Behavioral Health Consultants

 

Behavioral Health Consultants, LLC.

3018 Dixwell Avenue
Hamden, CT 06518

Toll Free:
1-800-864-2742
Local:
(203) 288-3554
Fax:
(203) 281-0235

Physicians Referral Form

Alcohol and Substance Abuse Questionnaire

  • Have you ever felt you should cut down on your drinking?

  • Have people annoyed you by criticizing your drinking?

  • Have you ever felt bad or guilty about your drinking?

  • Have you ever has a drink first thing in the morning (as an Eye-opener) to steady your nerves or get rid of a hangover?

  • Has drinking or use of a substance ever caused job or relationship difficulties?

  • Do you drink/ use substances to reduce stress?

  • Do you experience blackouts or unexplained periods of time after drinking/ using substances? 

  • Do you feel it is hard to stop once you have started drinking/ using substances?

  • Have family or friends asked you to stop drinking or using substances? 

If you answered Yes to any of the above questions, then you may be experiencing a problem with drinking or substance abuse and should consider consulting with your EAP or local mental health professional for further evaluation and possible treatment.

 

 

 

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