Questionnaire

ARE YOU AN ADDICT?
Ask yourself the following questions. Answer as honestly as possible.


1. Do you lose time from work due to drinking/using?
2. Is drinking/using making your home life unhappy?
3. Do you drink/use because you are shy?
4. Is drinking/using affecting your reputation?
5. Have you ever felt guilt/remorse after drinking/using?
6. Have you ever had any financial problems due to drinking/using?
7. Have you ever been arrested due to drinking/using?
8. Does your drinking/using make you careless of your families welfare?
9. Has your ambition decreased since drinking/using?
10. Have you ever lost friends due to drinking/using?
11. Do you drink/drug before noon fairly often?
12. Does drinking/using cause you to have difficulty sleeping?
13. Has your efficiency decreased since drinking/using?
14. Is drinking/using jeopardizing your job/business?
15. Do you drink/use to escape worries/troubles?
16. Do you drink/use alone?
17. Have you ever had a loss of memory due to drinking?
18. Do you drink/use to build your self confidence?
19. Have you ever gone to anyone for help about your drinking/using?
20. Has anyone ever complained or gone for help due to your drinking/using?

If you answered YES to any one of these questions, this can be a warning to the possibility that you may be alcoholic/addict..

If you answered YES to two questions, there are strong chances you are an alcoholic/addict.

If you answered YES to three or more questions, there is a high probability of alcoholism/addiction.

These questions have been adapted from the MAST and from a questionnaire used by Johns Hopkins University Hospital.

 
Evaluations:  

Residential Evaluation - English
Residential Evaluation - Spanish
Outpatient Evaluation - English
Outpatient Evaluation - Spanish

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