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Home
About Campobello
- History Of Campobello
- Why We are Different
Admission
After Care
Self Evalution
Resources
Contact

Survey – Chemical Dependency Treatment

Have you ever felt you should cut down on your drinking or drug use?	Yes No
Have people annoyed you by criticizing or complaining about your drinking or drug use?	Yes No
Have you ever felt bad or guilty about your drinking or drug use?	Yes No
Have you ever had a drink or drug in the morning (eye-opener) to steady your nerves or get rid of a hangover?	Yes No

If you find yourself answering yes or more of the above questions, please seek help by calling at 1-800-805-1833 for a confidential assessment and referral.

Family Questions

1. Do you often worry about a family member’s drinking or drug use?	Yes No
2. Does one of your family member’s use of alcohol cause fights and arguments?	Yes No
3. Have you ever felt guilty, apologetic or responsible for the drinking or drug use of someone else?	Yes No
4. Has a family member’s drinking or drug use ever ruined a special occasion?	Yes No
5. Have you ever felt afraid after a family member started drinking or using?	Yes No
6. Do you find yourself covering up for the consequences of someone else’s drinking or drug use?	Yes No
7. Have you ever tried to control the drinker/drug user’s behavior by hiding car keys, pouring out alcohol, hiding drugs?	Yes No
8. Have you ever lost sleep because of a family member’s drinking or drug use?	Yes No
9. Do you find yourself not talking to friends or family members about what is going on leaving you feeling isolated and alone?	Yes No
10. Does you family member have periods of remorse after drinking or using and apologize for his/her behavior?	Yes No

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Toll free number : 800.805.1833

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