Your answers to the questions in this short assessment will help to identify specific problems you might have with chemical dependency. Please answer each question by placing a check in the appropriate “yes” or “no” box. 1. Have you tried and failed to stop drinking or using drugs?YesNo2. Has a family member, a friend, or your employer expressed concern about your drinking and/or drug use?YesNo3. Do you feel guilty about drinking or using drugs?YesNo4. Have your responsibilities at work and/or home suffered because of your use of your drinking or use of drugs?YesNo5. Have you lied to people about your alcohol and/or drug use?YesNo6. Has your drinking or drug use caused you to suffer from sicknesses such as shaking, vomiting, or paranoia?YesNo7. Do you find it difficult to have a good time without using substances?YesNo8. Have you often thought that your life would be better without drug and/or alcohol use?YesNo9. Have you ever felt you should cut down on your drinking or drug use?YesNo10. Do you get annoyed when others want to discuss your drinking or drug use?YesNo11. Have you experienced negative consequences in relationships related to your drinking or drug use?YesNo12. Have you ever been arrested related to your drinking or drug use?YesNo13. Do you spend money you don’t have or that you should be spending on necessities for alcohol or drugs?YesNo14. Have you ever felt guilty about your drinking or drug use?YesNo15. Have you ever “doctor shopped” as a way to obtain prescription drugs?YesNo16. Have you ever felt the need to drink or use first thing in the morning?YesNo17. Do you feel you must drink or use drugs to get through your day?YesNo18. Have you ever sought medical attention because of your drug and alcohol use?YesNo19. Do you constantly think about the next time you will drink alcohol or take drugs?YesNo20. Have you suffered from memory loss after drinking or using drugs?YesNo21. Do you experience withdrawal symptoms after not drinking or using drugs for an extended period of time?YesNo22. Do you sometimes go to extensive lengths to obtain alcohol or drugs?YesNo23. Do you ever try to hide your drinking or drug use (or the extent thereof)?YesNo24. Do you sometimes remain intoxicated for several days at a time?YesNo25. Do you say or do things while intoxicated that you later regret while sober?YesNoNameThis field is for validation purposes and should be left unchanged. * This Chemical Dependency Self-Test was developed for Seeking Integrity by Dr. David Fawcett and Dr. Robert Weiss.