Rehab 4 Addiction

Welcome to the Alcoholism Questionnaire.  This questionnaire uses a scientifically proven formula developed by the National Council on Alcoholism and Drug Dependence (NCADD).

Do you suspect you or a loved one could be addicted to alcohol?

If so, complete the below alcoholism questionnaire. Doing so will assist you in determining whether or not a drug addiction has arisen.

Complete your details below and then answer the following 10 quick questions. And please be as honest as possible.

Now it's Time to Let's Begin!

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Do you avoid family and friends because of your drinking?


Do you drink alcohol to suppress negative emotions such as stress, disappointment and anger?


Has your tolerance for alcohol increased significantly since you first began to drink?


Have you ever experienced a blackout because of your drinking so you are unable to recall part of the previous evening when you drank?


When drinking with friends, do you attempt to drink a few extra drinks whilst these people are not looking?


Do you experience anxiety when you know alcohol will not be accessible for you, even if it is just for a few hours?


Do you feel emotionally hurried to drink the first drink of the day?


Do you experience guilt and shame because of your drinking?


Do family members or friends express concern about your drinking?


Do you continue to drink even when you friends or loved ones say they cannot drink anymore?