Please answer yes or no to each of the following:

Questions about Mental Health

• Have you been evaluated for or have you been diagnosed with mental illness, such as anxiety, depression, obsessive compulsive disorder, bipolar illness, panic disorder, addiction, phobias or schizophrenia?
  

• Do you experience feelings of helplessness, hopelessness, worthlessness or guilt?
  

• Have you lost interest in daily activities and find it difficult to experience pleasure?
  

• Have you experienced a change in eating or sleep habits, or level of energy?
  

• Do you often avoid social situations and prefer to be by yourself?

• Are you pursuing high risk behaviors, particularly while driving?

• Are you experiencing problems at home, work, school or in your finances?
  
  

Questions about Substance Use

• Does the use of substances (alcohol or drugs) negatively affect your role as an employee, spouse, parent, or friend?

• Do you use substances in situations where it is hazardous?

• Have you ever been arrested for public intoxication, disorderly conduct, domestic violence, or DUI?

• Has the use of substances resulted in arguments or fighting at work, home or other places?

• Has a friend, relative, doctor, or co-worker been concerned about your drinking or suggested you cut down?

These questions are intended to help a person recognize if he or she may be struggling with a co-occurring condition. If you are experiencing these symptoms, it is recommended that you seek a professional evaluation to determine the best course of treatment..

For an assessment and consultation with a licensed therapist at Lindner Center of HOPE, please call 513-536-HOPE (4673).