Rate how much your substance use is affecting each of the life areas listed below, using a scale of 1 to 10. The questions we’ve put under each category are there to help you think it through thoroughly. High scores mean the life area is greatly affected by your substance use. Score zero to mean no effect.

1. Physical Health

• Has your habit put you in harm’s way, through intoxicated driving, getting into dangerous situations, etc.?

• Have you had, or come close to, an overdose or drug-related collapse?

• Have you risked exposing yourself to drug-related diseases like HIV and hepatitis C?

• Do you know if you have damaged your body through drug use, e.g., your liver through alcohol use, your heart through cocaine use?

• Do you have a reliable source for drugs where you can trust that the cut is not going to be toxic?

• Have you not yet taken steps to properly educate yourself about the medical dangers of drug/alcohol use by reading articles or talking with your doctor?

Score out of 10: _______

2. Financial and Legal

• Does the financial load of your partying/substance use affect any of these areas: paying for the basics like the rent/mortgage; putting money aside for the future; spending on things you would otherwise have enjoyed, like new clothes or a vacation?

• Has it gotten you into debt?

• Are you having legal problems because of a drug arrest, a DUI, or other legal entanglement that resulted from your drug/alcohol use?

• Do you take risks around getting arrested for possession, sale, or drunk driving?

Score out of 10: _______

3. Relationship Issues

• Has drinking or drug use had a negative impact on your relationship with your partner, your family, or your friends?

• Are most of your friendships built primarily around drinking/drug use?

Score out of 10: _______

4. Job/Education

• Have you missed time from work or school because of your habit?

• Do you have drug tests in your workplace that you are afraid you will fail?

• Even if you show up on time, has your substance use had a negative impact on your job/school performance?

• Do you party so much on the weekends that you get back to work/school just barely in time to start the weekly grind again?

Score out of 10: _______

5. Internal Life

• Does it seem like your drug/alcohol use has made you a more depressed, anxious, or edgy person?

• Do you sometimes spiral into a bad mood or gt paranoid while you are drinking or high?

• Do you wonder if you your creativity, interests, or activities have decreased because of your substance use?

• Do you wonder if you have lost your sense of purpose or spirituality because of your drug/alcohol use?

Score out of 10: _______

Total score out of 50: _______

This total score represents in a number rating the price you believe you are paying for your substance use. If you multiply that number by two, it will give you a percentage score, which is something we are more used to.

Even scores that look low may give you cause for concern. If you score 25%, that is saying you believe your life could be 25% better without the drugs or alcohol. Cutting back on the substance use would be a powerful performance enhancer.

Your next step is to take Assessment #3, which will help you decide which course of action is best suited to creating this positive change for you.