Friend or Family Member Questionnaire

Use this questionnaire to evaluate the drinking and/or other drug using behavior of someone close to you, such as a friend or family member.  Please answer the following questions about the person whose drinking/using behavior concerns you and about its impact on you.  If you would like to speak with a professional about your concerns, please contact the Addiction Resource Council at 262-524-7921.

Section 1

Please answer the following questions related to your friend or family member's behavior:

1. Does the person drive while intoxicated/high?

2. Has the person or someone else been injured as a result of the person's drinking/drug using?

3. Is the person having problems with work, school, or family as a result of his or her drinking/drug using?

4. Does the person get angry if anyone mentions his or her drinking/using or expresses concerns about his or her drinking/using?

5. Has the person broken promises because of his or her drinking/using?

6. Are plans frequently upset, cancelled or delayed because of the drinker/user?

7. Can the drinker/user handle more alcohol now than when you first met him or her?

Section 2

Please answer the following questions about your behavior, feelings and beliefs in relation to the drinker/user:

1. Have you been hurt (either physically or emotionally) by the person's drinking/using behavior?

2. Are you ever afraid to be around the person when he or she is drinking/using because of the possibility of verbal or physical abuse?

3. Do you have money problems because of the person's drinking/using?

4. Do you tell lies to cover up for the person's drinking/using?

5. Do you blame the drinker's/user’s behavior on his or her companions?

6. Do you make threats, such as "If you don't stop drinking/using, I'll leave you"? 

7. Have you ever helped the person to "cover up" for a drinking/using episode by calling his or her employer, or telling others that he or she is feeling "sick"?

8. Have you refused social invitations out of fear or anxiety about the person? 

9. Do you think that if the person stopped drinking/using, your other problems would be solved?

10. Do you ever hide alcohol/other drugs from the person you are concerned about?

11. Do you ever buy alcohol/other drugs for the person you are concerned about?