One of the oldest and most time tested dependency evaluation tools for chemical dependency has its origins from the Johnson Institute of Minneapolis. Many variations exist, but the basic questions are as follows:
Has anyone ever suggested you quit or cut back on your drug/alcohol use?
Yes___ No___
Has drinking or using affected your reputation?
Yes___ No___
Have you made promises to control your drinking or using and then broken them?
Yes___ No___
Have you ever switched to different drinks or drugs or changed your using pattern in an effort to control or reduce your consumption?
Yes___ No___
Have you ever gotten into financial, legal, or marital difficulties due to using?
Yes___ No___
Have you ever lost time from work because of using or drinking?
Yes___ No___
Have you ever sneaked or hidden your use?
Yes___ No___
On occasion, do you feel uncomfortable if alcohol or your drug is not available?
Yes___ No___
Do you continue drinking or using when friends or family suggest you have had enough?
Yes___ No___
Have you ever felt guilty or ashamed about your drinking or using or what you did while under the influence?
Yes___ No___
Has your efficiency decreased as a result of your drinking or using?
Yes___ No___
When using or drinking, do you neglect to eat properly?
Yes___ No___
Do you use or drink alone?
Yes___ No___
Do you use or drink more than usual when under pressure, angry, or depressed?
Yes___ No___
Are you able to drink or use more now without feeling it, compared to when you first started using?
Yes___ No___
Have you lost interest in other activities or noticed a decrease in your ambition as a result of your drinking or using?
Yes___ No___
Have you had the shakes or tremors following heavy drinking or using or not using for a period of time?
Yes___ No___
Do you want to drink or use at a particular time each day?
Yes___ No___
Do you go on and off the wagon?
Yes___ No___
Is drinking or using jeopardizing your job?
Yes___ No___
If you answer “yes” to one or more of the above questions, it does not necessarily imply a chemical dependency problem, three or more “yes” answers suggest that you should more closely evaluate your drug and or alcohol use.
