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The Friary of Lakeview Center: Friend or Family Member Questionnaire |
Use this questionnaire to evaluate the drinking behavior of someone close to you, such as a friend or family member. Please answer the following questions about the person whose drinking behavior concerns you and about its impact on you.
If you would like to speak with a health professional about your concerns, please contact us Toll Free: 1-800-332-2271 or email us at [email protected]
Section 1
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Please answer the following questions related to your friend or family member's behavior:
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Does the person drive while intoxicated? |
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Has the person or someone else been injured as a result of the person's drinking? |
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Is the person having problems with work, school, or family as a result of his or her drinking? |
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Does the person get angry if anyone mentions his or her drinking or expresses concerns about his or her drinking? |
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Has the person broken promises because of his or her drinking? |
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Are plans frequently upset, cancelled or delayed because of the drinker? |
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Can the drinker handle more alcohol now than when you first met him or her? |
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Section 2 |
Please answer the following questions about your behavior, feelings and beliefs in relation to the drinker:
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Have you been hurt (either physically or emotionally) by the person's drinking behavior? |
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Are you ever afraid to be around the person when he or she is drinking because of the possibility of verbal or physical abuse? |
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Do you have money problems because of the person's drinking? |
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Do you tell lies to cover up for the person's drinking? |
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Do you blame the drinker's behavior on his or her companions? |
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Do you make threats, such as "If you don't stop drinking, I'll leave you"? |
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Have you ever helped the person to "cover up" for a drinking episode by calling his or her employer, or telling others that he or she is feeling "sick"? |
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Have you refused social invitations out of fear or anxiety about the person? |
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Do you think that if the person stopped drinking, your other problems would be solved? |
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Do you ever hide alcohol from the person you are concerned about? |
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Do you ever buy alcohol for the person you are concerned about? |
Questionnaire Interpretation:
- If you checked any of the boxes in Section 1, your friend or family member may have an alcohol problem.
- If you checked any of the boxes in Section 2, you may need help handling this person's drinking problem in a way that protects both of you.
- Please consider getting help for your friend or family member and/or for yourself by talking with a health professional today or getting a referral to speak with a professional at a later date.
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| Please contact us if you have any questions or concerns. |
4400 Hickory Shores Blvd. • Gulf Breeze, Florida 32563 • Local: (850) 932-9375 • Toll Free: 1-800-332-2271 • Email |
