Adult Substance Abuse and Mental Health 
This survey and your responses are completely anonymous.

Have you ever been diagnosed with a mental health disorder?
Yes
No
Have you ever been diagnosed with a substance abuse disorder?
Yes
No
Did your parents abuse alcohol or other forms of substances when you were a child? (Check all that apply)
No
Mother
Father
Stepparent(s)
The person(s) who raised me
If alcohol/substance abuse has been a family problem, how have you dealt with it? (Check all that apply)
It has not been a family problem
I confronted the abuser
I educated myself on the subject
The family member is in recovery
It has not bothered me
I confided in trusted friends or my spouse or partner
I sought counseling
It is still difficult for me
I have never told anyone about the incident(s)
Other
As a direct or indirect result of substance abuse, have you or a family member experienced any of the following? (Check all that apply)
No
Legal difficulty
Absence from work
Accidents
Loss of a job
Health problems
Violent behavior
Arguments with family or friends
Inpatient treatment program
Outpatient treatment program
Other
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