Is this for me

1) 1. Do you spend a lot of time thinking about your drugs and/or alcohol use? yes no

2) 1. Do you feel that you are losing control over your drugs and/or alcohol use? yes no

3) 1. Are you unable to stop once you start using? Do you often intend to just have one or two and end up using/drinking much more? yes no

4) 1. Do you feel that you need to use and/or drink to feel normal? yes no

5) 1. Are you irritable when you don’t have drugs and/or alcohol? yes no

6) 1. Do you spend more money than you want to on drugs and/or alcohol? yes no

7) 1. Do you spend a significant amount of your time finding, waiting or using /drinking? yes no

8) 1. Do you want to quit, reduce or change your use/drinking but can’t? yes no

9) 1. Do you feel down/ depressed when you’re out of drugs and/or alcohol? yes no

10) 1. Do you lie about how much you are using and/or drinking? yes no

11) 1. Have you been late or missed commitments and/or work because of your drugs and/or alcohol use? yes no

12) 1. Is your life a struggle? yes no

13) 1. Does it take drugs and/or alcohol to make you feel good? yes no

14) 1. Do you increasingly surround yourself with only people that use drugs and/or alcohol? yes no

15) 1. Are you finding that you need to take more drugs and/or alcohol to get high/drunk? yes no

16) 1. Are you increasingly experiencing more conflict with your loved ones or people close to you about your drug and/or alcohol use? yes no

17) 1. Do you feel guilty about your drug and/or alcohol use? yes no

18) 1. Do you break promises to yourself and/or to others because of your drug and/or alcohol use? yes no

19) 1. Do you feel that your drug and/or drinking affecting your health? yes no

20) 1. Do you find that you are avoiding having to spend time with people that don’t use and/or drink? yes no

21) How would you like ASC to contact you? email phone

22) At what time would you like ASC to contact you?

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