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Alcohol Assessment

1. Do you feel you are a normal drinker? ("normal" - drink as much or less than most other people)?
2. Have you ever awakened the morning after some drinking the night before and found that you could not remember a part of the evening?
3. Does any near relative or close friend ever worry or complain about your drinking?
4. Can you stop drinking without difficulty after one or two drinks?
5. Do you ever feel guilty about your drinking?
6. Have you ever attended a meeting of Alcoholics Anonymous (AA)?
7. Have you ever gotten into physical fights when drinking?
8. Has drinking ever created problems between you and a near relative or close friend?
9. Has any family member or close friend gone to anyone for help about your drinking?
10. Have you ever lost friends because of your drinking?
11. Have you ever gotten into trouble at work because of drinking?
12. Have you ever lost a job because of drinking?
13. Have you ever neglected your obligations, your family, or your work for two or more days in a row because you were drinking?
14. Do you drink before noon fairly often?
15. Have you ever been told you have liver trouble such as cirrhosis?
16. After heavy drinking have you ever had delirium tremens (D.T.?s), severe shaking, visual or auditory (hearing) hallucinations?
17. Have you ever gone to anyone for help about your drinking?
18. Have you ever been hospitalized because of drinking?
19. Has your drinking ever resulted in your being hospitalized in a psychiatric ward?
20. Have you ever gone to any doctor, social worker, clergyman or mental health clinic for help with any emotional problem in which drinking was part of the problem?
21. Have you been arrested more than once for driving under the influence of alcohol?
22. Have you ever been arrested, even for a few hours, because of other behavior while drinking?

Alcohol Dependence Assessment

1. Have you ever felt you should cut down on your drinking?
2. Have people annoyed you by criticizing your drinking?
3. Have you ever felt bad or guilty about your drinking?
4. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)?

Anxiety & Distress Assessment

1. In the past 4 weeks, about how often did you feel tired out for no good reason?
2. In the past 4 weeks, about how often did you feel nervous?
3. In the past 4 weeks, about how often did you feel so nervous that nothing could calm you down?
4. In the past 4 weeks, about how often did you feel hopeless?
5. In the past 4 weeks, about how often did you feel restless or fidgety?
6. In the past 4 weeks, about how often did you feel so restless you could not sit still?
7. In the past 4 weeks, about how often did you feel depressed?
8. In the past 4 weeks, about how often did you feel that everything was an effort?
9. In the past 4 weeks, about how often did you feel so sad that nothing could cheer you up?
10. In the past 4 weeks, about how often did you feel worthless?

Depression Assessment

1. I was bothered by things that don't usually bother me.
2. I did not feel like eating; my appetite was poor.
3. I felt that I could not shake off the blues even with the help of my family or friends.
4. I felt that I was just as good as other people.
5. I had trouble keeping my mind on what I was doing.
6. I felt depressed.
7. I felt everything I did was an effort.
8. I felt hopeful about the future.
9. I thought my life had been a failure.
10. I felt fearful.
11. My sleep was restless.
12. I was happy.
13. I talked less than usual.
14. I felt lonely.
15. People were unfriendly.
16. I enjoyed life.
17. I had crying spells.
18. I felt sad.
19. I felt that people disliked me.
20. I could not get going.

Drug Abuse Assessment

1. Have you used drugs other than those required for medical reasons?
2. Have you abused prescription drugs?
3. Do you abuse more than one drug at a time?
4. Can you get through the week without using drugs?
5. Are you always able to stop using drugs when you want to?
6. Have you had "blackouts" or "flashbacks" as a result of drug use?
7. Do you ever feel bad or guilty about your drug use?
8. Does your spouse (or parents) ever complain about your involvement with drugs?
9. Has drug abuse created problems between you and your spouse or your parents?
10. Have you lost friends because of your use of drugs?
11. Have you neglected your family because of your use of drugs?
12. Have you been in trouble at work because of your use of drugs?
13. Have you lost a job because of drug abuse?
14. Have you gotten into fights when under the influence of drugs?
15. Have you engaged in illegal activities in order to obtain drugs?
16. Have you been arrested for possession of illegal drugs?
17. Have you ever experienced withdrawal symptoms (felt sick) when you stopped taking drugs?
18. Have you had medical problems as a result of your drug use (e.g., memory loss, hepatitis, convulsions, bleeding, etc.)?
19. Have you gone to anyone for help for a drug problem?
20. Have you been involved in a treatment program especially related to drug use?

PTSD Assessment

1. Are you recalling traumatic emergency events that occurred years ago, now on a weekly or daily basis?
2. Do you recall traumatic events when you see someone in the general public that looked like a past victim?
3. Are you starting to become frustrated or angry when being dispatched for emergency calls?
4. Do you find yourself trying to avoid, go out of your way or think about certain situations that remind you of previous calls?
5. Do you find yourself feeling guilty or grieving about a patient(s) that died within the last 3 months?
6. Have you or someone close to you notice that your sleeping patterns have changed?
7. Are you experiencing dreams or nightmares about a past event(s)?
8. Have you been told that you have changed? by Friends, Family, or Fellow firefighters?
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