Family Drinking Survey
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1. Does someone in your family undergo personality changes when he or she drinks to excess?	Yes No
2. Do you feel that drinking is more important to this person than you are?	Yes No
3. Do you feel sorry for yourself and frequently indulge in self-pity because of what yo fell alcohol is doing to your family?	Yes No
4. Has some family member's excessive drinking ruined special occasions?	Yes No
5. Do you find yourself covering up for the consequences of someone else's drinking?	Yes No
6. Have you ever felt guilty, apologetic or responsible for the drinking of a member of your family?	Yes No
7. Does one of your family member's use of alcohol cause fights and arguments?	Yes No
8. Have you ever tried to fight the drinker by joining in the drinking?	Yes No
9. Do the drinking habits of some family members make you feel depressed or angry?	Yes No
10. Is your family having financial difficulties because of drinking?	Yes No
11. Did you ever feel like you had an unhappy home life because of the drinking of some members of your family?	Yes No
12. Have you ever tried to control the drinker's behavior by hiding the car keys, pouring liquor down the drain, etc.?	Yes No
13. Do you find yourself distracted from your responsibilities because of this person's drinking?	Yes No
14. Do you often worry about a family member's drinking?	Yes No
15. Are holidays more of a nightmare than a celebration because of a family member's drinking behavior?	Yes No
16. Are most of your drinking family member's friends heavy drinkers?	Yes No
17. Do you find it necessary to lie to employers, relatives or friends in order to hide your spouse's drinking?	Yes No
18. Do you find yourself responding differently to members of your family when they are using alcohol?	Yes No
19. Have you ever been embarrassed or felt the need to apologize for the drinker's actions?	Yes No
20. Does some family member's use of alcohol make you fear for your own safety or the safety of other members of your family?	Yes No
21. Have you ever thought that one of your family members had a drinking problem?	Yes No
22. Have you ever lost sleep because of a family member's drinking?	Yes No
23. Have you ever encouraged one of your family members to stop or cut down on his or her drinking?	Yes No
24. Have you ever threatened to leave home or to leave a family member because of his or her drinking?	Yes No
25. Did a family member ever make promises that he or she did not keep because of drinking?	Yes No
26. Did you ever which that you could talk to someone who could understand and help the alcohol-related problems of a family member?	Yes No
27. Have you ever felt sick, cried or had a "knot" in your stomach after worrying about a family member's drinking?	Yes No
28. Has a family member ever failed to remember what occurred during a drinking period?	Yes No
29. Does your family member avoid social situations where alcoholic beverages will not be served?	Yes No
30. Does your family member have periods of remorse after drinking occasions and apologize for his or her behavior?	Yes No
31. Please write any symptoms or medical or nervous problems that you have experienced since you have known your heavy drinker. (write on a separate sheet if more space is needed.)

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If you answer "YES" to any 2 of the above questions, there is a good possibility that someone in your family may have a drinking problem.

If you answer "YES" to 4 or more of the above questions, there is a definite indication that someone in your family does have a drinking problem.

(These survey questions are modified or adapted from the Children of Alcoholics Screening Test (CAST),
the Howard Family Questionnaire, and the Family Alcohol Quiz from Al-Anon.)

Adapted from the book, A Gift To Myself
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