The following questions are provided courtesy of Ginny Lyford Gustafson and Katherine Ketcham, co-authors of Living on The Edge.
I’m going to use the male gender in the following but one could use the female gender if that fits for you.
- Does your loved one have any close relatives – grandparents, parents, siblings, who have had drinking or drug problems?
- Does he consistently drink or use drugs more than his friends? Is he often the last one to leave the bar or party?
- Does he enjoy drinking or using drugs and look forward to occasions when he can use them? Does he have a reputation as a great “party person” or “the life of the party”?
- Does it sometimes seem that he doesn’t want to stop drinking or using drugs, even though everyone else has had enough?
- Has he experienced any change in his patterns of drug use – using more or using more often, using drugs when alone, or switching to other, sometimes stronger drinks or drugs?
- Has anyone close to him – spouse, parents, children, friends – ever worried or complained about his drinking or drug use?
- Does the thought of an occasion without alcohol or drugs – a church wedding and reception with a nonalcoholic punch, for example – make him anxious or perhaps even angry?
- Has he ever expressed bewilderment at how slowly other people drink, or wondered why they stop using drugs so soon after starting? Does he ever buy drinks or drugs for his friends in an effort to keep the party going?
- Does he tend to gulp down his first drinks or drugs and then, when he appears to feel the effects, consciously slow his pace to match others?
- When he is sober, does he sometimes regret things said or done when drinking or using drugs, apologizing to the people he loves and insisting that things will be different in the future?
- Has he ever tried to stop drinking or using drugs for a period of time – a week, or perhaps a month, because he felt it would be good for him, or because he wanted to prove that he could do it?
- Does he sometimes make promises about controlling or cutting down on his drug use and then break these promises within a few days or weeks?
- Does he seem to feel guilty about drinking or using drugs, and yet when someone he loves or respects mentions his or her concern, does he become hostile and defensive?
- Is he able to use or drink more now than he did a year ago? five years ago?
- Has he ever had a blackout – when he can’t recall some or all of the events that occurred when he was drinking? Does he have more blackouts now than he did a year ago?*
- Has he had any difficulties at work – regular sick days, difficulty in concentrating, complaints from co-workers or supervisors – that might be related to drinking or drugs?
- Does he sometimes say that he’s better off when he’s drinking or using drugs than when he’s sober? Do drugs, in fact, appear to get rid of his headaches, tensions, anxieties, and mood swings?
- Does he tend to think that his problems are the result of tensions and stress, or lack of understanding from his spouse, or unreasonable demands at work? Does he feel sorry for himself because no one seems to understand him? Does he turn to drugs for solace and comfort?
- Does he appear to crave drugs, actually wanting a drink or drug so intensely that he is willing to risk a fight with his spouse or a reprimand from his boss?
- Does he increasingly use more than he intended? Does he have trouble stopping once he’s started? Does he ever drink or use drugs in the morning?
- Do his hands sometimes shake uncontrollably the morning after he’s been using? Does he feel physically wretched (nauseated, shaky, queasy) and/or psychologically upset (depressed, anxious, tense, moody, irritable, paranoid) when sober? Do drugs make him appear to feel better instantly?
- Does he have any physical disorders or diseases that might be alcohol or drug related, such as lack of appetite; recurrent nausea, vomiting, or diarrhea; broken blood vessels around the nose and/or cheekbones; yellow, glassy eyes; gastritis; high blood pressure; pneumonia, heart palpitations, fatty liver, elevated liver enzymes, hepatitis, cirrhosis, DT’s*, seizures, or pancreatitis?
- Has he ever been hospitalized, or emergency room visits, for injuries, accidents, or traumas suffered while using alcohol or drugs?
- Does he ever express suicidal thoughts? Has he ever had hallucinations after drinking or using drugs? Does he ever have unreasonable fears – for example, does the doorbell or telephone ringing seem to make him anxious or fearful?
- Has he experienced any losses because of his drinking or drug use – loss of a job or financial security, divorce, alienated children or family, driver’s license suspended because of drunken driving, et cetera?
- Does he neglect eating, particularly during and just after using drugs? Does he neglect his body and personal appearance by not exercising regularly or not taking showers or baths?* Is his sex drive noticeably lessend? Does he refuse to go to a doctor for obvious medical problems?
- Is he able to use less of the drug than he once could, and when he does use, does he tend to keep using until he passes out or becomes physically ill?
*Blackouts are a very distinctive feature of alcoholism; they are not typically experienced by people addicted to other drugs.
*DT’s are also a distinctive feature of alcoholism
*Cocaine addicts will often show an increased interest in personal appearance when they begin using the drug; as it progresses the addict will typically lose interest in everything but the drug.
INTERPRETING THE QUESTIONNAIRE
The disease of addiction can be divided into three general stages: early, middle, and late. The questionnaire you just completed includes symptoms from each of these stages. Your answers will help identify (a) if your loved one is addicted to alcohol and/or drugs and (b) what stage of the disease he is in.
EARLY STAGE ADDICTION
Questions 1 – 9 cover the early stage of the disease, when the addiction is “hidden”; the person and his loved ones typically don’t even suspect that he has a problem. Many of the symptoms associated with this early stage are also experienced by non-addicted, social drinkers or druggers. For example, both early – stage Dependents and non-Dependents may answer “yes” to the question: “Does he enjoy drinking and look forward to drinking occasions?” But most non-Dependents would answer “no” to the majority of these questions.
If you answered “yes” to several of these questions, your loved one may be an early-stage Dependent – even if your answers to the rest of the questions are a truthful “no.” A “yes” answer to five or more of these questions is typical of the early-stage disease.
Questions 10 – 18 cover the middle-stage symptoms of addiction. In the middle stage, the Dependent’s problems become more obvious, even though the great majority of middle-stage Dependents look healthy and are generally in control of themselves and their lives. The disease has progressed significantly but not to the point where the Dependent is destitute and deathly ill – that will come later, if the drinking or drug use continues.
In the middle stage, the Dependent can still exert some control over his use, and chances are good that he will deny or rationalize his symptoms if he’s confronted. Denials and rationalizations are actually symptoms of the middle-stage addiction, and they indicate that the Dependent knows, deep inside, that he’s in trouble. However, because of his addiction, he can’t function without the drug, at least not for very long.
The middle stage of addiction can last for years before leading into the later, more deadly stage. People addicted to alcohol may continue as middle-stage alcoholics for as long as ten to twenty years. However, the alcohol-only addict is an increasing rarity; most alcoholics are also addicted to prescription or illegal drugs. Using more than one drug invariably causes a speeded-up addiction process, shortening the middle stage of the disease significantly. For some addicts, the disease progresses so quickly that the early and middle stages are left out altogether, and the addict is in serious trouble almost from the very beginning of his drug use. Free-basing cocaine, for example can lead to late-stage symptoms with a few months.
Questions 19 – 27 deal with the final, deteriorative stage of addiction, when the Dependent will look, act, and talk like he is addicted to alcohol or drugs. The disease has progressed to the point where the Dependent is physically ill both when he’s using and when he stops. Medical complications may seriously undermine the Dependent’s physical health.
The late-stage addict can no longer deny that he has a problem controlling his drinking or drugging, but neither can he imagine life without it. Because he is physically unable to control his intake, he usually ends a spree incoherent or passed out. Withdrawal symptoms (psychological and/or physical) become severe and incapacitating. As he continues to drink or use drugs, he will become increasingly withdrawn, fearful, and uncommunicative. Paranoia, hallucinations, and severe tremors are common in the late stage.
Unless he received effective treatment, the late-stage Dependent will die of medical complications caused by accelerated drinking or drug use or from accidents suffered while using. Death is the final symptom of the late-stage addiction.
SCORING THE QUESTIONNAIRE
Early stage: 5 – 8 points
Middle stage: 9 – 27 points
Late stages: 28 or more points