Substance abuse assessment questionnaire for self evaluation of drug and alcohol addiction.

Substance abuse difficulties affect each person differently, but there are many common factors which most people experience when they are struggling. Each individual has a unique level of resilience to manage their difficulties and most everybody experiences some degree of problems at some point in life.

However, there are times when drug abuse or emotional disturbances become unmanageable and may rise to the point of requiring formal assessment and treatment. Self-assessments help you to take a look at yourself in an honest, open manner. They are useful in considering symptoms and questions about problems that may have previously been ignored or minimized. They can help you to admit to yourself that you may really have a problem and that what family and friends have shared with you is well-intentioned and out of love. Self-assessments are able to be done in privacy and with complete anonymity. They often help identify the need to reach out for help and can bridge the gap toward taking the first step of picking up the phone to call an expert for assistance.

The following assessment questionnaire will help you to take a look at a cluster of common symptoms, but do not necessarily indicate a significant problem when taken out of context, or if you are troubled by a small range of symptoms.

You should answer these questions very honestly. If you answer the questions honestly, you will be able to better gauge whether or not you are experiencing any symptoms that may require further investigation. And if you need it, please know that the staff at Challenges is available to help you interpret your answers and to provide you with whatever information or help you may need.

If the team at Challenges can help by providing additional information or resources, please don’t hesitate to contact us.

Question1: Do you feel you have a lack of personal confidence to remain clean/sober or abstinent?
Yes   No

Question2: Has anyone suggested that you may be in denial?
Yes   No

Question3: Do you find yourself trying to convince yourself or others that you will never ever drink or use again?
Yes   No

Question4: Do you start imposing recovery on other people?
Yes   No

Question5: Do you become defensive when talking about your problem in recovery?
Yes   No

Question6: Have compulsive behaviors appeared, or have you adopted a non-structured lifestyle?
Yes   No

Question7: Do you over-react, or are impulsive behaviors beginning to appear?
Yes   No

Question8: Are you experiencing periods of loneliness?
Yes   No

Question9: Have you begun to focus on one certain area in your life, and are you unwilling to shift your focus? (TUNNEL VISION)
Yes   No

Question10: Are you experiencing periods of minor depression?
Yes   No

Question11: Are you experiencing a loss in the ability to plan constructively where attention to details lessen and wishful thinking begins?
Yes   No

Question12: Are your plans beginning to fail?
Yes   No

Question13: Do you find yourself daydreaming more often and is the "if only" syndrome entering into your daily routine?
Yes   No

Question14: Do you feel that nothing can be solved?
Yes   No

Question15: Are you vocalizing the immature wish to be happy, while feeling that you do not know what happiness is?
Yes   No

Question16: Are you experiencing periods of confusion?
Yes   No

Question17: Are you behaving irrationally with friends and family?
Yes   No

Question18: Are you easily angered?
Yes   No

Question19: Do you have irregular eating habits?
Yes   No

Question20: Do you feel you have an inability to concentrate, feel full of anxiety, or have feelings of being trapped?
Yes   No

Question21: Has there been a progressive loss of daily structure?
Yes   No

Question22: Are you experiencing periods of deep depression?
Yes   No

Question23: Have you had increasingly irregular attendance at recovery meetings?
Yes   No

Question24: Have you developed an "I do not care" attitude?
Yes   No

Question25: Are you openly rejecting help?
Yes   No

Question26: Are you becoming dissatisfied with life?
Yes   No

Question27: Do you have feelings of powerlessness and helplessness?
Yes   No

Question28: Do you spend time wallowing in self pity?
Yes   No

Question29: Are you having thoughts of social drinking/using?
Yes   No

Question30: Are you experiencing conscious lying?
Yes   No

Question31: Do you have a complete loss of self-confidence?
Yes   No

Question32: Are you harboring unreasonable resentments?
Yes   No

Question33: Have you discontinued attendance at Recovery Meetings altogether?("Developed an I do not need them attitude")
Yes   No

Question34: Do you feel overwhelming loneliness, frustration, anger and tension?
Yes   No

Question35: Have you started "controlled" drinking and using?
Yes   No

Question36: Have you developed an "I do not care" attitude?
Yes   No

Essay Question: Please write a description of your present feelings about recovery:


First Name


Last Name


Phone Number


Email Address: 


Code Word: 

Change Word

Author - Dr. Jeffrey Huttman Ph.D.

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