Friend and Family Member Questionnaire
Use this questionnaire to evaluate the drinking behavior of someone close to you, such as a friend or family member. Please answer the following questions about the person whose drinking behavior concerns you and about its impact on you.
If you would like to speak with a health professional about your concerns, please contact us Toll Free: 1-800-332-2271 or email us at TheFriary@bhcpns.org
|
| 1. Does the person drive while intoxicated? |
| 2. Has the person or someone else been injured as a result of the person's drinking? |
| 3. Is the person having problems with work, school, or family as a result of his or her drinking? |
| 4. Does the person get angry if anyone mentions his or her drinking or expresses concerns about his or her drinking? |
| 5. Has the person broken promises because of his or her drinking? |
| 6. Are plans frequently upset, cancelled or delayed because of the drinker? |
| 7. Can the drinker handle more alcohol now than when you first met him or her? |
| 8. Have you been hurt (either physically or emotionally) by the person's drinking behavior? |
| 9. Are you ever afraid to be around the person when he or she is drinking because of the possibility of verbal or physical abuse? |
| 10. Do you have money problems because of the person's drinking? |
| 11. Do you tell lies to cover up for the person's drinking? |
| 12. Do you blame the drinker's behavior on his or her companions? |
| 13. Do you make threats, such as "If you don't stop drinking, I'll leave you"? |
| 14. Have you ever helped the person to "cover up" for a drinking episode by calling his or her employer, or telling others that he or she is feeling "sick"? |
| 15. Have you refused social invitations out of fear or anxiety about the person? |
| 16. Do you think that if the person stopped drinking, your other problems would be solved? |
| 17. Do you ever hide alcohol from the person you are concerned about? |
| 18. Do you ever buy alcohol for the person you are concerned about? |
Questionnaire Interpretation:
- If you checked any of the boxes in Section 1, your friend or family member may have an alcohol problem.
- If you checked any of the boxes in Section 2, you may need help handling this person's drinking problem in a way that protects both of you.
- Please consider getting help for your friend or family member and/or for yourself by talking with a health professional today or getting a referral to speak with a professional at a later date.
Please contact us if you have any questions or concerns.
|
