Drug & Alcohol Addiction - Admission Questionnaire Rehabguide

Admission Questionnaire

Admission Questionnaire

Our Admission Process

As you begin your journey towards drug and alcohol recovery, the first step is a professional assessment. Before drug & alcohol addiction treatment begins, addiction professionals must better understand your physical and mental state to make your recovery experience smoother and more effective. To begin, our staff will ask you a series of questions relating to your demographic information, details of substance use, history of any withdrawal symptoms, and mental health conditions. , The intake process is your time to communicate any concerns and to help a recovery centre gain an accurate picture of your dependency issues, lifestyle and background.

Am I An Addict?

Having come this far, by just being here, you may have answered your own question. Look through the symptoms below and ask yourself; is it worth it? Just to have a drink?

Increase or decrease in appetite, changes in eating habits, unexplained weight loss/gain.

The smell of substance on breath, body or clothes.

Difficulty in paying attention, forgetfulness.

Changes in attitude/personality with no obvious cause or explanation.

Changes in behaviour, loss of interest in family and family activities.

Changes in personal grooming habits.

Vomiting, toilet problems.

Difficulty sleeping.

Extreme hyperactivity, excessive talking.

Increased smoking, nail-biting.

Tasks that were once easy are difficult or neglected.

Hiding alcohol in the house/ car/ workplace, etc.

Defensiveness, bad temper, restless behaviour.

Unexplained moodiness, irritability or nervousness.

Violent temper.

Unexplained silliness or giddiness, bizarre behaviour.

Car accidents, household accidents.

Scrapes, scratches, bumps, bruises.

A new crowd of friends, new hang-outs, avoiding old friends.

Friends who are heavy-drinkers or drug-users.

Lack of motivation/energy, poor discipline, boredom, ‘I don’t care’ attitude.

Paranoia, suspiciousness.

Excessive need for privacy, keeping doors locked/closed.

Secretive or suspicious behaviour.

Unexplained need for money, can’t explain where the money goes, stealing.

Chronic dishonesty, trouble with the police.

Needle-marks or bruises on lower arms, legs or soles of feet.

Unusual efforts to cover arms or legs.

Possession of drug paraphernalia.

Low self-esteem, low self-worth.

Depressive moods/feelings.

Feelings of powerlessness or resignation.

Thoughts of self-harming, thoughts of suicide, thoughts of ‘ending it all’.


Self Assessment





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