Do you wonder whether your problem with alcohol warrants treatment?
If so, here is your own personal self assessment survey.

Am I an Alcoholic?

You can find out by completing this self assessment survey from John Hopkin´s University.

1. Ask yourself the following 20 questions and answer them as honestly as you can:

1. Do you lose time from work due to drinking? Yes No
 
2. Is drinking making your home life unhappy? Yes No
 
3. Do you drink because you are shy with other people? Yes No
 
4. Is drinking affecting your reputation? Yes No
 
5. Have you ever felt remorse after drinking? Yes No
 
6. Have you got into financial difficulties as a result of drinking? Yes No
 
7. Do you turn to lower companions and an inferior environment when drinking? Yes No
 
8. Does your drinking make you careless of your family´s welfare? Yes No
 
9. Has your ambition decreased since drinking? Yes No
 
10. Do you crave a drink at a definite time daily? Yes No
 
11. Do you want a drink the next morning? Yes No
 
12. Does drinking cause you to have difficulty sleeping? Yes No
 
13. Has your efficiency decreased since drinking? Yes No
 
14. Is drinking jeopardizing your job or business? Yes No
 
15. Do you drink to escape from worries or trouble? Yes No
 
16. Do you drink alone? Yes No
 
17. Have you ever had a complete loss of memory as a result of drinking? Yes No
 
18. Has your physician ever treated you for drinking? Yes No
 
19. Do you drink to build up your self-confidence? Yes No
 
20. Have you ever been to a hospital or institution on account of drinking? Yes No

 

If you have answered YES to any one of these questions, there is a definite warning that you may be an alcoholic.

If you have answered YES to any two, the chances are that you are an alcoholic.

YES answers to three or more, is definitely consistent with an alcoholic.

 

2. Congratulations on completing the twenty questions.

If you wish for one of our A Home Away counsellors to contact you for a free, personal consultation, please complete your contact information for how you wish to be reached.

NB: Your confidentiality is strictly respected; your information will not be provided to any outside person or agency.

 

Name:
 
Email:
 
Phone Number:
   
Address:
 
City/Town:
 
Province/State:
 
Postal Code/ZIP:

3. You deserve to get the type of help you need.
Are you ready to consider treatment at A Home Away?

Yes

No

What is the best time to call you?

4. What is your preferred method of contact?

Telephone

E-Mail

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