Are you at Risk?
A Questionnaire for Women about their Alcohol and Substance Abuse

Purpose of this questionnaire:

• Increase awareness of signs of problematic alcohol or drug use
• Provide a tool for self-assessment of attachment to alcohol or drug use

Answer yes or no to the following questions as honestly as you can, thinking specifically of the last six months. Drug use in these questions refers to any chemical substance that has a mood-altering effect. This includes prescription or over-the-counter medications.

• Do you like the feeling that alcohol or drugs give you?
• Do you look forward to times when you can drink or use drugs without interference, perhaps when your responsibilities are less than normal?
• Do you feel that you deserve to have a drink or use drugs to help you unwind in the evening after work, parenting or other home responsibilities are complete for the night?
• Does drinking or drug use make it easier for you to cope with competing demands?
• Does drinking or drug use temporarily lessen your loneliness and/or emptiness?
• Do you believe drinking or using drugs helps you to fit in socially?
• Do you believe drinking or using drugs helps you to stay in a difficult relationship?
• Do you have fewer arguments when you are drinking or using drugs?
• Does drinking or drug use allow you to more easily express your anger?
• Does drinking or drug use soften bad memories and the distress associated with them?
• Do you use alcohol or drugs to numb feelings of grief or loss?
• Do you drink or use drugs to control your weight?
• Do you drink or use drugs to lessen distress about your appearance?
• Do you drink or use drugs to numb uncomfortable feelings in sexual encounters?
• Do you drink or use drugs to enhance sexual responsiveness?
• Does drinking or drug use help you get to sleep more easily?
• Does drinking or drug use prevent you from getting restful sleep?
• Does alcohol or drug use help take away anxious thoughts and feelings?
• Do you believe that alcohol or drug use enhances your intellectual ability or creativity?
• Do you drink or use drugs to enhance your work or school performance?
• Have you experienced more physical complaints such as chronic pain, gastrointestinal, or gynecological problems since your drinking or drug use has become more regular?
• Do you have trouble cutting back on your drinking or drug use?
• Do you feel more disconnected from your spiritual self and experience less satisfaction with life?

A yes to four or more questions indicates that you may have an attachment to your alcohol or drug use that may be problematic. If answering any of these questions made you feel uncomfortable or question your drug or alcohol use, it is important for you to consider seeking a professional evaluation of your substance use. This may begin with your family physician or a specialist in chemical dependency treatment.

This is not a standardized diagnostic instrument and is intended only to provide an initial screening to suggest need for a professional evaluation of substance use.

Excerpted from Sheila Blume, MD "Women: Clinical Aspects," Substance Abuse: A Comprehensive Textbook, Third Edition, 1997, Editors: Joyce Lowinson, Pedro Ruiz, Robert Millman, John Langrod and summarized by Eileen Beyer, Psy. D., CAC Diplomate.

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