Questionnaire

IS SOMEONE'S DRINKING GETTING TO YOU ?

Alateen is for you!

Alateen is for young people whose lives have been affected by someone else's drinking. The following twenty questions are to help you decide whether Alateen is for you.

Circle Yes or No

Y... N...1. Do you have a parent, close friend or relative whose drinking upsets you?

Y... N... 2. Do you cover up your real feelings by pretending that you don't care?

Y... N... 3. Are holidays and gatherings spoiled because of drinking?

Y... N... 4. Do you tell lies to cover up for someone else's drinking or what's happening in your home?

Y... N... 5. Do you stay out of the house as much as possible because you hate it there?

Y... N... 6. Are you afraid to upset someone for fear it will set off a drinking bout?

Y... N... 7. Do you feel nobody really loves you or cares what happens to you?

Y... N... 8. Are you afraid or embarrassed to bring your friends home?

Y... N... 9. Do you think the drinker's behaviour is caused by you, members of your family, friends, or rotten breaks in life?

Y... N... 10. Do you make threats, such as "If you don't stop drinking, fighting I'll run away"?

Y... N... 11. Do you make promises about behaviour such as “I’ll get better school marks, go to church, or keep my room clean", in exchange for a promise that the drinking and fighting will stop?

Y... N... 12. Do you feel that if your mom or dad loved you, he or she would stop drinking?

Y... N... 13. Do you ever threaten or actually hurt yourself to scare your parents into saying "I'm sorry", or "I love you"?

Y... N... 14. Do you believe that no one could possibly understand how you feel?

Y... N... 15. Do you have money problems because of someone else's drinking?

Y... N... 16. Are mealtimes frequently delayed because of the drinker?

Y... N... 17. Have you considered calling the police because of the drinker's abusive behaviour?

Y... N... 18. Have you refused dates out of fear or anxiety?

Y... N... 19. Do you think your problems would be solved if the drinking stopped?

Y... N... 20. Do you ever treat people (teachers, schoolmates, teammates, etc.) unjustly because you are angry at someone for drinking too much?

If you answered yes to some of these questions, Alateen may be able to help you

Copyright Al-Anon Family Group Headquarters, Inc. @ 1981.

Is Someone's Drinking Getting to You? (S-20)