If you or someone you know is in crisis right now: call or text 988 (Suicide & Crisis Lifeline). For a possible overdose or any medical emergency, call 911. For help finding treatment, the SAMHSA National Helpline is free and open 24/7 at 1-800-662-4357.
The short answer
You may need professional help if alcohol or drug use is hard to control and is causing problems in your health, relationships, work or safety. This checklist can help you see your own patterns, but only a qualified health professional can tell you whether you need treatment and which kind. “Rehab” is one option among several, and many people do not need a residential program.
Before you start
Being unsure is normal. Many people wonder whether their use is “bad enough” to count, and asking the question is a reasonable first step.
A few things to keep in mind:
- Be honest with yourself. No one else will see your answers.
- A “yes” is information, not a judgment. It does not mean you are weak or a failure.
- This is not a diagnosis. It is a screening tool to help you decide whether to talk to a professional.
The self-assessment checklist
Think about the past 12 months. Check each statement that applies to you or to the person you are worried about. The questions follow the 11 criteria doctors use to diagnose a substance use disorder.
Control
☐ I have used more, or for longer, than I meant to.
☐ I have wanted to cut down or stop, or tried to, and could not.
☐ I spend a lot of time getting, using or recovering from alcohol or drugs.
☐ I have strong cravings or urges to use.
Impact on daily life
☐ I have missed work or school, or let down my family, because of my use.
☐ I keep using even though it has caused problems in my relationships.
☐ I have given up or cut back on activities I used to enjoy.
Risk
☐ I have used in situations that could be dangerous, such as driving or operating machinery.
☐ I keep using even though I know it is harming my physical or mental health.
Body
☐ I need more than I used to in order to get the same effect (tolerance).
☐ I have physical or emotional symptoms when I cut down or stop, such as shaking, sweating, nausea, anxiety or trouble sleeping (withdrawal).
If you take a medication exactly as prescribed under a doctor’s care, tolerance and withdrawal do not count toward this total.
Count your checks
| Checks | What it may suggest | Suggested next step |
|---|---|---|
| 0-1 | Criteria for a disorder are probably not met | If you are still worried, talk to a doctor or counselor. Concern alone is reason enough. |
| 2-3 | Possible mild substance use disorder | Schedule an assessment with a doctor, counselor or addiction specialist. |
| 4-5 | Possible moderate substance use disorder | Seek a professional assessment soon. Treatment is likely to help. |
| 6 or more | Possible severe substance use disorder | Seek a professional assessment as soon as you can. Do not stop alcohol or sedatives suddenly on your own. |
These ranges mirror how clinicians rate severity, but a score from a checklist is not a diagnosis. A professional looks at your whole situation.
Red flags that mean getting help sooner
Regardless of your score, take these seriously:
- Close calls. You or someone else thought you might have overdosed, or you have woken up unsure what happened.
- Mixing substances, especially alcohol with opioids or sedatives, which can slow breathing dangerously.
- Using alone or using in ways that raise the risk of overdose.
- Blackouts or memory gaps after drinking or using.
- Impaired driving or legal trouble connected to use.
- Withdrawal symptoms, particularly with alcohol or sedatives. Seizures, hallucinations, severe confusion, a racing heart or high fever are medical emergencies.
- Thoughts of suicide or self-harm. Call or text 988.
- Pregnancy. Tell a doctor right away so you can get safe care for you and your baby.
- Repeated failed attempts to stop or cut back.
Does needing help mean needing rehab?
Not necessarily. “Rehab” is a broad word, and treatment comes in levels. Clinicians often use a framework from the American Society of Addiction Medicine (ASAM) to match the level of care to the person.
In simple terms:
- Outpatient care: regular therapy or counseling while you live at home and keep your routine.
- Intensive outpatient or partial hospitalization: several hours of treatment a few days a week (or most days), while living at home.
- Residential (inpatient) treatment: you live at the facility for a period of time.
- Medically managed inpatient care: hospital-level care for severe withdrawal or medical complications.
Signs that a more structured level of care may be worth discussing with a professional include:
- A risk of dangerous withdrawal
- Previous attempts at lighter-touch treatment that did not hold
- An unsafe or unstable home environment
- Serious mental health symptoms alongside substance use
- Little support outside of treatment
A professional makes this recommendation, not a checklist. Many people start at one level and move up or down over time.
Learn more: [Inpatient vs Outpatient Rehab: Which Level of Care Is Right for You?] · [PHP vs IOP: Partial Hospitalization and Intensive Outpatient Compared]
Common reasons people wait, and what to know
“I can stop whenever I want.” If that is true, trying a break can be informative, but do not do it alone with alcohol or sedatives. If you cannot stop, or feel unwell when you try, that is useful information.
“It’s not bad enough.” You do not need to hit rock bottom. Starting earlier is usually easier on your health, relationships and job.
“I’m still functioning.” Many people with a substance use disorder hold jobs and families together. Functioning well on the outside does not rule out a problem.
“I’m afraid of what people will think.” Your worries about judgment and work are real. Ask about confidentiality when you contact a provider, and look into job protections such as [Can You Take FMLA Leave to Go to Rehab?].
“I can’t afford it.” Many options exist at different price points, including insurance coverage, Medicaid and low-cost programs. See [Free and Low-Cost Rehab Options Without Insurance].
If you are answering for someone else
You can notice patterns, but you cannot diagnose a loved one or force them to change. If several statements above seem true of them, the most helpful step is usually a calm, caring conversation, not a confrontation. Describe what you have seen, say you are worried, and offer to help them find an assessment.
Learn more: [How to Talk to a Loved One About Addiction Without Pushing Them Away]
What to do next
- Share your results with a professional. A primary care doctor, therapist or addiction specialist can do a proper assessment.
- Call the SAMHSA National Helpline at 1-800-662-4357 for free, 24/7 referrals.
- Search FindTreatment.gov for licensed providers near you.
- Check your insurance benefits to see what is covered: [Does Insurance Cover Rehab? How to Check Your Benefits Step by Step].
- Do not wait for a crisis. If you are unsure, book the assessment anyway.
What happens at an assessment?
An assessment is a conversation. A clinician asks about your substance use, health history, mental health, medications, home and work life, and goals. They may use screening tools such as the AUDIT-C for alcohol or the DAST-10 for drugs. Afterward they explain what they found and recommend options. You can ask questions and decide what to do next.
Frequently asked questions
How do I know if I need rehab?
If your substance use is hard to control and is causing harm to your health, relationships, work or safety, it is worth getting a professional assessment. A clinician can tell you whether you need treatment and at what level.
Do I have to hit rock bottom before getting help?
No. Treatment can help at any point, and getting help earlier usually means less damage and an easier path.
Can I quit on my own?
Some people can, but it is not safe for everyone. Stopping alcohol or sedatives suddenly after heavy or long-term use can be life-threatening. Talk to a doctor before you try.
Is an online self-test enough?
No. A self-test can help you reflect, but it cannot replace an assessment by a professional who knows your full situation.
How do I know if I need inpatient or outpatient care?
A clinician decides based on factors such as withdrawal risk, your health, your living situation, your support and your past treatment experiences. Many people start with outpatient care.
What if I am not sure my loved one has a problem?
You do not need to be certain to express concern. Tell them what you have noticed and that you care, and offer to help them talk to a professional.
Sources
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR).
- American Society of Addiction Medicine. The ASAM Criteria. asam.org
- National Institute on Alcohol Abuse and Alcoholism (NIAAA). Rethinking Drinking. niaaa.nih.gov
- National Institute on Drug Abuse (NIDA). Drug Misuse and Addiction. nida.nih.gov
- SAMHSA. National Helpline and FindTreatment.gov. samhsa.gov
This article is for general information only and is not medical advice. It does not replace a diagnosis or treatment from a qualified health professional