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Substance Abuse Questionaire  

476 Cahaba Park Circle

Birmingham, AL 35242

(205)980-4470

 Full Name:  
Session Objective:  

INSTRUCTIONS:

Below are some statements that describe what some people get out of drinking alcohol (or other substance abuse).  How often to you feel this way when you are drinking alcohol?  By answering the statements below, you provide us a guide that will enable us to know the most effective way to rid you of the Substance Abuse habit permanently.

Click the bubble under the response that best fits you.  The default answer is "always".
No.

QUESTION

Always Frequently Occasionally Seldom Never
1 I drink alcohol to perk myself up.
2 I get some enjoyment from fixing a drink.
3 I find drinking alcohol pleasurable.
4 Drinking alcohol takes my mind off my cares and worries.
5 I really notice when I am not drinking alcohol.
6 I find myself drinking alcohol and do not remember fixing the drink.
7 Drinking alcohol gives me a lift.
8 Handling my drink is part of the enjoyment of drinking alcohol.
9 Drinking alcohol is pleasant and relaxing.
10 When I feel upset, I drink alcohol.
11 I find myself drinking alcohol when talking on the phone.
12 I get a craving for alcohol when I haven't had a drink for awhile.
13 I drink alcohol automatically without being aware of it.
14 I enjoy drinking alcohol while watching TV.
15 I fix a drink of alcohol when I feel angry about something.
16 I think about drinking alcohol as soon as I awaken.
17 When I am not drinking, I find it almost unbearable.
18 I fix a drink without realizing I already have one.
                   

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