Self-Assessment of Alcohol Use

This self-assessment is simply a guide to assist you in identifying potential problems. It does not take the place of an in-person assessment by a trained and qualified professional.

1.	Do you drink more than you used to, in order to achieve the same effects?	yes	no
2.	Have you ever missed work or another important obligation because you felt ill after drinking the previous day or night?	yes	no
3.	Do you find that you often drink more or spend more time drinking than you intended?	yes	no
4.	Have you tried to quit drinking or broken promises to yourself or others to cut down on your drinking?	yes	no
5.	Do many of your leisure time activities involve drinking?	yes	no
6.	Have you given up things you used to enjoy as a result of drinking?	yes	no
7.	Have friends or relatives made comments or complained to you about drinking too much?	yes	no
8.	Have you ever received a DUI (Driving Under the Influence) Charge?	yes	no
9.	Have there been times where you felt you would have gotten a DUI charge if you had been pulled over by the police?	yes	no

About this assessment: This self-assessment is based on diagnostic criteria used by mental health and medical professionals to determine substance abuse and dependence. (Diagnostic and Statistical manual IV, DSM - IV, American Psychiatric Association).

Rosecrance Health Network
3815 Harrison Avenue • Rockford, IL 61108
phone: 1-815-391-1000 • fax: 1-815-391-5041