Center Pointe Alcohol and Drug Use Screening - Center Pointe [PDF]

or drug use? If honest answers to the questions above indicate that you or someone you know may have an addiction, pleas

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The following questions are designed to help an individual recognize concerns regarding the use of alcohol or other mood-altering substances. A “yes” answer to two or more questions may indicate that drinking or drug use has become problematic and may warn of addiction. Please answer yes or no to each of the following questions:

Have you tried to decrease your alcohol or drug use, but couldn’t? Do you sometimes lie about how much or how frequently you drink alcohol or use drugs? Do you ever feel guilty or ashamed about your alcohol or drug use? Have friends or family members expressed concern about your alcohol or drug use? Have you experienced a period of blackout or memory loss while drinking or using drugs? Has your alcohol or drug use caused problems in your marriage or other relationships? Have you experienced trouble at work or with the law because of alcohol or drug use? If honest answers to the questions above indicate that you or someone you know may have an addiction, please consider a clinical evaluation with an addiction treatment professional to assess the need for assistance and treatment. CenterPointe offers free, confidential assessments and can help determine if treatment is recommended. Call 1.800.345.5407 or complete the form below. Name... Email... Phone... Comments...

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