| Yes |
No |
| ____ |
____ |
- Use to feel better: I use alcohol or drugs to get
away from things that bother me or are hard to face.
|
| ____ |
____ |
- Use to solve most problems: I use alcohol
or drugs to try to solve most of my problems and things that
bother me.
|
| ____ |
____ |
- It takes more: It takes more or stronger
kinds of alcohol or drugs to get the same feelings than it
used to.
|
| ____ |
____ |
- Memory loss: Sometimes after I have been
using, I do not remember what happened.
|
| ____ |
____ |
- Sneaking: Sometimes I hide from other
people how much I'm using or drinking. This might be because
I do not want people to know or because I do not want to
share.
|
| ____ |
____ |
- Dependence: I rarely do anything for fun
unless I use alcohol or drugs.
|
| ____ |
____ |
- Fast start: I use stronger alcohol or
drugs or use a lot quickly at first to get a "good
start."
|
| ____ |
____ |
- Feel guilty: I feel guilty about using
alcohol or drugs or about the things that I do when I use.
|
| ____ |
____ |
- Do not listen: Other people complain or
try to talk to me about my using but I do not listen.
|
| ____ |
____ |
- Regular blackouts: I do not remember
what happened and I get into trouble when I use alcohol or
drugs.
|
| ____ |
____ |
- Excuses: I use problems in my life as an
excuse for using alcohol or drugs. I feel that I have to use
to deal with these problems.
|
| ____ |
____ |
- Using more than others: I use more than
most people, so I hang around people who use as much or more
so that I feel that I fit in.
|
| ____ |
____ |
- Feel bad: I feel bad about how my using
hurts other people, but I don't know what to do about it.
|
| ____ |
____ |
- Show off: I show off or get pushy with
other people to feel better and prove that I am okay.
|
| ____ |
____ |
- Promises: I promise to get my life in
order and do better. I mean it, but it doesn't work out that
way.
|
| ____ |
____ |
- Control: I try to control my use, but it
doesn't work.
|
| ____ |
____ |
- Give up other things: I've stopped doing
things that I used to do that didn't involve using alcohol
or drugs.
|
| ____ |
____ |
- Make changes: I change jobs, move, or
leave a relationship to try to make my life better, but it
doesn't make any difference.
|
| ____ |
____ |
- Work and money troubles: I have problems
on the job, owe money or can't work at all because of my
using.
|
| ____ |
____ |
- Avoid friends and family: I avoid old
friends and family that do not use—unless I need something
from them.
|
| ____ |
____ |
- Neglect food: I do not eat healthy foods
or eat at regular times, especially when I'm using.
|
| ____ |
____ |
- Resentment: I feel like other people are
out to get me, and I feel angry a lot.
|
| ____ |
____ |
- Withdrawal: I need a drink or a drug in
the morning or else I get the shakes or sweats because I
feel terrible.
|
| ____ |
____ |
- Can't make decisions: I can't make
decisions about even small things. I just wait until things
happen.
|
| ____ |
____ |
- Health problems: I am sick, have lost a
lot of weight, or feel physically bad most of the time.
|
| ____ |
____ |
- Decrease in amount to get high: It takes
less for me to get high or doesn't matter how much I use
because I can't get the effect I want.
|
| ____ |
____ |
- Over the line: I do things I said I
would never do or things that do not reflect the way I was
raised.
|
| ____ |
____ |
- Use all the time: I use whenever I can,
and I don't try to have a normal life.
|
| ____ |
____ |
- Find someone worse: I try to use with
people who are worse off than I am so that I feel better.
|
| ____ |
____ |
- Major damage: Even when I'm not using, I
have a hard time thinking, remembering,and doing things that
used to be easy.
|
| ____ |
____ |
- Afraid: I feel like something terrible
might happen to me, people are out to get me, and I have to
be on guard at all times.
|
| ____ |
____ |
- Give up: I don't try to change anything.
I just wait to see what happens.
|
| ____ |
____ |
- Using is everything: Getting something
to use, using, and getting over using are my whole life.
|
| ____ |
____ |
- Turn to God: I want God or religion to
save me from my life.
|
| ____ |
____ |
- I'm lost: I don't try to pretend my life
is normal. I know I am an addict or an alcoholic. I believe
that things will never change.
|
| ____ |
____ |
- Desperation: I am willing to do anything
to get better.
|
| ____ |
____ |
- Confinement: I have been in jails and
mental wards because of my using.
|
