Whiteside Manor - Affordable California Drug and Alcohol Treatment Center
We'll help you find and stay on the right path
Call 1-800-300-RECOVER (7326)

 

 

 

 

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Drug and Alcohol Self Evaluation

Prospective drug and alcohol rehab clients may contact our Admissions Department for an assessment with The following self-evaluation is designed to assist you in better understanding your use of alcohol and /or drugs, to determine if your use patterns are safe, risky or harmful. Your answers will serve to identify if you have a substance abuse problem, a chemical dependency and perhaps most importantly, if the time to seek help is now!

 

 

 

 

  1. Yes   No
    Have you ever had to see your doctor as a result of your drinking or drug use?
  2. Yes   No
    Is your drinking or drug use affecting your home-life?
  3. Yes   No
    Have you ever been committed to a hospital or institution as a result of your drug abuse or drinking?
  4. Yes   No
    Do you feel like you have more self-esteem when you are intoxicated?
  5. Yes   No
    Is your drinking or drug abuse affecting your employment or business?
  6. Yes   No
    Has your efficiency decreased since you began drinking or abusing drugs?
  7. Yes   No
    Do you find you have a craving for a drink or your drug of choice at certain definite times of the day?
  8. Yes   No
    Does your drinking or drug abuse make you careless of your family's well-being?
  9. Yes   No
    Have you lost time from work due to your drinking or drug abuse?
  10. Yes   No
    Are you shy when you are not drunk or high?
  11. Yes   No
    Has your drinking or drug abuse affected your reputation with your family, friends and business affairs?
  12. Yes   No
    Do you drink or use drugs to escape your troubles?
  13. Yes   No
    Do you ever drink or use drugs alone?
  14. Yes   No
    Have you ever felt bad about actions you took after drinking or using drugs?
  15. Yes   No
    Have you ever "blacked out" or had a loss of memory as a result of your drinking or drug abuse?
  16. Yes   No
    Have you ever had problems sleeping as a result of your drinking or drug abuse?
  17. Yes   No
    Do you ever feel like you need a drink or drug the next morning?
  18. Yes   No
    Do you find yourself associating with seedy people and hanging out in dangerous or inferior environments since you began drinking or using drugs?
  19. Yes   No
    Is your drinking or drug use affecting your financial situation?
  20. Yes   No
    Do you find you have less ambition when you are drinking or using drugs?
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CARF Accredited   California Department of Alcohol and Drug Programs

 

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