Online Assessment - Ready for Addiction Recovery?

Ready to Start Your Recovery? Take Our Free Online Assessment

If you think you might have a problem with alcohol or another drug, SSH is here to help guide you along the path to recovery. Our certified clinicians and consulting physician can provide an assessment that will help identify which program would be the best “fit" for you and customize services to your individual needs.

Just fill out the confidential assessment below, click Submit, and we’ll be in touch.

This assessment process is 100% confidential. We do not share any information.

Not sure if it’s time for addiction treatment? Take the quiz below our assessment, and for each “Yes" answer, click the question for an explanation.

Online Assessment Form (Confidential)

Name *

First

Last

Email *

Comment or Message *

Phone Number

You're contacting SSH for:

If contacting us for someone other than yourself, please enter their name:

Please select your time zone:

Best Time to Call

What is the primary drug of abuse?

What is the method of intake?

Is there a secondary drug of abuse? If so, which one?

What is the method of intake?

At What Age Did The User First Take Drugs?

How Old is the User Now?

At What Age Did The User's Life Become Unmanageable?

What Are The Current Problems of The User's Addiction?

What Is The Family's Attitude Toward The User's Addiction?

Does the User Admit to Having a Problem?

Does the User Want Help?

How Many Times Has This User Been In Treatment for Their Addiction?

If the user has sought treatment before, how many of these involved the 12-Step (AA/NA Model) approach to recovery?

Did the User have any success with these treatment episodes? If so, how long did they stay sober/clean?

Does The User Have Any Known Medical Conditions?

If So, Please List The Condition(s) and Any Necessary Details:

Has This Person Ever Been Diagnosed With Any Psychiatric Disorders?

If so, is He / She Currently On Medication for A Psychiatric Disorder?

If Yes, please specify any medications taken:

Does The User Have Medical Insurance?

If Yes, who is the Insurance Carrier?

Does The User Have Any Current Legal Issues?

If so, please describe the issues:

Please provide us with any other relevant information, and any questions you may have.

Name

Addiction Quiz

12 quick questions. Count how many times you answer ‘Yes.’

Did you ever decide to stop drinking/using for a week, but only lasted a couple days? - YES / NO

Most of us made all kinds of promises to ourselves and to our families. We could not keep them. Then we came to recovery which said, “Just try not to drink or use today." (If you do not drink or use today, you cannot get drunk or high today.)

Do you wish people would mind their own business about your drinking/using? - YES / NO

In recovery, we do not tell anyone to do anything. We just talk about our own drinking/using, the trouble we got into, and how we stopped. We will be glad to help you too.

Ever switched to another drink/drug, hoping it would keep you from getting drunk/high? - YES / NO

We tried all kinds of ways. We made our drinks weak, or just drank beer, or we did not drink cocktails, or only drank on weekends. You name it, we tried it. But if we drank anything with alcohol in it, we eventually got drunk. If we used any drug, we eventually got high.

Have you ever needed a drink upon waking during the past year? - YES / NO

Do you “need" a drink or drug to get started, or to stop shaking? This is a pretty sure sign that you are not drinking/using “socially."

Do you envy people who can drink or use without getting in trouble? - YES / NO

At one time or another, most of us have wondered why we were not like most people who truly can take it or leave it.

Have you had problems connected with drinking/using in the past year? - YES / NO

Be honest! Doctors say that if you have a problem with alcohol and/or drugs (DUI/DWIs, accidents, etc.) and keep on drinking/using, it will get worse. Never better. Eventually, you will die, or end up in an institution for the rest of your life. The only hope is to stop drinking and using.

Has your drinking/using caused problems at home? - YES / NO

Before we came into recovery, most of us said that it was the people or problems at home that made us drink or use. We could not see that our drinking/using just made everything worse. It never solved problems anywhere, anytime.

Do you ever try to get "extra" drinks/drugs at a party, because you don't get enough? - YES / NO

Most of us used to have a “few" before we started out if we thought it was going to be that kind of party. And if drinks were not served fast enough, we would go someplace else to get more.

You can stop any time you want, right? - YES / NO

Many of us kidded ourselves into thinking that we chose drinking and/or using because we wanted to. After we came into recovery, we found out that once we started to drink/use, we couldn’t stop.

Have you missed days of work or school because of drinking/using? - YES / NO

Many of us admit now that we “called in sick" lots of times when the truth was that we were hungover, drunk or high.

Do you ever have blackouts? - YES / NO

A “blackout" is when we have been drinking or using for hours or days which we cannot remember. When we came to recovery, we found out that this is a pretty sure sign of addictive using and/or alcoholic drinking.

Have you ever felt your life would be better if you did not drink or use drugs? - YES / NO

Many of us started to drink or use because mind-altering substances made life seem better, at least for a while. By the time we got into recovery, we felt trapped. We were drinking and/or using to live and living to drink or use. We were sick and tired of being sick and tired.

What’s your score? Did you answer “YES” more than 3 times?

If so, you are probably struggling with substance abuse issues. We can show you how to stop!

Support Systems Homes is here to help. If you would like to receive a call from our knowledgeable support staff, please complete the form above.