Alcoholism/Addiction Diagnosis Questionnaire

Alcoholism is a progressive, chronic, usually fatal disease. It is characterized by denial and rationalization of the problems caused by drinking.

For the catastrophically injured person or caregiver who becomes chemically dependent, the denial and rationalization are likely to be stronger. After all, it might be reasoned, anyone might drink or use drugs to excess if they had to deal with these unique problems.

For these reasons, alcoholism or addiction may go unrecognized. If recognized, friends or family may be reluctant to say anything in the face of an already difficult situation. While the questionnaire below specifically addresses alcoholic drinking behaviors, it can be useful diagnosing other drug addiction. (It is safe to say that one who is chemically dependent is likely to be a multi-drug abuser.)

  1. Do you have close relatives who are alcoholic?
  2. Do you drink more than your friends?
  3. Have you experienced any change in your drinking patterns—drinking more and more often, drinking alone, or switching to a stronger drink?
  4. Has anyone close to you—spouse, parent, child ever worried or complained about your drinking?
  5. When you are sober, do you sometimes regret things you've said or done while drinking? Do you find yourself apologizing to the people you love for your drinking behavior and promising to change?
  6. Have you ever tried to stop drinking for a period of time (a week, perhaps a month) because you felt it would be good for you? Or because you wanted to prove you could do it?
  7. Do you sometimes make promises to yourself about controlling or cutting down on your drinking and then find yourself breaking these promises?
  8. Are you able to drink more now than you did a year ago? Do you tend to drink much more?
  9. Have you ever had a blackout when you can't recall some or all of the events that occurred when you were drinking? Do you have more blackouts now than you did a year ago?
  10. Do you sometimes feel that you're better off when you're drinking than when you're sober? Does drinking, in fact, get rid of your headaches, tension, anxiety, mood swings?
  11. Do you feel increasingly guilty about your drinking, yet when someone you love mentions his/her concern you become hostile and defensive?
  12. Do you tend to think that your problems are the result of tension and stress, or lack of understanding from spouse, family, or friends for what you are going through? Do you feel that unreasonable demands are being placed upon you?
  13. Do you feel sorry for yourself because no one seems to understand you and the problems you are facing? Do you turn to alcohol for solace and comfort?
  14. Do you increasingly drink more than you intended to drink? Do you have trouble stopping once you have started to drink? Do you ever drink in the morning?
  15. Do your hands sometimes shake uncontrollably the morning after you have been drinking? Do you feel physically ill (nausea, the shakes, queasiness) and/or psychologically upset (depressed, anxious, tense, moody, irritable) when sober? Does alcohol make you feel better at these times?
  16. Do you have any physical diseases or disorders that might be alcohol-related? Examples are gastritis, recurrent diarrhea, persistent nausea, high blood pressure, heart palpitations, fatty liver, cirrhosis, DTs, seizures, pancreatitis.
  17. Have you ever been hospitalized for injuries, accidents, or traumas suffered while drinking?
  18. Do you ever have suicidal thoughts? Hallucinations after a drinking bout? Unreasonable fears?
  19. Have you ever experienced any losses because of your drinking—loss of job, divorce, alienated children or family, a suspended driver's license for drunk driving?
  20. Do you neglect eating when drinking? Do you neglect your own physical care or hygiene?
  21. Are you able to drink less than you once could, and when you drink, tend to drink until you pass out or get so sick you cannot drink anymore?

Alcoholism is a disease characterized by an increased tolerance (early on) to alcohol, symptoms of withdrawal upon abstinence from alcohol use, and the risk of relapse or recidivism common in early recovery attempts.

Alcoholism can be divided into three stages: early, middle, and late. The questions asked above include symptoms from each stage. By determining the number of questions to which you responded "yes" you may be able to identify whether you are an alcoholic, and what stage you may be in.

Questions 1 – 5

Answering "yes" to these questions may indicate early stage alcoholism, when the disease is not apparent. Many of the symptoms in this early stage are also experienced by non-alcoholic drinkers.

Questions 6 – 12

These questions refer to the middle stage symptoms of alcoholism. In this middle stage the alcoholic's problems become more obvious, even though the majority of middle stage alcoholics look healthy and generally appear to be in control of themselves and their lives. At this stage in his/her drinking, the alcoholic can still maintain some control—and he/she will deny or rationalize symptoms if confronted. The middle stage of alcoholism can last a long time—years, in fact.

Questions 13 – 21

These questions refer to the final, deteriorative stages of alcoholism. The late stage alcoholic can no longer deny he or she has a problem controlling drinking. Unless the late stage alcoholic receives treatment, most will die of medical complications caused by their disease, or from accidents suffered while drunk.

A detailing of the physical and psychological complications associated with alcoholism and other drug dependency can be found in the numerous volumes written on the subject.


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