SELF ASSESSMENT INVENTORY

Anticipation	___	I often daydream about drinking and getting high.
Attention	___	It has always been hard for me to sit still and concentrate; I am easily distracted.
Blackouts	___	Sometimes I can’t remember things I said or did while drinking or using drugs.
Body	___	I think my drinking and/or other drug use has hurt my body.
Bruises	___	I seem to easily bruise.
Complaints	___	Members of my family and others close to me have expressed concern about my drinking and/or other drug use.
Depression	___	I feel more and more like just giving up; I sometimes think that I’d be better off dead.
Events	___	My heavy drinking and/or drug use began at a time of great difficulty in my life.
Euphoria	___	I have very vivid, pleasant memories of my early experiences drinking or getting high.
Family	___	There are several people within my family and extended family who have experienced alcohol and/or other drug problems.
Friends	___	I prefer to spend my time with friends whose drinking and/or other drug use is similar to my own.
Food	___	My eating habits have changed as a result of my alcohol and/or other drug use.
Guilt	___	I regret things I have done while I was high or intoxicated.
Hopelessness	___	I’m beginning to think things are never going to work out for me.
Hoarding	___	I feel more comfortable when I have a large quantity of alcohol or other drugs on hand.
Illegal	___	I have deceived others or committed illegal acts as a result of my alcohol and/or other drug use.
Intimacy	___	I tend to pick intimate partners who have alcohol or other drug problems.
Justify	___	I find myself spending more time making excuses to others about my drinking and/or other drug use or explain things I did while using.
Kids	___	I have verbally or physically abused my children during periods of drinking and/or other drug use.
Leisure	___	Most of my leisure time and activities involve drinking or drug use.
Loss of Control	___	I cannot predict or control how much alcohol or other drugs I will consume once I begin.
Menstruation	___	My drinking and/or drug use increases in the days before menstruation.
Morality	___	My morals have deteriorated as a result of my drinking and drug use.
Neglect	___	I have neglected my family as a result of my alcohol/drug use.
	___	I have left my younger children unsupervised or made poor choices of temporary caretakers for my children as a result of alcohol/drug use.
Onset	___	I began using alcohol or other drugs at a younger age than most of my female peers.
Permissive	___	There are times that I am too permissive with my children.
Preoccupation	___	I spend considerable time thinking about drinking or getting high.
Promises	___	I have failed to keep promises and resolutions I made to others about my drinking or drug use.
Quitter	___	I seem to give up on everything I start.
Quantity	___	I am using more alcohol or other drugs than I would like.
Respect	___	I have lost the respect of my family and friends due to my drinking and/or other drug use.
Risk	___	I have shared needles or participated in unprotected sex while under the influence of alcohol/drugs.
Sanity	___	I sometimes feel like I’m two totally different people; it’s like I become someone different when I’m drinking or using drugs.
Shame	___	I sometimes feel that I deserve the bad things that happen to me.
	___	I think women with alcohol and drug problems are worse than men who have such problems.
Sleep	___	I often use alcohol of other drugs to help me get to sleep.
	___	I have fallen asleep at work or when supervising my children because of staying up all night drinking or using.
Tolerance	___	It seems to take more alcohol or other drugs to get high than when I first began using.
	___	It seems to take a lot less alcohol or other drugs to get high than it did a few years ago.
Trauma	___	I experienced sexual abuse as a child and/or sexual trauma as an adult.
Unbecoming	___	My physical appearance has declined as a result of my alcohol and other drug use.
Victim	___	I have a history of getting involved in relationships in which I am emotionally or physically harmed.
Violence	___	I have been physically harmed by an intimate partner.
Withdrawal	___	I experience physical/emotional discomfort during periods without alcohol or other drugs.
seX	___	I do not enjoy sex anymore unless I’m high.
eXchange	___	I have traded sex for cocaine or other drugs.
Yearning	___	I daydream a lot about getting straight and improving my family’s lot in life.
	___	I wish I wasn’t an addict.
lost Youth	___	I have given up many of my hopes and dreams.
craZy	___	I sometimes feel like I’m losing my mind or that I’m two different people in one body.
Zero	___	I feel that alcohol or other drugs have taken away all of my self-esteem, hopes and dreams. I have nothing but the drug.