Rideauwood - Addiction and Family Services

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Self-Assessment Questionaire

For ADULTS who want to know if they have an alcohol or drug problem
(You can substitute "drugs" for "alcohol" if it fits your circumstances)

		Never	Some times	Often	Nearly Always
1.	Do you find difficulty in getting the thought of drinking out of your mind?	0	1	2	3
2.	Is getting drunk more important than your next meal?	0	1	2	3
3.	Do you plan your day around when and where you can drink?	0	1	2	3
4.	Do you drink in the morning, afternoon and evening?	0	1	2	3
5.	Do you drink for the effect of alcohol without caring what the drink is?	0	1	2	3
6.	Do you drink as much as you want irrespective of what you are doing the next day?	0	1	2	3
7.	Given that many problems might be caused by alcohol, do you still drink too much?	0	1	2	3
8.	Do you know that you won't be able to stop drinking once you start?	0	1	2	3
9.	The morning after a heavy drinking session do you need your first drink to get yourself going?	0	1	2	3
10.	The morning after a heavy drinking session do you wake up with a definite shakiness of your hands?	0	1	2	3
11.	After a heavy drinking session do you wake up and retch or vomit?	0	1	2	3
12.	The morning after a heavy drinking session do you go out of your way to avoid people?	0	1	2	3
13.	After a heavy drinking session do you see frightening things that later you realize were imaginary?	0	1	2	3
14.	Do you go drinking and the next day find you have forgotten what happened the night before?	0	1	2	3

Note : Reproduced with permission from D.Raistrick, M.d. (1991). Leeds Addiction Unit, Leeds, UK.

SCORING: Any YES answer indicates some problem with alcohol dependence. A score of 10 – 19 indicates a medium dependence. A score of 20 or more indicates a high dependence. If you scored 6 or more we urge you to contact us at Rideauwood or some other reputable alcohol/drug treatment resource.

OR TRY THIS ONE:
	. Have you ever felt you should cut down on your drinking and/or use of drugs?
	. Have people annoyed you by criticizing your drinking or use of drugs?
	. Have you ever felt guilty about your drinking or drug use?
	. Have you ever consumed alcohol or drugs early in the day to steady nerves, get rid of a hangover, or to get the day started?
	. If you answered YES to one or more of these questions, you may have a problem with alcohol and/or drugs. Two or more indicates a serious problem.
If you want to discuss this, call Rideauwood's Intake counsellor at (613) 724.4881.