Are You an Alcoholic or Chemically Dependent Person?

 JOHNS HOPKINS UNIVERSITY HOSPITAL SCREENING QUESTIONNAIRE

Are You an Alcoholic or Chemically Dependent Person?

Please answer these questions honestly to know if you have a problem with alcohol / substance abuse:

1. Do you lose time from work due to drinking?
2. Is drinking making your home life unhappy?
3. Do you drink / use because you are shy with other people?
4. Is drinking / using affecting your reputation?
5. Have you ever felt remorse after drinking / using?
6. Have you gotten into financial difficulties as a result of drinking / using?
7. Do you turn to an inferior environment when drinking / using?
8. Does your drinking / using make you careless of your family’s welfare?
9. Has your ambition decreased since drinking/using?
10. Do you crave a drink / drug at a regular time every day?
11. Do you want a drink / drug the next morning?
12. Does drinking/using cause you to have difficulty sleeping?
13. Has your efficiency decreased since drinking / using?
14. Is drinking / using jeopardizing your job or business?
15. Do you drink / use to escape from worries or troubles?
16. Do you drink / use while alone?
17. Have you ever had a complete loss of memory as a result of drinking / using?
18. Has your physician ever treated you for drinking / using?
19. Do you drink / use to build up self confidence?
20. Have you ever been in a hospital or institution because of your drinking / using?

I)                   Answering YES to any of the following questions could be a warning that you are alcohol- or chemically- dependent.

II)                 Answering YES to any two questions are an indication that you are alcohol / chemically dependent.

III)              If you answer YES to three or more questions, please seek help immediately.

Note:  The above test questions are derived from a questionnaire used by Johns Hopkins University Hospital, Baltimore, Maryland, U.S.A. in deciding whether or not a patient is alcoholic.