GET HELP NOW

This self-test is not intended to be used for the diagnosis or treatment of any medical or emotional condition. We advise you to consult your doctor about any concerns you may have regarding this questionnaire.

The purpose of this survey is to give you some insight into whether or not you may have a problem with Alcohol and/or Drugs.

Print out this page and mark the appropriate button with your answer. If you would like some literature sent to you or to be contacted by NDFW Please fill out your name and address on the “Contact Us” form.

Do you lose time from work due to your drinking or drug use?

YES


NO
Is your drinking/drug use making your home life unhappy?

YES


NO
Do you drink or use drugs because you are shy with other people?

YES


NO
Is drinking or using drugs affecting your reputation?

YES


NO
Have you ever felt remorse after drinking or using drugs?

YES


NO
Have you gotten into financial difficulties because of your drinking or drug use?

YES


NO
Do you turn to lower companions and inferior environments when drinking or using drugs?

YES


NO
Does your drinking or drug use make you careless of your family’s welfare?

YES


NO
Has your ambition decreased since drinking or using drugs?

YES


NO
Do you crave a drink or a drug at a definite time daily?

YES


NO
Do you want a drink or to use drugs the next morning?

YES


NO
Does drinking or using drugs cause you difficulty in sleeping?

YES


NO
Has your efficiency decreased since drinking or using drugs?

YES


NO
Is drinking or using drugs jeopardizing your job or business?

YES


NO
Do you drink or use drugs to escape from worries or troubles?

YES


NO
Do you drink or use drugs while you are alone?

YES


NO
Have you ever had a complete loss of memory as a result of your drinking or drug use?

YES


NO
Has your physician ever treated you for drinking or using drugs?

YES


NO
Do you drink or use drugs to build up your self confidence?

YES


NO
Have you ever been in a hospital or institution on account of drinking or using drugs?

YES


NO
If you answered YES to any one of the questions, there is a definite warning that you may be an alcoholic.
     
If you answered YES to any two, the chances are that you are an alcoholic.
     
If you answered YES to three or more, you are definitely an alcoholic.
     
(The above test questions are used by Johns Hopkins University Hospital, Baltimore MD., In deciding whether or not a patient is alcoholic.)
     
If you would like some literature sent to you or to be contacted by New Directions please complete the contact form on the right hand side of this page.
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