Addiction

Name* :

Email* :

Contact Number* :

Addiction :


Please answer the questions below, keeping the last one year in mind


1. Have you or your loved one ever thought that they should cut down their Alcohol or Drug use ?

YesNo


2.Have you or your loved one ever felt annoyed when people have commented on their Alcohol or Drug use ?

YesNo


3. Have you or your loved one ever felt guilty or badly about their Alcohol or Drug use ?

YesNo


4. Have you or your loved one ever had to consume Alcohol or Drugs to steady their nerves first thing in the morning ?

YesNo


5. Have you or your loved one had problem with family and friend due to their Alcohol or Drug use ?

YesNo


6. Have you or your loved one ever missed work or school because of Alcohol or Drug use ?

YesNo


7. Have you or your loved one ever gotten into legal problems because of Alcohol or Drug use ?

YesNo


8. Have you or your loved one become less efficient because of Alcohol or Drug use ?

YesNo


9. Can you or your loved one get through the week without consuming Alcohol or Drugs ?

YesNo


10. Have you or your loved one ever seeked help for reducing the consumption of Alcohol or Drugs ?

YesNo