Addiction Checklists


Addiction Checklist – A Place of Hope

I tend to conceal certain behaviors
There is a slow deterioration of family “pride”
I protect the consequences of my behavior
I make secret pact(s) with other family members
I tend to deny what is obvious to others
I am feeling distant from other family members
I am increasing my use of alibis, excuses, and justification for my actions
There is a growing distrust within my family
I engage in self-righteous criticism and tend to judge others
I have more and more self-doubt and fear
I often feel superior to others
I neglect spiritual pursuits, including prayer and meditation
I tend to overlook my behavior
I sense changes in eating or sleeping patterns
I distrust those outside my family
I’m having more accidents, illnesses, and injuries due to increased stress
I often rationalize my behavior
I find there’s more loss of time on the job
I often fantasize and obsess about my problems
My ability to work or function is decreasing
I hold the belief that if others changed, most of my problems would vanish
I am having a conflict with my former value system — my once-clear set of personal ethics
I attempt to “catch” or “trap” others in some act of which I do not approve
I have made attempts at suicide or have nurtured suicidal thoughts
My mood swings are intense, moving from high to low
I have increasing financial problems
I have a list of ongoing resentments and disappointments
I feel I am over-extended and over-involved in my work and other outside activities
I find myself losing friendships
More and more I am engaging in self-defeating or degrading behavior



Addiction Checklist – Partners In Pain

Addiction behaviors—since last visit:

1. Patient used illicit drugs or evidences problem drinking
2. Patient has hoarded meds
3. Patient used more narcotic than prescribed
4. Patient ran out of meds early
5. Patient has increased use of narcotics
6. Patient used analgesics PRN when prescription is for time contingent use
7. Patient received narcotics from more than one provider
8. Patient bought meds on the streets

Addiction behaviors—within current visit:

1. Patient appears sedated or confused (e.g., slurred speech, unresponsive)
2. Patient expresses worries about addiction
3. Patient expressed a strong preference for a specific type of analgesic or
a specific route of administration
4. Patient expresses concern about future availability of narcotic
5. Patient reports worsened relationships with family
6. Patient misrepresented analgesic prescription or use
7. Patient indicated she or he ‘‘needs’’ or ‘‘must have’’ analgesic meds
8. Discussion of analgesic meds was the predominant issue of visit
9. Patient exhibited lack of interest in rehab or self-management
10. Patient reports minimal/inadequate relief from narcotic analgesic
11. Patient indicated difficulty with using medication agreement

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