Is your drinking or using out of control?

Only you can decide if your drinking or using is problematic.

Answer the following questions as honestly as you can *
Answer the following questions as honestly as you can
Drinking/using is making my home life unhappy.
My drinking/using makes me careless of my family's welfare.
I drink/use because I am shy with other people.
Drinking/using is affecting my reputation.
I drink/use to escape from worries or trouble.
I drink/use alone.
I have lost time from work due to drinking/using.
My ambition has decreased since drinking/using.
Has your efficiency decreased since drinking/using.
Drinking/using is jeopardising my job or business.
I have felt remorse after drinking or using.
I am in financial difficulties as a result of drinking or using.
I seek out an inferior environment when drinking.
I crave a drink or a drug at a definite time daily (wine-o'clock, gin-time, 4.20 etc.)
Drinking/using causes me difficulties in sleeping.
I want a drink or a drug the next morning.
I drink/use to build up my self-confidence.
I have had a complete loss of memory as a result of drinking.
I have been treated by my doctor for drinking/using.
I have been in hospital or prison because of drinking.
When I have a drink/drug, I can stop whenever I want (after 1, after 2).
When I have decided that I'm not going to drink or use at all, I can stick to that.
If you have answered Agree/Strongly Agree to any of the questions, it is possible that you may have a problem. If you would like to send this form to me and set up a free, confidential, no-strings 20-minute phone consultation for 12-Step Coaching, please fill out your contact details below and press submit.
Name *
Consent *