Hemet Valley
Adult Addiction
Recovery Center

1. After drinking have you ever noticed an increase in your heart rate or beating in your chest?
YES     NO

2. When talking with others, do you ever underestimate how much you actually drink?
YES     NO

3. Does alcohol make you sleepy so that you often fall asleep in your chair?
YES     NO

4. After a few drinks, have you sometimes not eaten or been able to skip a meal because you didn't feel hungry?
YES     NO

5. Does having a few drinks help decrease your shakiness or tremors?
YES     NO

6. Does alcohol sometimes make it hard for you to remember parts of the day or night?
YES     NO

7. Do you have rules for yourself that you won't drink before a certain time of the day?
YES     NO

8. Have you lost interest in hobbies or activities you used to enjoy?
YES     NO

9. When you wake up in the morning, do you ever have trouble remembering part of the night before?
YES     NO

10. Does having a drink help you sleep?
YES     NO

11. Do you hide your alcohol bottles from family members?
YES     NO

12. After a social gathering, have you ever felt embarrassed because you drank too much?
YES     NO

13. Have you ever been concerned that drinking might be harmful to your health?
YES     NO

14. Do you like to end an evening with a nightcap?
YES     NO

15. Did you find your drinking increased after someone close to you died?
YES     NO

16. In general, would you prefer to have a few drinks at home rather than go out to social events?
YES     NO

17. Are you drinking more now than in the past?
YES     NO

18. Do you usually take a drink to relax or calm your nerves?
YES     NO

19. Do you drink to take your mind off your problems?
YES     NO

20. Have you ever increased your drinking after experiencing a loss in your life?
YES     NO

21. Do you sometimes drive when you have had too much to drink?
YES     NO

22. Has a doctor or nurse ever said they were worried or concerned about your drinking?
YES     NO

23. Have you ever made rules to manage your drinking?
YES     NO

24. When you feel lonely, does having a drink help?
YES     NO

Scoring: Five or more "yes" responses are indicative of an alcohol problem.

For more information, Please contact the Hemet Valley Recovery Center admissions department at (951) 765-4900 or (800) 493-0930.

Reproduced courtesy of Frederic C. Blow, Ph.D., at University of Michigan Addiction Research Center