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Substance dependence has been described as a chronic, progressive and potentially fatal disease. Review the following list of symptoms and check the ones that you feel you or someone you care about has experienced.


1. Behavior(s) while under the influence of a substance that are markedly different from non-using behaviors.


2. Blackouts (lack of remembrance of part or all of some activity or event.)


3. A sense of defensiveness over one's use, resulting in disguising or sneaking the use of the substance.


4. A growing tolerance to the substance (takes more to achieve the desired affect.)


5. Increased preoccupation with using the substance (looking forward to future use, increased anticipation of use, thinking more often about using.)


6. The experience of discomfort as the substance wears off ( e.g. hangover, agitation, thirst, headache, stomach upset.)


7. Using more than intended; loss of control (loss of the ability to guarantee the outcome of using.)


8. Rationalizations, alibis, excuses, explanations developing around negative consequences arising from use (e.g. "I was overtired. It hit me harder than usual." "I shouldn't have drunk on an empty stomach." "It must have been bad stuff."


9. Using to change mood or energy level (using to slow down or reenergize.)


10. Anti-social behaviors increasing (behavior that separates (anti-) from the group (social); behavior that is contrary to group norms or standards.)


11. Changing patterns of use or lifestyle to establish better control over consequences from using (e.g. drinking beer instead of distilled liquor, changing residence ["geographic cure'], changing friends, changing schools/jobs/careers.)


12. Legal complications around use (DWI, suspensions from school, suit.)


13. Family problems arising around use (increased criticism, social embarrassment, threats of separation/divorce, arguments.)


14. Financial problems (expense of substance use impacting on financial manageability.)


15. Problems on the job/in school (bypassed promotion, involvement of Employee Assistance personnel, lay-off, suspension, probation, loss of job, grade decline.)


16. Health problems (e.g. heart problems, liver problems, injuries from "accidents," gastrointestinal problems.)


17. Binging (prolonged drinking or using episodes, sometimes separated by periods of abstinence.)


18. Withdrawal symptoms (e.g. tremors, shakiness, high anxiety, depression.)


19. Protecting the supply (making sure the substance is always available, hiding it.)


20. Emotional extremes (unreasonable resentments, rage, isolation, reclusive, manic, hyperactivity.)


21. Free-floating anxiety/Nameless fears (e.g. sense of impending doom lacking any realistic threat, hallucinations, delirium tremens.)

Symptoms 1-6 are considered pre-dependence markers in and of themselves. However, if you checked 3 or more of the first six, there is a likelihood of already being dependent.

Symptoms 7-15 are generally classified as early or acute stage symptoms of dependence.

Symptoms 16-21 are classified as late or chronic stage symptoms, indicating that the disease is approaching a level that is likely to become life threatening or result in some form of custodial care (such as incarceration or institutionalization.)

*Signs and Symptoms are based on the work of Dr. E. M. Jellinek.


Substance Abuse or Dependence/Addiction can have a profoundly negative effect on the quality of life of those who are emotionally attached to the abuser or addict. These effects can be physical, mental/emotional and/or spiritual in nature. As the abuser or addict encounters each symptom of his or her problem, those around that individual often react with similar behaviors and attitudes. Answer the following questions to see if the quality of your life is being impacted by someone else's substance abuse or dependence/addiction.

Physical Effects*

1. Do you experience headaches on a regular basis (at least weekly)?

2. If you are accustomed to headaches, are they becoming more severe?

3. Do you experience stomach discomfort on a regular basis (at least weekly)?

4. Do you take medications, either over-the-counter (OTC) or by prescription for headaches, stomach distress and/or bowel problems at least weekly?

5. Have you noticed skin rashes/itchiness?

6. Do you suffer recurring back, shoulder or neck pains?

7. Have your visits to a medical professional increased (e.g. doctor, chiropractor)?

8. Have you been experiencing dizziness, sweating, and/or shortness of breath?

9. Have you been diagnosed with panic disorder, depression, attention deficit disorder, traumatic stress disorder or anxiety-related disorder?

10. Do you suffer from nameless fears and anxieties?

* Some of the symptoms noted are also symptoms of conditions unrelated to living with a substance abuser/dependent. However, they are often indicative of chronic stress in one's environment, such as that resultant from substance abuse/dependence.


Emotional/Mental Effects

1. Are you experiencing wide mood swings?

2. Is it difficult to concentrate on tasks or projects?

3. Do you find yourself preoccupied with thoughts of maintaining control over yourself or others?

4. Are you embarrassed by the abuser/dependent's attitudes or behaviors?

5. Do you find yourself defending, excusing or rationalizing the behaviors of the abuser/dependent (e.g. "He/she was overtired." "He/she drank on an empty stomach." "He/she is under so much stress lately.")

6. Is your job performance suffering?

7. Is your energy constantly going toward "keeping things together."?

8. Are you violating your own standards and values (e.g. lying, acting out, thinking of or having an extramarital affair)?

9. Are you afraid to verbalize or show your true feelings?

10. Are you feeling trapped or victimized?

11. Are you using humor to avoid feeling pain?

12. Are you becoming someone you do not like?

13. Are you relying on mood or mind-altering, pain killing or sleeping medications increasingly to function?

14. Have you lost your sense of humor?

15. Is it difficult to complete tasks or projects or have fun doing them?


Spiritual Effects

1. Are you feeling isolated and alone?

2. Do you feel like you are living a lie?

3. Do you feel compelled to keep your feelings, thoughts and observations secret?

4. Are you feeling like the responsibility for the family is on your shoulders?

5. Are you withdrawing from social involvements (e.g. dropping memberships, avoiding events, becoming a non-participant.)?

6. Are you experiencing self-doubt?

7. Have you decreased involvement with your past belief system?

8. Do you feel unsupported or rejected by others?

9. Have you lost a sense of or spirit of "belonging?"

10. Do you feel purposeless and resigned?

11. Do you feel misunderstood or as though no one could understand your situation?


If you have answered "yes" to any combination of five or more of these questions you may well be living with substance abuse/dependence.



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