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1. Do you use/drink in the morning to start your day? yes no
2. Do you have to keep using/drinking once you have started? yes no
3. Do you lie to loved ones and/or friends about using/drinking? yes no
4. Are there family problems because of your using/drinking? yes no
5. Do you sell personal items to use or drink? yes no
6. Do you not keep promises because of using/drinking? yes no
7. Is your reputation changing because of using/drinking? yes no
8. Do you use/drink to feel more confident? yes no
9. Have you lost a job because of using/drinking? yes no
10. Are you in trouble financially because of using/drinking? yes no
11. Do you miss work because of using/drinking? yes no
12. Do you use/drink when you are alone? yes no
13. Do you have blackouts? yes no
14. Do you feel bad after using/drinking? yes no
15. Have you ever been hospitalized because of using/drinking? yes no
16. Is health deteriorating because of using/drinking? yes no
17. Are less concerned with the company you keep and the places you go? yes no
18. Have you been arrested because of your using/drinking? yes no

If you answered “yes” once you should be aware…you may have the tendency to develop a drug and/or alcohol problem. 

If you answered, “yes” to two or more of the above questions you have a problem with drugs and/or alcohol and should call today and talk with a representative…we’re here to help! If you’re uncomfortable with calling in…e-mail us at .

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