Answer the following questions either yes or no.

1. ___ Do friends/partner/family ever worry or complain about your alcohol/drug use?

2. ___Have you ever missed a class to go party or because of a hangover?

3. ___Is drinking or using drugs affecting your studying or grades?

4. ___Have you ever attributed a poor grade on a test to partying too much the night before?

5. ___Do you drink or use drugs because it makes you feel more social?

6. ___Do you argue or fight with your friends when you drink or use drugs?

7. ___Have you ever injured yourself when drinking or using drugs?

8. ___Do you drink or use drugs because it has been a hard week?

9. ___Do you gulp drinks or play drinking games?

10. ___Have you ever forgotten what happened when you drank or used drugs?

11. ___Have you lied about your drinking or drug use?

12. ___After drinking or using drugs, have you ever had sex and been sorry or embarrassed later?

13. ___After drinking or using drugs, have you had unprotected sex or one night stands?

14. ___Have you ever gotten into trouble with the college because of drinking or using drugs?

15. ___Have you ever been arrested for driving while under the influence of alcohol or drugs?

16. ___Do you feel guilty about your alcohol or drug use?

17. ___Have you experienced financial problems because you spent too much money on alcohol or drugs?

18. ___Have you felt angry because someone said you drink or use drugs too much?

19. ___Are you unable to stop drinking or using drugs when you want too?

20. ___Would you like to talk to a counselor about you drinking or drug use?

A yes answer to three or more of the above questions may indicate a problem with your use of alcohol or drugs. For a confidential assessment and evaluation of your use of alcohol or drugs, please call the Health Services at ext. 3394 to make an appointment with Alden Kent PA-C/LCSW.

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