Your Personal Observations

What attempts have you made to control your use?  (i.e., abstinence, treatment, A.A.)

What do you see as the negative consequences of your use?  (legal, physical, job, school, social, mental, emotional, family) 

What are the negative consequences of your use from the viewpoint of a concerned person?

Chemical Dependency Diagnostic Criteria

Do you ever look forward to the end of a day so you can have a couple of drinks (or drugs) and relax?

Do you sometimes look forward to the end of the week so you can have some fun drinking or using drugs?

Does the thought of drinking or using sometimes enter your mind when you perhaps should be thinking of something else?

Do you sometimes feel the need to have a drink or use drugs at a particular time of day?

Do you find that you can often drink or use more than others and not show it too much?

Has anyone ever commented on your ability to hold your liquor or drugs?

Have you ever wondered about your high capacity to drink or consume rugs and perhaps

been somewhat proud of this ability?

Gulping Drinks

Do you usually order a double or drink your first two or three drinks fairly fast?

Do you usually have a couple of drinks before going to a party or out to dinner?

Drinking Alone

Do you ever stop somewhere and have a couple of drinks by yourself?

Do you sometimes drink at home alone or when no one else is drinking?

Do you ever drink or use drugs to calm your nerves, reduce tension or to relieve stress?

Do you find it difficult to enjoy a party or dance if there is nothing to drink or no drugs to take?

Do you ever use alcohol or drugs to help you get to sleep at night?

Do you ever use alcohol or drugs to relieve discomfort?

The morning following an evening of drinking or using drugs, have you ever had the experience of not being able to remember everything that happened the night before?

Have you ever had difficulty recalling how you got home the night before?

Sneaking Drinks

Do you sometimes stash a bottle away around the house in the event you may "need" a drink sometimes?

Do you ever keep a bottle in the trunk of your car "just in case?"

Do you ever plan to have a drink or two and then have several more than you planned?

Do you sometimes drink more than you think you should?

Is your drinking sometimes different than you would like it to be?

Have you ever had the shakes or hand tremors the morning after?

Have you taken a drink in the morning to ease a hangover?

Does your family know you drink or use drugs too much?

Does your family ever object to your drinking or using?

Has your family ever threatened intervention because of this?

Do you sometimes drink or use drugs even though you can’t afford to?

Have you ever missed work or school because of a hangover?

Have you ever lost a job because of drinking or using?

Has drinking or using ever caused you to be less efficient in school or work?

Have you ever been threatened with suspension from school because of drinking or using or been told to "cool it or watch it?"

Has a doctor ever told you to cut down or stop your drinking or using drugs for any reason at all?

Have you ever been hospitalized because of drinking or using drugs or complications from drinking or using?

Do you sometimes do things while drinking or using that you are ashamed of later?

Do you have a very definite preference to socialize with people who drink or use drugs as opposed to those who do not?

Has drinking or using drugs become important or time consuming to the extent that other interests are to some extent neglected?

According to Heilman criteria, if your answers in the four different categories are predominantly "Yes", this constitutes chemical dependency.