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Self Assessment Form

Alcohol Self Assessment Questionnaire

Are you worried you're addicted to alcohol?

Complete our self-assessment form and click on submit. We'll tell you if you're likely to have a dependancy and how to get you the help you need.

Do you ever feel that you need to drink first thing in the mornings?

Yes
No

Do you use alcohol to overcome shyness or to make you feel more confident?

Yes
No

Do you crave alcohol or find your concentration is affected by thoughts of drinking?

Yes
No

Do you ever become verbally or physically aggressive when you are under the influence of alcohol?

Yes
No

Do you sweat or shake if you don’t drink every day?

Yes
No

Can you take alcohol out of your life if you want to?

Yes
No

Have you ever had a blackout, loss of memory or seizure as a result of your alcohol drinking?

Yes
No

Have you ever lost a job or faced disciplinary action because of your drinking or drinking behaviours?

Yes
No

Have you ever lost friends or a relationship because of your drinking or drinking behaviours?

Yes
No

Has alcohol use affected your general health and well-being?

Yes
No

Do you use alcohol to escape from your problems or to manage feelings of stress, anxiety, low mood or sleeplessness?

Yes
No

Have you ever been arrested or faced charges for any criminal actions when you have been under the influence of alcohol?

Yes
No

Have you ever sought treatment, help or support for alcohol abuse?

Yes
No
Thank you for completing our self-assessment form.

Your results indicate:

You do have problems with alcohol and probably do have an addiction to alcohol.

By completing our form, you’ve taken your first, brave step.

You’ve recognised that you have a problem with alcohol addiction and that you need help.

Call us today on 02031511488 and our qualified telephone counsellors will give you free, confidential advice to start you on your path to a healthy recovery.

Remember, we’re on hand 24 hours, 7 days a week.

Or complete this form and we will get back to you right away:

Health Insurance

Our Rehabs accept most of the major private health insurers.

  • AVIVA Health Insurance
  • AXA Health Insurance
  • Bupa Health Insurance
  • Standard Life Health Insurance
  • Vitality Health Insurance
  • Cigna Health Insurance
Get Confidential Help Now

Our trained addiction counsellors are
on hand 24 hours a day

Rehab treatment Centres

We'll help you find help near you.

If you are experiencing problems as a result of your alcohol or drug use, or if you are drinking or using drugs to cope with existing problems, our National Addiction Treatment & Rehabilitation Directory contains over 700 addiction treatment services that may be able to help you when you decide to do something about them.

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Who am I calling?

Calls will be answered by admissions at UK Addiction Treatment Group.

We look forward to helping you take your first step

0203 811 5619