Chemical Dependency Questionnaire
Are you an Alcoholic or an Addict?
Ask yourself the following “yes or no” questions.
Answer them as honestly as you can.
1. Do you lose time from work due to drinking or drug use?
2. Does drinking or drug use make your home life unhappy?
3. Do you drink or use drugs because you are shy with people?
4. Has drinking or drug use affected your reputation?
5. Have you gotten into trouble with money because of your drinking or drug use?
6. Do you associate with people you don’t respect and hang out in places you don’t want to be in when drinking or using drugs?
7. Does your drinking or drug use make you careless of your family’s welfare?
8. Does your drinking or drug use decrease your ambition?
9. Do you want a drink or more drugs “the morning after?”
10. Do you have a hard time sleeping because of your drinking or drug use?
11. Has your ability to work decreased since drinking or using drugs?
12. Does drinking or using drugs get you into trouble on the job or in business?
13. Do you drink or use drugs to escape from your problems or worries?
14. Do you drink or use alone?
15. Have you ever had a complete loss of memory as a result of drinking or drug use?
16. Has a doctor ever treated you for drinking or drug use?
17. Do you drink or use drugs to build up self confidence?
18. Have you ever been arrested, locked up, or hospitalized on account of drinking or drug use?
19. Have you ever felt guilty after drinking or using?
20. Do you have to have a drink or use at a certain time each day?
21. Do you drink or use chemicals to alleviate anxiety or depression?
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