INSTRUCTIONS: Carefully consider each question and answer either “YES ”or ”NO”.

Yes NO
I am a normal drinker.
Family and friends think I am a normal drinker.
Occasionally I feel guilty about my drinking.
I have no problems stopping after one or two drinks.

Family or friends have complained or worried about my drinking.

The morning after a night of drinking I struggle to remember parts of the evening.

Drinking has created marital problems.
I have attended at least one recovery group meeting for myself.
I can always stop drinking when I want to.

I control my drinking to only certain places or times of the day.

I have consumed alcohol before noon.
I have gotten into physical fights when drinking.
Drinking has caused me trouble at work.
I have lost employment due to drinking.

I have lost relationships because of my drinking.

One or more family members have sought help to deal with my drinking.

I’ve been diagnosed with physical problems due to drinking. (liver; stomach; digestive; etc.)
I have neglected responsibilities to employer and/or family for two or more days in a row because of drinking.
Legal issues have resulted from my drinking. (arrest; DUI; etc.)

I have experienced severe shakes, heard voices, DT’s, or delusions after heavy drinking.

I have sought professional help to deal with emotional problems that were caused in part by drinking.

I was in-patient at a hospital or mental health ward where drinking was a contributing factor.

I have sought help for my drinking in the past.

In the past I have been in treatment for drinking.

Your Score

If Your SCORING RESULTS: Is It means...
9 or more: Alcoholism Probable
5 or more: Alcoholism Possible
4 points: Borderline
0 to 3 points: Issues Possible
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*IMPORTANT: These self-assessment questions are but a tool to help identify what might be symptoms of addiction. In no way does it replace the evaluation of a therapy professional. If you identify with some of these symptoms consider seeking the assessment of a professional or contacting THE JEREMIAH PROJECT
( All contacts and services of the Jeremiah Project meet
“Confidentiality” Federal Regulations – Reg.#42 CFR, Part 2 ).

                                               PO Box 476, Brownstown, PA 17508 Phone: (717) 627-7106 Fax:: (717) 738-0258