Select the statements that best reflect what you have been experiencing over the last few months.
Please be honest with your answers. This inventory may help you or someone you know to identify an issue that might be negatively affecting your life.
☐ 1. I have tried to stop drinking and failed.
☐ 2. I have missed days at work or school or my performance has suffered because of drinking.
☐ 3. I have had a loss of memory or “blackout” after I’ve been drinking.
☐ 4. I have had legal difficulty because of my drinking.
☐ 5. My drinking causes problems in my personal relationships.
☐ 6. I wish people would stop bothering me about my drinking.
☐ 7. I sometimes need a drink in the morning to get started or to stop shaking.
☐ 8. I feel like my life would be better if I stopped drinking.
☐ 9. I drink because I have problems or need to relax.
☐ 10. I think about dying or killing myself.
– If you checked statement 10, please seek help immediately, regardless of the other statements you checked. Caring people are standing by to help. Contact Lifeways at our Malheur location, (800) 995-9169, or at our Umatilla location at (866) 343-4473.
– If you checked two or more of these statements, you should schedule a free behavioral health screening at Lifeways.
– If you checked less than two statements but still feel your ability to function in life is impaired, you should schedule a free behavioral health screening at Lifeways.
We are here to help. Please contact Lifeways at our Malheur location at (800) 995-9169 or at our Umatilla location at (866) 343-4473.
This assessment was developed to help you become more familiar with what you or someone you care about may be experiencing. If it can help explain your feelings, share this inventory with someone who cares about you or with a behavioral health professional.
It’s important to note that only a health care professional can diagnose a behavioral health disorder.