Yonge & Eglinton
1. Do you lose time from work due to your drinking or use of drugs?
2. Is drinking or using drugs making your home life unhappy?
3. Do you drink or use drugs because you are shy with other people?
4. Is drinking or using drugs affecting your reputation?
5. Have you ever felt remorse after drinking or using drugs?
6. Have you gotten into financial difficulties as a result of your use?
7. Have you turned to lower companions and an inferior environment?
8. Does your drinking and drug use make you careless of your family's welfare?
9. Has your ambition decreased since drinking or using drugs?
10. Do you crave a drink or a drug at a definite time daily?
11. Do you want to use the next morning?
12. Does drinking or drugs cause you to have difficulty in sleeping?
13. Has your efficiency decreased?
14. Is drinking and/or drug use jeopardizing your job or business?
15. Do you drink or use drugs to escape from worries or troubles?
16. Do you drink or use drugs alone?
17. Have you ever had loss of memory as a result of your drinking or using drugs?
18. Has your physician ever treated you for drinking or drug abuse?
19. Do you drink or use drugs to build up your self-confidence?
20. Have you ever been in a hospital on account of your alcohol or drug use?