Substance Abuse Assessment UnityPoint Trinity

Substance Abuse Assessment

Do you feel you are a normal drinker or drug user? ("normal"-consume as much or less than most other people)? Have you ever awakened after drinking or using drugs and and found that you could not remember a part of the evening? Does any near relative or close friend ever worry or complain about your drinking or drug use? Can you stop drinking without difficulty after one or two drinks?Do you ever feel guilty about your drinking or drug use?Have you ever attended a meeting of Alcoholics Anonymous (AA) or Narcotics Anonymous (NA)?Have you ever gotten into physical fights when drinking or using drugs?Has drinking or drug use ever created problems between you and a near relative or close friend?Has a family member or close friend gone to anyone for help about your drinking or drug use?Have you ever lost friends because of your drinking or drug use?Have you ever gotten into trouble at work because of drinking or drug use?Have you ever lost a job because of drinking or drug use?Have you ever neglected your obligations, your family, or your work for two or more days in in a row because you were drinking or using drugs?Do you drink before noon fairly often?Have you ever been told you have liver trouble such as cirrhosis?After heavy drinking have you ever had delirium tremens (D.T.'s), severe shaking, visual or auditory (hearing) hallucinations?Have you ever gone to anyone for help about your drinking or drug use?Have you ever been hospitalized because of drinking or drug use?Has your drinking or drug use ever resulted in your being hospitalized in a psychiatric ward?Have you ever gone to any doctor, social worker, clergyman or mental health clinic for help with any emotional problems in which drinking was part of the problem?Have you been arrested more than once for driving under the influence of alcohol or drugs?Have you ever been arrested, even for a few hours, because of other behavior while drinking?Name (optional)Email (optional)Phone (optional)Would you like a member of our staff to contact you?Note: Clicking "submit" will send your answers and personal information (if provided) to a member of our staff via email.