Test For Addiction

Copied from format used by Johns Hopkins University Hospital, Baltimore, Maryland

Answer these questions honestly, (no one will see your answers but you) with "yes" or "no" answers

1. Do you lose time from work due to drinking/using?
2. Is drinking/using making your home life unhappy?
3. Do you drink/use because you are shy with other people?
4. Is drinking/using affecting your reputation?
5. Have you ever felt remorse after drinking/using?
6. Have you gotten into financial trouble as a result of drinking/using?
7. Do you turn to "lower companions" and an inferior environment when drinking/using?
8. Does your drinking/using make you careless of your family's welfare?
9. Has your ambition decreased since you have been drinking/using?
10. Do you crave a drink/drug at a definite time daily?
11. Do you want a drink/drug the next morning?
12. Does drinking/using cause you difficulty sleeping?
13. Has your efficiency decreased since drinking/using?
14. Is your drinking/using jeopardizing your job or business?
15. Do you drink/use to escape from worries or trouble?
16. Do you ever drink/use alone?
17. Have you ever had a complete loss of memory as a result of drinking? This is called an alcoholic blackout. (or been embarrassed about your actions due to drinking/using)
18. Has your physician ever treated you for your drinking/using? (or treated your injuries as a result of drinking/using?)
19. Do you drink/use to build up your self-confidence?
20. Have you ever been to a hospital or institution on account of your drinking/using?