Do I Have a Substance Abuse Problem?
This short questionnaire is designed to help identify symptoms and warning signs of a current or potential problem with alcohol or other drugs.* Please read each statement, recording the indicated numeric score for your true or false response. *Please note: “Drug” refers to any mood-altering substance, including prescription medication.
1. My use of alcohol or other drugs has increased over the past year.
(If answer is true, give yourself 1 point.)
(If answer is false, give yourself 0 points.)
2. I have attempted to cut down on how much or how often I drink or use other drugs but have not been very consistent.
(If answer is true, give yourself 1 point.)
(If answer is false, give yourself 0 points.)
3. I have lied or minimized to family or friends about how much, or how often I drink or use other drugs.
(If answer is true, give yourself 1 point.)
(If answer is false, give yourself 0 points.)
4. I drink or use other drugs even when I have planned not to.
(If answer is true, give yourself 1 point.)
(If answer is false, give yourself 0 points.)
5. In the last year I have said to myself, or others, “I can quit any time,” or, “I don’t have a problem.”
(If answer is true, give yourself 1 point.)
(If answer is false, give yourself 0 points.)
6. On more than one occasion I could not remember some things that happened while I was drinking or using other drugs.
(If answer is true, give yourself 2 points.)
(If answer is false, give yourself 0 points.)
7. On more than one occasion, I have said or done things while using alcohol or other drugs that I deeply regret.
(If answer is true, give yourself 2 points.)
(If answer is false, give yourself 0 points.)
8. My use of alcohol or other drugs has caused tension or problems in at least one of my most important relationships.
(If answer is true, give yourself 1 point.)
(If answer is false, give yourself 0 points.)
9. In the last year, I have missed work or school because of alcohol or other drugs.
(If answer is true, give yourself 1 point.)
(If answer is false, give yourself 0 points.)
10. I have had accidents or been injured as a result of drinking or drug use.
(If answer is true, give yourself 1 point.)
(If answer is false, give yourself 0 points.)
11. I have legal problems related to drinking or drug use.
(If answer is true, give yourself 1 point.)
(If answer is false, give yourself 0 points.)
Results
Total your score. If your score is:
0 points: Based on your responses to the questionnaire you do not appear to have a current problem with substance abuse. However, if you completed this questionnaire because you are concerned about your use of alcohol or other drugs, you may want to learn more. Your Employee Assistance Program (EAP) is a good place to start.
1 to 3 points: Your score indicates that you currently are experiencing some of the symptoms associated with substance abuse. Substance abuse is a progressive problem with potentially devastating consequences. You could benefit from contacting your Employee Assistance Program (EAP).
4 or more points: Your score indicates that you currently are experiencing many of the symptoms associated with substance abuse. Substance abuse is progressive and characterized by repeated harmful consequences. You should consult your Employee Assistance Program (EAP) as soon as possible.
by Drew Edwards, MS
© 2001-2004 LifescapeSolutions
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