Confidential Survey Have any family members or friends ever expressed concern about your substance abuse? Yes No Is drinking or using affecting your personal relationships? Yes No Has drinking or using resulted in a negative performance at school or work? Yes No Do you ever drink or use drugs when you’re alone? Yes No Have you ever lied to a family, friends or a medical professional about your drinking or drug use? Yes No Do you have trouble sleeping at night without the aid of drugs or alcohol? Yes No Have you ever “blacked out,” waking with zero memory of what happened while drinking or using? Yes No Do you ever use or drink as a way to manage anxiety, stress or other negative occurrences? Yes No Have you found yourself drinking or using at a regular time each day? Yes No Do you ever feel concerned you might have a drinking or using problem? Yes No Time's up 2020-05-04T15:33:36+00:00
