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Ron Israel MA, LAADC, CADC II
ADDICTION COUNSELING FOR INDIVIDUALS AND FAMILIES
Addiction Questionnaire
 
  TAKE A FEW MINUTES TO HONESTLY ANSWER THE FOLLOWING QUESTION:



  1.  Do you ever drink or use drugs alone ? 

  2.  Have you ever tried to stop using only to start again after a few days ? 

  3.  Has your job or school performance ever suffered due to your alcohol or drug use ?

  4.  Has anyone close to you ever complained about your use of drugs or alcohol ?

  5.  Have you ever been arrested/ had legal problems due to your drug or alcohol use ?

  6.  Have you ever been in detox , hospital, or drug rehab center due to your using ?

  7   Do you continue to use despite negative consequences ?

  8.  Have you ever experienced an alcohol blackout or had a drug overdose ?

  9.  Do you personally think you may have a problem with drugs or alcohol in your life ?


   

    
  If you can answer yes to 2 or more questions, it's time to get some help.