Initial assessment: Addiction Questionnaire

This initial assessment consists of seven questions. Please answer them keeping in mind your situation for the past two weeks.


1. Which addiction do you have?


2. How long have you had this addiction?


3. Have you had previous therapy or rehabilitation experience for this or other addictions?

4. How much does this addiction hamper your daily life at the moment? (scale 1-5)

5. How much does your addiction hamper your work performance at the moment? (scale 1-5)

6. How often do you feel guilt or anxiety because of your addiction?

7. Does your addiction cause problems in your relationships?

All done.

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What other addiction do you have?


What kind of experience?