Substance Abuse Self Assessment

For Emergency Services, Contact BHR at 314-469-6644 or 800-811-4760

Alcohol Abuse Self Assessment

The following questions ask about your use of alcohol. Answer the questions honestly to get the most accurate assessment of any potential problems.

Note: Error is possible in any assessment. Errors may indicate that no problem exists when one actual does or fail to identify a problem that does exist. For more accurate help in deciding if a problem needs attention, contact one of the services identified in these pages.

1. How often do you have a drink containing alcohol?
Never
Monthly or less
2-4 times per month
2-3 times per week
4 or more times per week

2. How many drinks containing alcohol do you have on a typical day when you are drinking
None
1 or 2
3 or 4
5 or 6
7-9
10 or more

3. How often do you have six or more drinks on one occasion?
Never
Less than monthly
Monthly
Weekly
Daily or almost daily

4. How often during the last year have you found that you were unable to stop drinking once you started?
Never
Less than monthly
Monthly
Weekly
Daily or almost daily

5. How often during the last year have you failed to do what was normally expected from you because of drinking?
Never
Less than monthly
Monthly
Weekly
Daily or almost daily

6. How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?
Never
Less than monthly
Monthly
Weekly
Daily or almost daily

7. How often during the last year have you felt guilt or remorse after drinking?
Never
Less than monthly
Monthly
Weekly
Daily or almost daily

8. How often during the last year have you been unable to remember what happened the night before because of drinking?
Never
Less than monthly
Monthly
Weekly
Daily or almost daily

9. Have you or someone else been injured as the result of your drinking?
Never
Less than monthly
Monthly
Weekly
Daily or almost daily

10. Has a friend, relative, doctor, or other health worker been concerned about your drinking or suggested you cut down?
Never
Less than monthly
Monthly
Weekly
Daily or almost daily

11. How important is substance abuse treatment to you at this time?
Extremely Important
Very important
Moderately important
Slightly important
Not at all important

12. Sex?
Female Male

13. Age?
18 or younger Over 18

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