One of the oldest and most time tested evaluation tools for chemical dependency has its origins from the Johnson Institute of Minneapolis. Many variations exist, but the basic questions are as follows:

1. Yes___ No___ Has anyone ever suggested you quit or cut back on your drug/alcohol use?
2. Yes___ No___ Has drinking or using affected your reputation?
3. Yes___ No___ Have you made promises to control your drinking or using and then broken them?
4. Yes___ No___ Have you ever switched to different drinks or drugs or changed your using pattern in an effort to control or reduce your consumption?
5. Yes___ No___ Have you ever gotten into financial, legal, or marital difficulties due to using?
6. Yes___ No___ Have you ever lost time from work because of using or drinking?
7. Yes___ No___ Have you ever sneaked or hidden your use?
8. Yes___ No___ On occasion, do you feel uncomfortable if alcohol or your drug is not available?
9. Yes___ No___ Do you continue drinking or using when friends or family suggest you have had enough?
10. Yes___ No___ Have you ever felt guilty or ashamed about your drinking or using or what you did while under the influence?
11. Yes___ No___ Has your efficiency decreased as a result of your drinking or using?
12. Yes___ No___ When using or drinking, do you neglect to eat properly?
13. Yes___ No___ Do you use or drink alone?
14. Yes___ No___ Do you use or drink more than usual when under pressure, angry, or depressed?
15. Yes___ No___ Are you able to drink or use more now without feeling it, compared to when you first started using?
16. Yes___ No___ Have you lost interest in other activities or noticed a decrease in your ambition as a result of your drinking or using?
17. Yes___ No___ Have you had the shakes or tremors following heavy drinking or using or not using for a period of time?
18. Yes___ No___ Do you want to drink or use at a particular time each day?
19. Yes___ No___ Do you go on and off the wagon?
20. Yes___ No___ Is drinking or using jeopardizing your job?