Families

Do you have money problems because of your loved one’s use of alcohol or drugs?

Yes
No

Do you tell lies to cover up for your loved one’s drinking or drug use?

Yes
No

Do you feel that if your loved one cared about you, he or she would stop?

Yes
No

Do you blame the behaviour of your loved one on his or her companions?

Yes
No

Are plans frequently upset or cancelled, or meals delayed, because of your loved one?

Yes
No

Do you make threats such as “If you don’t stop drinking, I’ll leave you”?

Yes
No

Do you secretly try to smell the drinker’s breath?

Yes
No

Are you afraid to upset your loved one for fear it will set off a bout?

Yes
No

Have you been hurt or embarrassed by your loved one’s behaviour?

Yes
No

Are holidays and gatherings spoiled because of drinking or drug use?

Yes
No

Have you considered calling the police due to fear of abuse?

Yes
No

Do you search for hidden alcohol or drugs?

Yes
No

Do you ever ride in a car with an impaired driver?

Yes
No

Have you refused social invitations out of fear or anxiety?

Yes
No

Do you feel like a failure because you can’t control your loved one’s problem?

Yes
No

Do you think that if your loved one stopped drinking or using, your other problems would be solved?

Yes
No

Do you ever threaten to hurt yourself in order to scare your loved one?

Yes
No

Do you feel angry, confused or depressed most of the time?

Yes
No

Do you feel there is no one who understands your problems?

Yes
No

Do you want to leave contact details?

Yes
No

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Do you want us to call you back?

Yes
No

Select a day for us to call you back*

Preferred time for call back*

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Phone number for call back*

Name*

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Email*

We will send you a confirmation of your call back request to this email address.

Does Your Loved One Have a Problem?