Drug Rehab Needs Assessment

1. Do you currently use alcohol or illegal drugs?
2. Are you taking prescription drugs?
3. Do you take more medication than prescribed?
4. Do you have more than one prescription for narcotics from the same or different physicians?
5. Do you obtain drugs off the streets?
6. Do you drink or use drugs to relieve feelings of stress when you're under pressure?
7. Do you sometimes drink or use drugs after a disappointment or rough day?
8. Is drinking or using drugs one of the first things you make a point of doing whenever you have a reason to celebrate for example, a job promotion, birthday, or anniversary?
9. Do you feel uneasy if alcohol isn't available at a restaurant, party or event?
10. In the past year have you ever had a drink or used drugs upon waking up to feel better from the night before?
11. Do you sometimes feel slightly guilty about your drinking or drug use?
12. When you're sober, do you sometimes regret things you've said or done while drinking or using drugs?
13. Are other people bothered by your intake of drugs and alcohol? Do they make comments or make it apparent they are uncomfortable around you when you are intoxicated?
14. Have you ever failed to keep promises about controlling your drinking?
15. Do you ever sneak drinks or hide your drug use at parties or get high or "buzzed" before attending social events so that people can't gauge how much you are using or drinking?
16. In the past year have you been in trouble at school, work, or with the law as a result of drinking or drug use?
17. In the past year has your drug use or drinking caused problems at home with your family, children, parents, or spouse?
18. Have you missed school, work, or important family commitments because you were high, hung-over, or drunk?
19. Do you wish you could be like other people who drink and/or use and do not get in trouble? Do you envy them?
20. Do you ever have "blackouts" or periods you can't remember while using drugs or drinking?
21. Have you been using drugs for more than a year?
22. Have you ever felt that if you could only quit using or drinking that your life would be much better?
23. Do you tell yourself that you can quit anytime but still get drunk and or high without meaning to?
24. Have you ever decided to stop your drug use or drinking and been unable to do so for any length of time?
25. Have you ever made an attempt to stop using or drinking by switching from beer to liquor, liquor to beer, heroin to pills, or from hard drugs to pot and found that either you were unsuccessful or that you just added a new "flavor" to your drinking and using?
26. Have you ever received addiction treatment?