Home » Admissions » Professional Pre-Assessments » Addiction Assessment Think of someone close to you whom you are concerned about, answer the following questions truthfully and discover if your friend or loved one has a problem with drug or alcohol addiction. Name:*(At least your first name is required)Email Address:* Phone Number:*Is your friend or loved one unhappy with their life direction?:YesNoDo you feel they may have a problem with drugs/alcohol?:YesNoDo they use drugs/alcohol continuously?:YesNoCan they stop drinking after one glass?:YesNoDo they drink alone?:YesNoIs drinking/drug use affecting their reputation?:YesNoDoes drug/alcohol use cause problems with their job?:YesNoHas drug/alcohol use negatively affected their relationships?:YesNoDo they refuse to go places where they cannot use drugs/alcohol?:YesNoDo they need to use drugs/alcohol to have fun socially?:YesNoDo they do (or have they done) things that are illegal to get drugs/alcohol?:YesNoDo they lie about their drinking?:YesNoDo they use drugs/alcohol to escape their problems?:YesNoHave they had medical problems from using drugs/alcohol?:YesNoHas drug/alcohol use caused them legal problems?:YesNoDo they have withdrawals when they cannot get drugs/alcohol?:YesNoDo they use drugs/alcohol to cope with fear or anger or depression?:YesNoDo you think they are willing and able to get treatment?:YesNoWould you like more information about drugs/alcohol rehab from The River Source?:YesNo