Questionnaire
ALCOHOL AND DRUG USE QUESTIONNAIRE
(Answer these questions as honestly as you can)
| Question | Yes | No | |
|---|---|---|---|
| 1. | Are my peers, friends or family alleging that my drinking or drug use is interfering with my work? | ( ) | ( ) |
| 2. | Do I plan my day around my drinking/drug use? | ( ) | ( ) |
| 3. | Do I ever feel I need a drink/drug to face certain situations? | ( ) | ( ) |
| 4. | Do I frequently drink/use drugs alone? | ( ) | ( ) |
| 5. | Have I ever had a loss of memory when apparently functioning because of my drinking/drug use? | ( ) | ( ) |
| 6. | Do I ever drink/use drugs before a meeting or court appearance to calm my nerves, gain courage, or improve my performance? | ( ) | ( ) |
| 7. | Do I want a drink or take a drug the morning after a hard night drinking/drugging? | ( ) | ( ) |
| 8. | Have I missed deadlines or appointments because of my drinking/drug use or because of a hangover? | ( ) | ( ) |
| 9. | After drinking/drug use, have I ever felt any of the following: fear, remorse, guilt, loneliness, depression, severe anxiety, terror, or impending doom? | ( ) | ( ) |
| 10. | Is my drinking/drug use making me careless about my finances, health or other responsibilities? | ( ) | ( ) |
| 11. | While drinking/drugging, have I ended up in places I would not normally frequent or with people I would not normally socialize with? | ( ) | ( ) |
| 12. | Do I need or desire a drink/drug to steady my nerves at a particular time of day or week? | ( ) | ( ) |
| 13. | Have I ever lied, cheated or stolen to support or cover up my drinking/drug use? | ( ) | ( ) |
| 14. | Have I ever tried unsuccessfully to quit drinking/drugging for any length of time? | ( ) | ( ) |
| 15. | Have I made attempts to control my drinking/drug use by limiting it to special occasions, special times of the day, or certain days of the week, certain number or types of drinks/drugs? | ( ) | ( ) |
| 16. | Do I avoid people in order to hide the effects of my drinking/drug use? | ( ) | ( ) |
| 17. | Have I ever been hospitalized or treated by a doctor directly or indirectly as a result of my drinking/drugging? | ( ) | ( ) |
| 18. | Is there anyone in any generation of my family who has been diagnosed, treated for, or sought help for an alcohol, drug or other addiction problem? | ( ) | ( ) |
If you answered YES to one or more of these questions, you owe it to yourself, your family, your clients and your profession to contact a lawyer assistance program. See the links on this site.