A Questionnaire for Moms About Their Alcohol and Substance Abuse:
- Develop awareness for moms who have questions about their alcohol consumption
- Help moms understand the role that alcohol plays in their lives
- Provide an assessment tool for moms who alcohol consumption is concerning them or others
Directions: Read the following questions and answer yes or no, specifically thinking about the last 6 months to a year. Put a star next to any question that makes you particularly uncomfortable. Drug use refers to any mind or mood-altering substance, including marijuana, prescriptions pills, or street drugs.
1. Do you like the effect that alcohol or drugs has on you?
2. Does drinking or drug use make it easier for you to cope with the responsibilities of motherhood?
3. Do you feel that you deserve to have a drink or use drugs to help you relax after a long day?
4. Do you look forward to times when you can drink or use drugs in peace- perhaps after the kids have gone to bed?
5. Do you ever drink or use drugs when your children are awake and under your care?
6. Have you ever driven while under the influence of drugs or alcohol?
7. Have you ever driven with children in your car while under the influence?
8. Does drinking or drug use ease feelings of loneliness and isolation?
9. Do you find yourself drinking with other moms during play-dates, book-clubs, or other social events that center around alcohol?
10. Do you believe drinking or using drugs helps you cope with the stress of marriage?
11. Have your friends, relatives, or spouse ever expressed concern to you about your drinking?
12. Does drinking or drug use help you cope with feelings of frustration or anger?
13. Do you drink or use drugs to manage your weight?
14. Do you drink or use drugs to feel more sexually open and responsive?
15. Does drinking or drug use help you get to sleep at night?
16. Does alcohol or drug use help you deal with feelings of anxiety?
17. Do you believe that alcohol or drug use helps you be more creative?
18. Have you ever tried to cut back on your drug or alcohol use?
19. If yes, were you successful?
20. Have you suffered any physical consequences from alcohol or drug use; i.e., blackouts, vomiting or other gastro-intestinal distress, hangovers, weight loss or gain?
If you answered yes to three or more of these questions, you may have a problem with alcohol or drugs. There is help available- consider seeking support from a therapist or addiction counselor in order to get a professional evaluation. If you are in the LA area, please email me at jenginsberg1@gmail.com and check out my site at jenniferginsberg.com for more information about my individual, group, and intervention services.
*This survey is not a diagnostic tool and is only to be used for the purposes of self=assessment.
December 16th, 2009 at 3:34 pm
Okay so there were 20 questions and I answered yes to almost all of them. I won’t say which ones I didn’t answer yes to because I’d like to add to the mystery that is me. But I will say that question 19 provided one of my few “no’s” so obviously I DON’T HAVE A PROBLEM! Thanks for clearing that up.
Mwah!
December 19th, 2009 at 11:38 pm
do you think there can be an addiction to botox and beauty?
December 19th, 2009 at 11:41 pm
you can substitute substance abuse for needing to look a specific way.