|
1.
|
Do you feel you have a lack of personal confidence to remain clean/sober or abstinent?
|
No
Yes
|
|
2.
|
Has anyone suggested that you may be in denial?
|
No
Yes
|
|
3.
|
Do you find yourself trying to convince yourself or others that you will never ever drink or use again?
|
No
Yes
|
|
4.
|
Do you start imposing recovery on other people?
|
No
Yes
|
|
5.
|
Do you become defensive when talking about your problem in recovery?
|
No
Yes
|
|
6.
|
Have compulsive behaviors appeared, or have you adopted a non-structured lifestyle?
|
No
Yes
|
|
7.
|
Do you over-react, or are impulsive behaviors beginning to appear?
|
No
Yes
|
|
8.
|
Are you experiencing periods of loneliness?
|
No
Yes
|
|
9.
|
Have you begun to focus on one certain area in your life, and are you unwilling to shift your focus? (TUNNEL VISION)
|
No
Yes
|
|
10.
|
Are you experiencing periods of minor depression?
|
No
Yes
|
|
11.
|
Are you experiencing a loss in the ability to plan constructively where attention to details lessen and wishful thinking begins?
|
No
Yes
|
|
12.
|
Are your plans beginning to fail?
|
No
Yes
|
|
13.
|
Do you find yourself daydreaming more often and is the "if only" syndrome entering into your daily routine?
|
No
Yes
|
|
14.
|
Do you feel that nothing can be solved?
|
No
Yes
|
|
15.
|
Are you vocalizing the immature wish to be happy, while feeling that you do not
know what happiness is?
|
No
Yes
|
|
16.
|
Are you experiencing periods of confusion?
|
No
Yes
|
|
17.
|
Are you behaving irrationally with friends and family?
|
No
Yes
|
|
18.
|
Are you easily angered?
|
No
Yes
|
|
19.
|
Do you have irregular eating habits?
|
No
Yes
|
|
20.
|
Do you feel you have an inability to concentrate, feel full of anxiety, or have feelings of being trapped?
|
No
Yes
|
|
21.
|
Has there been a progressive loss of daily structure?
|
No
Yes
|
|
22.
|
Are you experiencing periods of deep depression?
|
No
Yes
|
|
23.
|
Have you had increasingly irregular attendance at recovery meetings?
|
No
Yes
|
|
24.
|
Have you developed an "I do not care" attitude?
|
No
Yes
|
|
25.
|
Are you openly rejecting help?
|
No
Yes
|
|
26.
|
Are you becoming dissatisfied with life?
|
No
Yes
|
|
27.
|
Do you have feelings of powerlessness and helplessness?
|
No
Yes
|
|
28.
|
Do you spend time wallowing in self pity?
|
No
Yes
|
|
29.
|
Are you having thoughts of social drinking/using?
|
No
Yes
|
|
30.
|
Are you experiencing conscious lying?
|
No
Yes
|
|
31.
|
Do you have a complete loss of self-confidence?
|
No
Yes
|
|
32.
|
Are you harboring unreasonable resentments?
|
No
Yes
|
|
33.
|
Have you discontinued attendance at Recovery Meetings altogether?("Developed
an I do not need them attitude")
|
No
Yes
|
|
34.
|
Do you feel overwhelming loneliness, frustration, anger and tension?
|
No
Yes
|
|
35.
|
Have you started "controlled" drinking and using?
|
No
Yes
|
|
36.
|
Are you feeling a loss of control?
|
No
Yes
|
