Intervention Questionnaire Does your loved one need an intervention? Please complete this brief questionnaire to determine if your loved one would benefit from a drug or alcohol intervention. This questionnaire is not intended to replace or provide a medical diagnosis. If you are experiencing a medical emergency please call 9-1-1. If you feel that your loved one is in danger of hurting themselves, please call the National Suicide Prevention Lifeline at 1-800-273-8255. Disclaimer: Feinberg Consulting disclaims any liability, loss, or risk sustained as a consequence, directly or indirectly, of the use and application of this questionnaire. Email 1. Do you find yourself consistently making excuses for your loved one's behavior? Yes No Not sure None 2. Do you constantly feel exhausted or burn-out from worrying about your loved one? Yes No Not Sure None 3. Does your loved one make you feel guilty or that their problems are your fault? Yes No Not Sure None 4. Does your loved one seem to always go from one crisis to another? Yes No Not Sure None 5. Are you worried that if you intervened your loved one would be mad at you or never speak to you again? Yes No Not Sure None 6. Have you ever caught or suspected your loved one of lying or stealing from you? Yes No Not Sure None 7. Have you noticed significant mood changes in your loved one? Yes No Not Sure None 8. Does your loved one seem to spend less time in social settings? Yes No Not Sure None 9. Are you and other family members all on the same page about how to address your loved one's addiction or mental health concerns? Yes No Not Sure None Time's up
