Resources and Tools - Questionnaires

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Alcohol & Drugs: Self Assessment Questionnaire

This self-assessment tool does not diagnose or directly measure your substance use. Based on your responses to the questions below, it indicates the extent to which you could be vulnerable to problems associated with excessive drug and alcohol use.

Disclaimer: This awareness tool is intended to increase recognition of your drug and alcohol use. This awareness tool is not to be used to diagnose or measure a substance abuse problem. A thorough evaluation by your physician or other health care provider is required to diagnose any substance abuse issues. If you are concerned about your drug and alcohol use book an appointment to see a Hurst Place counsellor.

Read each question, one at a time and simply answer “Yes” or “No” to the following questions. If you answered yes to more than five of these questions you should seek some assistance to address your substance use.

1. Do you occasionally drink/drug heavily after a disappointment, a quarrel, or when the boss gives you a hard time?

2. When you have trouble or feel under pressure, do you drink/drug more than usual?

3. Have you ever noticed that you are able to handle more liquor/drugs than you could when you first started drinking?

4. Did you ever wake up on the “morning after” and discover that you could not remember part of the evening before, even thought your friends tell you that you did not pass out?

5. When drinking/using with other people do you try to hide the quantity that you drink/use?

6. Are there certain occasions when you feel uncomfortable if liquor/drugs is not available?

7. Have you ever noticed that when you begin drinking/using you are more in a hurry to get the first drink/drug than you used to be?

8. Do you sometimes feel a little guilty about your drinking/using?

9. Are you secretly irritated when your family and friends talk about your drinking/using?

10. Have you noticed that you are starting to have more “blackouts?”

11. Do you often find that you wish to continue drinking/using after your friends say that they have had enough?

12. Do you usually find reasons to drink/use heavily?

13. When you are sober, do you often feel sorry for the things you said or did while drinking/using?

14. Have you tried switching brands or trying different ways to control your drinking/using?

15. Have you often failed to keep the promises you made to yourself about quitting or cutting down on your substance use?

16. Have you ever tried to control your drinking/using by changing jobs, or moving to a different place?

17. Are you having more work, school, or financial problems?

18. Do you eat very little, or less often when you are drinking/using?

19. Do you occasionally have a drink/drug in the morning to help you start the day?

20. Do you sometimes stay intoxicated for several days at a time?

21. Do you drink/use to escape from worries or trouble?

22. Do you drink/use when you are alone?

Family Members
Ask yourself the following questions:

• Have you tried to control another person’s alcohol or drug use?
• Do you spend a great deal of time worrying about another person’s alcohol or drug use?
• Have you become more quiet and withdrawn, because you don’t want other people to know about your family member’s alcohol or drug use?
• Has your personality changed? For example, do you feel you are “just not yourself” due to someone’s alcohol or drug use.

Gambling
Early warning signs:

• Spending more time and money than intended
• Arguing about gambling with family and friends
• After losing, having the urge to return as soon as possible to win back losses
• Feeling guilt or remorse about gambling
• Borrowing money to gamble
• Considering illegal ways to obtain money to gamble
• Missing work in order to gamble
• Hiding the extent to which you gamble

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