It’s not me man…I’ve got a problem
1. Do you ever use alone? [Yes] [ No]
2. Have you ever substituted one coffee drink for another, thinking that one particular beverage was the problem? [Yes] [ No]
3. Have you ever manipulated or lied to a barrista to obtain free drinks? [Yes] [ No]
4. Have you ever stolen coffee or stolen to obtain coffee? [Yes] [ No]
5. Do you regularly use caffiene when you wake up or when you go to bed?
[Yes] [ No]
6. Have you ever taken sleeping pills or valerian root to overcome the effects of caffiene? [Yes] [ No]
7. Do you avoid people or places that do not approve of you using caffiene? [Yes] [ No]
8. Have you ever used a drug without knowing what it was or what it would do to you? [Yes] [ No]
9. Has your job or school performance ever suffered from the effects of your caffiene use? [Yes] [ No]
10. Have you ever been arrested as a result of using caffiene? [Yes] [ No]
11. Have you ever lied about what or how much you use? [Yes] [ No]
12. Do you put the purchase of coffee ahead of your financial responsibilities?Ê [Yes] [ No]
13. Have you ever tried to stop or control your using? [Yes] [ No]
14. Have you ever been in a jail, hospital, or drug rehabilitation center because of your using? [Yes] [ No]
15. Does using interfere with your sleeping or eating? [Yes] [ No]
16. Does the thought of running out of caffiene terrify you? [Yes] [ No]
17. Do you feel it is impossible for you to live without caffiene? [Yes] [ No]
18. Do you ever question your own sanity? [Yes] [ No]
19. Is your caffiene use making life at home unhappy? [Yes] [ No]
20. Have you ever thought you couldn’t fit in or have a good time without caffiene? [Yes] [ No]
21. Have you ever felt defensive, guilty, or ashamed about your using? [Yes] [ No]
22. Do you think a lot about Starbucks? [Yes] [ No]
23. Have you had irrational or indefinable fears? [Yes] [ No]
24. Has using affected your sexual relationships? [Yes] [ No]
25. Have you ever taken caffiene in forms you didn’t prefer? [Yes] [ No]
26. Have you ever used caffiene because of emotional pain or stress? [Yes] [ No]
27. Have you ever overdosed on caffiene? [Yes] [ No]
28. Do you continue to use despite negative consequences? [Yes] [ No]
29. Do you think you might have a caffiene problem? [Yes] [ No]
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