Family member assessment | Seven Hills Behavioral Institute

Yes

No

1.

Have you been hurt (either physically or emotionally) by the person's alcohol or drug use behavior?

2.

Are you ever afraid to be around the person when he or she is using alcohol or drugs because of the possibility of verbal or physical abuse?

3.

Do you have money problems because of the person's use of alcohol or drugs?

4.

Do you tell lies to cover up for the person's alcohol or drug use?

5.

Do you blame the alcohol or drug user's behavior on his or her companions?

6.

Do you make threats, such as "If you don't stop drinking or using drugs, I'll leave you"?

7.

Have you ever helped the person to "cover up" for an alcohol or drug episode by calling his or her employer, or telling others that he or she is feeling "sick"?

8.

Have you refused social invitations out of fear or anxiety about the person?

9.

Do you think that if the person stopped drinking or using drugs, your other problems would be solved?

10.

Do you ever hide alcohol from the person you are concerned about?

11.

Do you ever buy alcohol for the person you are concerned about?

Family or Friend Substance Abuse Assessment

Privacy is paramount at Seven Hills Behavioral Institute

Section 1

Section 2

Yes	No
		1.	Does the person drive while intoxicated or high?
		2.	Has the person or someone else been injured as a result of the person's drinking or using drugs?
		3.	Is the person having problems with work, school, or family as a result of his or her drinking or using drugs?
		4.	Does the person get angry if anyone mentions his or her substance use or expresses concerns about his or her use?
		5.	Has the person broken promises because of his or her drinking or using drugs?
		6.	Are plans frequently upset, canceled or delayed because of the alcohol or drug use?
		7.	Has your family member or friend's drinking or drug use caused family, job or legal problems?
		8.	Can your friend or family member handle more alcohol or drugs now than a few years ago?
			Even if you answered "No" to all of the questions in Section 1, your friend or family member may still have a substance abuse problem. 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 allow us to send you our brochure to examine in the privacy of your home or office. Or call Seven Hills Behavioral Institute at (877) 774-4557 to speak with one of our caring staff members. One "Yes" answer indicates a possible alcohol problem. Please allow us to send you our brochure to examine in the privacy of your home or office. Or call Seven Hills Behavioral Institute at (877) 774-4557 to speak with one of our caring staff members. Two or more "Yes" answers indicates that a problem is likely to exist. Please allow us to send you our brochure to examine in the privacy of your home or office. Or call Seven Hills Behavioral Institute at (877) 774-4557 to speak with one of our caring staff members.