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TEEN CODEPENDENT QUESTIONNAIRE
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| For Teens who wonder if alcohol / drug
problems in your family can affect you
in a number of ways, some you probably don't even realize. |
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| Read through the following questions and decide which
best describes your feelings, behaviour, and experience related
to a family members alcohol/drug use. |
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Yes
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No
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| 1. Do you worry about your mom's or dad's drinking/
using? |
5
|
4
|
3
|
2
|
1
|
0
|
| 2. Are you afraid to be around them when they're drinking/using? |
5
|
4
|
3
|
2
|
1
|
0
|
| 3. Have you felt afraid to have your friends
over because of what your |
5
|
4
|
3
|
2
|
1
|
0
|
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drinking parent might do or say? |
| 4. Do you wonder sometimes if it's your fault that
your parent drinks? |
5
|
4
|
3
|
2
|
1
|
0
|
| 5. Are you finding more and more excuses to stay away
from home? |
5
|
4
|
3
|
2
|
1
|
0
|
| 6. Do you sometimes feel that you hate
your parents when they're |
5
|
4
|
3
|
2
|
1
|
0
|
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drinking/using and then feel guilty for hating them? |
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7. Did your parent ever yell at or hit
you or other family members when
|
5
|
4
|
3
|
2
|
1
|
0
|
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drinking? |
|
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|
|
|
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| 8. Do you trust your parents? |
5
|
4
|
3
|
2
|
1
|
0
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9. Have you ever tried to "make"
your parent stop drinking
|
5
|
4
|
3
|
2
|
1
|
0
|
| |
(like hiding or emptying a bottle of liquor, or talking
to them, etc.) |
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|
|
|
|
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| 10. Are you embarrassed when your parents are drinking/using? |
5
|
4
|
3
|
2
|
1
|
0
|
| 11. Do you lie about your parents to other people? |
5
|
4
|
3
|
2
|
1
|
0
|
12. Do you ever feel sick, cry, or have
a "knot" in your stomach after
|
5
|
4
|
3
|
2
|
1
|
0
|
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worrying about your parent's drinking? |
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13. Have you ever taken over any chores
and duties at home that were
|
5
|
4
|
3
|
2
|
1
|
0
|
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usually done by a parent before he or she started
drinking? |
|
|
|
|
|
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14. Do you try to make your parents happy
so they won't get upset
|
5
|
4
|
3
|
2
|
1
|
0
|
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and drink more? |
|
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|
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|
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15. Do you have a hard time concentrating
at school, thinking about
|
5
|
4
|
3
|
2
|
1
|
0
|
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home a lot? |
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|
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|
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16. Do you sometimes drink or take drugs
to forget about things at
|
5
|
4
|
3
|
2
|
1
|
0
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home? |
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| 17. Do you ever drink with your parents? |
5
|
4
|
3
|
2
|
1
|
0
|
18. Do you feel you can't talk about the
drinking in your home . or even
|
5
|
4
|
3
|
2
|
1
|
0
|
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how you feel inside? |
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|
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19. Have you ever wished you had never
been born or thought of
|
5
|
4
|
3
|
2
|
1
|
0
|
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suicide? |
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| 20. Do you feel close to one of your relatives?
|
5
|
4
|
3
|
2
|
1
|
0
|
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Who? _________________________________ |
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21. Have you ever talked to someone outside
of home about what's
|
5
|
4
|
3
|
2
|
1
|
0
|
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going on for you? |
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| No matter how many of your answers were
"yes", there's really just one more, very important question
you need to ask yourself: Do You Want To Start Feeling Better? If
so, start sharing your secret with someone. |