1. Have you ever decided to stop drinking or using drugs for a week or so, but only lasted for a couple of days?

2. Do you wish people would mind their own business about your drinking or drug use -- stop telling you what to do?

3. Have you ever switched from one kind of drink or drug to another in the hope that this would keep you from getting drunk or high?

4. Have you had to have an eye-opener upon awakening during the past year? Do you need a drink or drug to get started, or to stop shaking?

5. Do you envy people who can drink or use drugs without getting into trouble?

6. Have you had problems connected with drinking or using drugs during the past year?

7. Has your drinking or drug use caused trouble at home?

8. Do you ever try to get extra drinks at a party because you do not get enough? Do you ever “hide” your drugs from your friends so you have more?

9. Do you tell yourself you can stop drinking or taking drugs any time you want to, even though you keep getting drunk or high when you don't mean to?

10. Have you missed days of work or school because of drinking or drug use?

11. Do you have "blackouts"?

12. Have you ever felt that your life would be better if you did not drink or use drugs?