"I am free today. For the first time in my life I have inner peace, no fear, no worries, I'm happy."

Barry S

PSP
Providence Supporting People
A Registered Charity
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Do I Have a Problem?

If you would prefer to speak confidentially to one of our highly trained clinicians please call us on 01202 39 30 30

Confidential Call Back
Please complete this form and one of our specialist consultants will contact you immediately.
Alternatively call us on: 01202 39 30 30 or 07887 990 990

1.	Do you ever drink or use alone?	Yes No
2.	Is drinking or using causing problems in your family?	Yes No
3.	Do you drink or use to escape your problems?	Yes No
4.	Do you feel remorseful after drinking or using?	Yes No
5.	Have you made promises to yourself or someone else about stopping?	Yes No
6.	Has drinking or using affected your health?	Yes No
7.	Have you ever tried to stop or control your using?	Yes No
8.	Does your drinking or using interfere with you sleeping and eating?	Yes No
9.	Are you having money troubles because of drinking or using?	Yes No
10.	Do you get defensive when asked about your drinking or using?	Yes No
11.	Have alcohol or drugs cost you more than just money?	Yes No
12.	Have other people commented on your drug or alcohol usage?	Yes No

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