?
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7. Does addiction run in
your family?
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8. Do you experience
cravings at a certain time of day?
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9. Do you use in the
morning?
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10. Do you use to escape
reality?
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11. Do you keep your use, or amount
of use, a secret?
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12. Have you ever experienced memory
loss (blackout)?
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13. Have you ever been hospitalized
due to your use?
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14. Have you ever had legal problems
due to your use?
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15. Have you ever felt you should cut
down on your use?
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16. Have people ever expressed
concern about your use?
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17. Have you noticed an increase in your
tolerance?
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18. Have you lost interest in things
you once enjoyed due to your use?
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19. Have you noticed a drop in your
level of self-esteem?
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20. Have you ever tried to quit on
your own and been unsuccessful?
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This self-assessment does not provide a precise measurement of a
drug or alcohol problem. However, If you answered yes
to three or more of these questions, there is a good chance a
problem with drugs and/or alcohol exists.
*The American Society of Addiction Medicine’s version of the
CAGE Assessment Tool and “Twenty Questions of Alcoholics Anonymous”
are the source of this versioned self-assessment.
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