Parents Questionnaire

The following questionnaire regarding specific physical and behavioral signs of drug and alcohol use will help you determine whether your child is using drugs. Your first impressions are generally the best.

If you schedule an assessment, please print out one questionnaire for each parent, answer, and bring it to your appointment.

Name:
Email:
Phone:

YES	NO	Question
		Do you notice a change in your teenager's sleeping patterns? (Alcohol and drug use disrupts normal sleeping patterns.)
		Does your teenager have a persistent runny nose, bloodshot eyes, coughing. wheezing? (Cocaine use causes a runny nose. Marijuana use causes coughing, wheezing, bloodshot eyes.)
		Does your teen demonstrate slurred or agitated speech? (Unusual speech patterns are a strong indicator of alcohol and drug use.)
		Are you receiving complaints from your teen's teachers? Do you get reports that your teenager is missing classes? (Drug use can interfere with normal social patterns at school.)
		Is your teenager's academic performance diminishing? Or do extracurricular activities or hobbies no longer hold interest? (Drugs and alcohol use displace healthy, functional habits.)
		Is your teenager furtive or secretive about his or her behavior? Does he or she insist on a locked bedroom? (Teenagers with a drug or alcohol problem will attempt to hide evidence of their use.)
		Do you notice a change in your teenager's friends or peer group? (A teenager who is having drug or alcohol problems will pursue relationships with people who share the same attitudes and habits.)
		Does your teenager demonstrate a lack of interest in personal appearance or hygiene? (Youngsters abusing drugs or alcohol may not notice their appearance, not realizing the physical changes that occur.)
		Do you notice an unusual smell on clothing or breath? (Alcohol, nicotine, and marijuana use is detectable on the breath, skin, and clothes after use.)
		Did you notice an increase in the amount of money your teenager is borrowing? Are you missing money or valuables? (A youngster's drug or alcohol use tends to increase and become more expensive. At some point, the craving for drugs is more intense than healthy remorse about stealing from loved ones.)
		Have you found unaccounted-for cash belonging to your teenager? (This is a possible sign your teenager is dealing drugs.)
		Do you notice a change in the way your teenager expresses himself or herself? Does he or she seem emotionally unstable, hyperactive, or hyper-aggressive? (Drugs and alcohol abuse cause radical and distinct changes in personality.)
		Is your teenager hostile when confronted with concerns about possible drug or alcohol use? Does he or she simply refuse to cooperate with your inquiry? (A young abuser will tend to avoid discussion and deny drug use for fear of being discovered.)
		Do you catch your teenager lying? (Lying to cover up becomes second nature to a young abuser.)
		Does your teenager refuse to do chores or miss curfew regularly? (Drug or alcohol abuse disrupts a young person's sense of responsibility and participation in family life.)
		Is your teenager creating a chaotic and hostile environment in the home? (Young abusers can be so deeply affected by their chemical addiction that they can no longer act in their own best interest. The addiction acts on behalf of the young person causing him or her to act unruly, unmanageable, and unapproachable.)
		Does your teenager frequently appear to be depressed, fatigued or sleepy? (Drug or alcohol abuse affects a youngster's energy level, causing him or her to feel wiped out.)
		Is there a history of substance abuse in the genetic family tree? Is there any alcoholism or drug addiction (including nicotine) in your extended family? (There is a strong correlation between teen's experimentation progressing into dependency if there is a family history of substance usage.)

Please contact us after you submit your questionnaire.

Lorraine and Richard Platt

Marriage & Family Therapists

CONTACT US

311 Miller Avenue, Ste. E
Mill Valley, CA 94941
Map/Get Directions

Lorraine 415-302-1700
Richard 415-760-8541

Raising teens is a challenge. Couples
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