Lakeview Center
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

Please answer the following questions related to your friend or family member's behavior:

 

Does the person drive while intoxicated?

 

Has the person or someone else been injured as a result of the person's drinking?

 

Is the person having problems with work, school, or family as a result of his or her drinking?

 

Does the person get angry if anyone mentions his or her drinking or expresses concerns about his or her drinking?

 

Has the person broken promises because of his or her drinking?

 

Are plans frequently upset, cancelled or delayed because of the drinker?

 

Can the drinker handle more alcohol now than when you first met him or her?
Section 2
Please answer the following questions about your behavior, feelings and beliefs in relation to the drinker: 

 

Have you been hurt (either physically or emotionally) by the person's drinking behavior?

 

Are you ever afraid to be around the person when he or she is drinking because of the possibility of verbal or physical abuse?

 

Do you have money problems because of the person's drinking?

 

Do you tell lies to cover up for the person's drinking? 

 

Do you blame the drinker's behavior on his or her companions? 

 

Do you make threats, such as "If you don't stop drinking, I'll leave you"? 

 

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"?

 

Have you refused social invitations out of fear or anxiety about the person? 

 

Do you think that if the person stopped drinking, your other problems would be solved?

 

Do you ever hide alcohol from the person you are concerned about? 

 

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.
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
Pensacola FL Florida
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