Family Drinking Survey

Read each of the following statements and Select either "Yes" or "No" in the box to the right of each statement.

1. Does someone in your family undergo personality changes when he or she drinks to excess?

2. Do you feel that drinking is more important to this person than you are?

3. Do you feel sorry for yourself and frequently indulge/in self-pity because of what you feel alcohol is doing to your family?

4. Has some family member's excessive drinking ruined special occasions?

5. Do you find yourself covering up for the consequences of someone else's drinking?

6. Have you ever felt guilty, apologetic, or responsible for the drinking of a member of your family?

7. Does one of your family member's use of alcohol cause fights and arguments?

8. Have you ever tried to fight the drinker by joining in the drinking?

9. Do the drinking habits of some family members make you feel depressed or angry?

10. Is your family having financial difficulties because of drinking?

11. Did you ever feel as if you had an unhappy home life because of the drinking of some members of your family?

12. Have you ever tried to control the drinker's behavior by hiding the car keys, pouring liquor down the drain, etc?

13. Do you find yourself distracted from your responsibilities because of this person's drinking?

14. Do you often worry about a family member's drinking?

15. Are holidays more of a nightmare than a celebration because of a family member's drinking behavior?

16. Are most of your drinking family member's friends heavy drinkers?

17. Do you find it necessary to lie to employers, relatives, or friends in order to hide your partner's drinking?

18. Do you find yourself responding differently to members of your family when they are using alcohol?

19. Have you ever been embarrassed or felt the need to apologize for the drinker's actions?

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?

21. Have you ever thought that one of your family members had a drinking problem?

22. Have you ever lost sleep because of a family member's drinking?

23. Have you ever encouraged one of your family members to stop or cut down on his or her drinking?

24. Have you ever threatened to leave home or to leave a family member because of his or her drinking?

25. Did a family member ever make promises that he or she did not keep because of drinking?

26. Did you ever wish that you could talk to someone who could understand and help the alcohol-related problems of a family member?

27. Have you ever felt sick, cried, or had a "knot" in your stomach after worrying about a family member's drinking?

28. Has a family member ever failed to remember what occurred during a drinking period?

29. Does your family member avoid social situations where alcoholic beverages will not be served?

30. Does your family member have periods of remorse after drinking occasions and apologize for his or her behavior?



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


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522 2nd Street, Suite 3, Hudson, WI 54016
Contact Dr. Zimmerman at or 715.386.9011