Yes
No
1. Do you ever look forward to the end of a day’s work so you can have drinks or drugs?
Yes
No
2. Do you sometimes look forward to the end of the week so you can have some fun drinking and using?
Yes
No
3. Do you find that you can often drink or use more than others and not show it too much?
Yes
No
4. Have you noticed that you are able to handle more liquor or drugs than you did when you were first drinking or using?
Yes
No
5. Do you often find that you wish to continue drinking or using after your friends say that they have had enough?
Yes
No
6. Do you ever take more than the prescribed amount of medication?
Yes
No
7. Do you usually have drinks or drugs before going to a party or out to dinner?
Yes
No
8. Do you sometimes drink at home alone, or when no one else is drinking?
Yes
No
9. Do you ever stop in a bar or club and have a couple of drinks alone?
Yes
No
10. Do you sometimes use drugs alone?
Yes
No
11. Have you ever been arrested for a DWI or DUI?
Yes
No
12. Do you ever drink or use drugs to calm your nerves, reduce tension, or relieve stress?
Yes
No
13. Do you find it difficult to enjoy a party or dance if there is nothing to drink or no drugs to take?
Yes
No
14. Have you taken a drink in the morning or taken drugs to ease a hangover?
Yes
No
15. The morning following an evening of drinking or "drugging," have you ever been unable to remember everything that happened the night before?
Yes
No
16. Do you sometimes stash a bottle or drugs around the house in case you may need a drink or drugs sometime?
Yes
No
17. Do you sometimes feel a little guilty about your drinking or using?
Yes
No
18. Have you ever had the shakes or hand tremors in the morning after?
Yes
No
19. Did you ever stop in to have a drink or two and then have several more than you planned?
Yes
No
20. Have you ever missed work or school because of a hangover?
Yes
No
21. Have you often failed to keep the promises you have made to yourself about controlling or cutting down on your drinking or using?
Yes
No
22. Do you eat very little or irregularly when you are drinking or using?
Yes
No
23. Do you have a very definite preference to associate with people who drink or use drugs as opposed to those who do not?
Yes
No
24. Do you sometimes do things while drinking or using that you are ashamed of later?
Yes
No
25. Do you sometimes stay drunk or high for several days at a time?