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Alcohol & Drug Use Questionnaire - NYC Bar Lawyer Assistance Program
Answer these questions as honestly as you can
Are my peers, friends, or family alleging that my drinking/drug use is interfering with my work?
Do I plan my day around my drinking/drug use?
Do I ever feel I need a drink/drug to face certain situations?
Do I frequently drink/use drugs alone?
Have I ever had a loss of memory when apparently functioning because of my drinking/drug use?
Do I ever drink/drug before a meeting or court appearance to calm my nerves, gain courage, or improve my performance?
Do I want, or take, a drink/drug the morning after a hard night drinking/drugging?
Have I missed deadlines or appointments because of my drinking/drug use or because of a hangover?
After drinking/drug use, have I ever felt any of the following: fear, remorse, guilt, loneliness, depression, severe anxiety, terror, or a feeling of impending doom?
Is my drinking/drug use making me careless about my finances, health or other responsibilities?
While drinking/drugging, have I ended up in places I would not normally frequent or with people I would not normally socialize with?
Do I need or desire a drink/drug to steady my nerves at a particular time of day or week?
Have I ever lied, cheated or stolen to support or cover up my drinking/drug use?
Have I ever tried unsuccessfully to quit drinking/drugging for any length of time?
Have I made attempts to control my drinking/drug use by limiting it to special occasions, special times of the day, or certain days of the week, certain number or types of drinks/drugs?
Do I avoid people in order to hide the effects of my drinking/drug use?
Have I ever been hospitalized or treated by a doctor directly or indirectly as a result of my drinking?
Is there anyone in any generation of my family who has been diagnosed, treated for, or sought help for an alcohol, drug or other addiction problem such as gambling?