Addictions & Compulsions Assessment

Struggling with addictive / compulsive behaviors, tired of the same old tradtional methods of 12 step support groups. Affordable help is just click away. Within just a few short sessions you can learn what it takes to eliminate addictive habits and conditions from your life. Take just a moment to fill out the following questionnaire, including contact information. Call for free evaluation to help determine if this is the right step for you. Don’t let money become a barrier to your enjoyment of your life, be sure and ask about my sliding fee scale.

Name
Phone Number:
Email
What addictive / compulsive behavior are you struggling with?
If you are struggling with drug abuse / addiction, what is your primary drug of choice?
What other Drugs do you use?
Have you ever felt you should cut down on your drug or alcohol use?
Have people annoyed you by criticizing your drug or alcohol use?
Have you ever felt guilty about your drug or alcohol use?
What other methods have you used to deal with this issue: (i.e. drug and alcohol treatment, 12 step groups, private counseling), and how did these methods help the issue?
What are the benefits that you have received from your drug use, or addictive compulsive behavior?
What are the consequences of your drug use, or addictive compulsive behavior?