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Are you preoccupied with thoughts of drinking?:
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Can you stop drinking after one glass?:
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Do you drink alone?:
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Is drinking affecting your reputation?:
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Is drinking causing problems with your job?:
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Have your relationships been negatively affected?:
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Do you refuse to go places where you cannot drink?:
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Do you need to drink to have fun socially?:
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No
Is drinking causing you financial difficulties?:
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No
Do you hide alcohol from family or friends?:
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No
Do you lie about your drinking?:
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No
Do you drink to escape your problems?:
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No
Do you drink to overcome shyness with other people?:
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No
Has alcohol resulted in legal problems (DUI/DWI)?:
Yes
No
Do you worry that friends or family know you drink?:
Yes
No
Do you have memory loss from drinking?:
Yes
No
Do you ever crave alcohol?:
Yes
No
Do you drink to cope with fear or anger or depression?:
Yes
No
Are you willing and able to get treatment at The River Source?:
Yes
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