YES	NO
1.	Have you ever decided to stop drinking or drugging for a week or even a few days, but only to break your promise to yourself or your family?
2.	Do you wish people would mind their own business about your drinking and drugging?
3.	Have you ever switched from one kind of drink or drug to another thinking that this would help you get "in control of your life"?
4.	Do you ever drink or drug in the morning?
5.	Do you envy people who can use alcohol or drugs without getting in trouble?
6.	Have you had problems connected with drinking or drugging during the past few months?
7.	Has your drinking or drugging caused trouble in your family or at home?
8.	Do you ever try to get "extra" drinks or drugs at a party because you do not get enough?
9.	Do you tell yourself you can stop using alcohol or drugs any time you want, even though you keep getting high when you do not want to?
10.	Have you missed days of work or school because of your using alcohol or drugs?
11.	Do you have "blackouts", where you cannot remember when your drunk or high?
12.	Have you ever felt that your life would be better if you did not use alcohol or drugs?

Disclaimer - This assessment is not intended to diagnose or treat any medical or emotional condition. Please contact us directly for a full evaluation.