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Family & Friends:- Alcohol/Drug Problem Questionnaire
 
01. Do you have a family member or friend whose drinking and/or drug using is getting out of control?
  YesNo
02. Have they tried to stop drinking or using, but could only manage to stop for a day or so at a time?
  YesNo
03. Do they regularly have a drink or a drug when they wake up, or last thing at night?
  YesNo
04. When they wake up in a morning, have you noticed that they appear sweaty?
  YesNo
05. Do they appear to be craving for drink or drugs on a regular basis?
  YesNo
06. If they don’t have a drink or a drug for 12 to 24 hours, do they look physically unwell?
  YesNo
07. Is their drink / drug-taking causing problems within your own family?
  YesNo
08. Are they drinking or using their drugs in isolation?
  YesNo
09. Is your family member or friend afraid to leave the house because of his/her alcohol or drug problem?
  YesNo
10. Once they start drinking or using drugs, do you find that they are not able to stop?
  YesNo
 
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