1. Has a friend, family member, co-worker or your doctor expressed concerns that they think you have a problem?

No Yes

2. Are your family members and friends saying they wish you could be the way you used to be?

No Yes

3. Have you decided to stop using alcohol or drugs just to find you’ve started again?

No Yes

4. Do you become annoyed or irritated when others talk to you about their concerns?

No Yes

5. Have you ever hidden drugs or alcohol from friends and/or family or have you hidden a “secret” emergency supply of alcohol or drugs?

No Yes

6. Have you ever driven under the influence of alcohol or drugs?

No Yes

7. Have you ever blacked out while drinking or using?

No Yes

8. Do you set limits on yourself with the amount you plan to drink and then find it difficult to follow your own limit?

No Yes

9. Have you ever endangered yourself by buying off the street?

No Yes

10. Have you ever sold favors for drugs?

No Yes

11. Have you ever not been able to remember how you got home?

No Yes

12. Have you felt great remorse over things you have done while under the influence of drugs or alcohol?

No Yes

13. Have you felt great remorse over things you have done while under the influence of drugs or alcohol?

No Yes

14. Do you cancel or just not turn up for appointments and meetings when drinking?

No Yes

15. Have your children ever asked what is wrong with you?

No Yes

16. Have you ever lost a job because of your inability to perform?

No Yes

17. Do you lie about your alcohol consumption or drug use?

No Yes

18. Do you find that you are able to drink more than you used to?

No Yes

19. Do you find it impossible to stop for any prolonged period of time?

No Yes

20. DISCLAIMER

This Site Does Not Provide Medical Advice.

The contents of the Brookhaven Retreat, LLC (“Brookhaven”) website ( the "Content") are for informational purposes only. The Content is not intended to be a substitute for professional psychological psychiatric or medical advice, diagnosis, or treatment. Consult with your physician, psychiatrist, psychologist, or other qualified health provider without delay to gain more information regarding your specific medical and/or psychological condition.

If you think you may have a medical emergency, call your doctor or 911 immediately. Brookhaven does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the Site. Reliance on any information provided by Brookhaven, Brookhaven employees, others appearing on the Site at the invitation of Brookhaven, or other visitors to the Site is solely at your own risk.

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