| Ask yourself the following questions and answer them as honestly as you can. |
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| 1. Do you avoid people and/or places that do not condone your usage? |
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| 2. Do you like to use alone? |
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| 3. Do you use because your family drives you crazy? |
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| 4. Have you ever stolen your friend's drugs? |
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| 5. Do you guard your supply? |
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| 6. Have you been arrested for drinking, drunk driving, or driving under the influence of an intoxicant? |
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| 7. Have you ever stolen drugs, money, or someone else's possessions to buy your drug of choice? |
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| 8. Did you smoke your plant before it was two feet tall? |
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| 9. Do you spend your money on drugs rather than food and other necessities? |
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| 10. Do you think that everyone in the world is crazy except yourself? |
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| 11. Do you wonder why some people don't want to use? |
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| 12. Does the thought of running out of your drug of choice leave you with a feeling of impending doom? |
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| 13. Do you get more drugs or alcohol when your supply is running low or as soon as you run out? |
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| 14. Do you neglect your responsibilities because you'd rather get high? |
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| 15. Have you tried substituting one drug for another, thinking that "one" particular drug was your problem? |
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| 16. Do you con doctors for "legal" drugs, telling yourself that it's okay to use them because they aren't illegal? |
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| 17. Do you have more than one prescription at one time with different doctors? |
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| 18. Do you use something to help you get going in the morning, or to slow you down at night? |
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| 19. Do you use illegal or "hard" drugs and think there is nothing that can be done to kick the habit? |
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| 20. Have you ever been in trouble with friends, family, school, jobs, or the law because of drug/alcohol related incidents? |
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| 21. Do you have more than one hiding place for your drugs? |
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| 22. Do you have empty alcohol containers in your vehicle? |
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| 23. Do you lose time from work due to drinking? |
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| 24. Is drinking making your home life unhappy? |
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| 25. Do you drink because you are shy with other people? |
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| 26. Is using affecting your reputation? |
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| 27. Have you ever felt remorse after drinking or using? |
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| 28. Have you gotten into financial difficulties as a result of drinking or using? |
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| 29. Do you or have you turned turn to lower companions and an inferior environment when drinking? |
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| 30. Does your using make you careless of your family's welfare? |
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| 31. Since you began to use, has your ambition decreased? |
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| 32. Do you crave a drink at a definite time daily? |
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| 33. Do you want a drink the next morning? |
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| 34. Does your use cause you to have difficulty in sleeping? |
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| 35. Has your efficiency decreased since you started using? |
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| 36. Is using or drinking jeopardizing your job or business? |
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| 37. Do you drink or use to escape from worries or trouble? |
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| 38. Have you ever had a complete loss of memory as a result of drinking? |
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| 39. Has your physician ever treated you for drinking? |
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| 40. Do you drink or use to build up your self-confidence? |
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| 41. Have you ever been to a hospital or institution because of drinking or an overdose? |
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