Adult Alcoholism and Drug Abuse Self Test

Do You Have A Chemical Dependency Problem?

This questionnaire will only be meaningful if you are honest with yourself.

Do you lose time from work due to drinking or using drugs?	Yes:	No:
Is drinking or using making your home life unhappy?	Yes:	No:
Do you drink or use drugs because you are shy with other people?	Yes:	No:
Have you ever felt remorse after drinking or using?	Yes:	No:
Have you ever gotten into financial difficulties as a result of your drinking or using?	Yes:	No:
Do you turn to lower companions and an inferior environment when drinking or using?	Yes:	No:
Does your drinking or your using make you careless of your families welfare?	Yes:	No:
Has your ambition decreased since drinking or using drugs?	Yes:	No:
Do you crave a drink or drugs at a definite time daily?	Yes:	No:
Does your drinking or using cause you to have difficulty sleeping?	Yes:	No:
Is drinking or using jeopardizing your job or business?	Yes:	No:
Do you drink or use to escape from worries or troubles?	Yes:	No:
Do you drink or use drugs alone?	Yes:	No:
Have you ever been to a hospital or institution because of drinking or using?	Yes:	No:

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Key
• One YES answer is a warning
• Two YES answers, you probably are Chemically Dependent
• Three or more YES answers, you are Chemically Dependent and you need help NOW.

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DON'T BE AFRAID...
Many times we know we have a problem - or we know someone we care about that has a problem - but we're not ready to admit that the problem is that bad!

If you think that someone you know, or that you yourself, might have a problem with alcohol or drugs, it makes sense to check it out. Talk with us at Fairbanks. We'll help you find answers and options. We believe that knowledge can replace fear.

Our service is completely confidential, so there is no reason to be afraid to ask questions. We are here to help!

The problems of alcohol and drug abuse and addiction can destroy lives, devastate families, and debilitate entire communities.

Alcoholism and Drugs are leading factors in the following:*
Homelessness	40%
Child Abuse and Neglect	38%
Domestic Violence Disputes	50%
Juvenile Delinquency	30%
Aggravated Assaults	62%
Automobile Accidents	50%
Homicides	50%
Fire Deaths	80%
*Indiana Dept of Health/Indiana Dept. of Correction/ Blueprint To End Homelessness

At Fairbanks, we understand the disease of addiction and have years of experience helping people move toward a better life through recovery.
When we focus our efforts and resources on addiction recovery, we are taking steps toward a better future not just for men, women and adolescents who struggle with addiction, but for the families and communities in which those individuals reside.

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Mission Statement
Fairbanks is a nonprofit organization focused on recovery from alcoholism and other drug problems, serving as a resource to improve the well-being of individuals, families and communities by offering hope and support through its programs and services.

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Call us. We can help.

Fairbanks
8102 Clearvista Parkway
Indianapolis, Indiana 46256
(317) 849-8222
www.fairbankscd.org

Fairbanks Access Center
(317) 572-9396

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Adult Alcoholism and Drug Abuse Self Test

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