Tickets & information about the Social Justice Conference – 18-20 September 2024 – are now live

Possible Dependence

The way that you are drinking is likely to be affecting your physical and mental health, and even your relationships.

If you have scored at this level, we recommend that you don’t suddenly stop as this may be dangerous and could make you very unwell. Find out more on Drinkaware withdrawal symptoms.

Our Advice

We can help you make positive changes and reduce the problems drinking may be causing you. Please contact us to get specific advice and support. You can now make a referral below.

If you don’t want to see one of our workers, you can also speak to your GP who will be able to offer you support and advice.

    SELF REFERRAL FORM

    What service location would you like to refer into? (Required)

    ABOUT YOU

    How should we contact you? Select all that apply (Required)

    PhoneTextEmailLetter

    Can we contact you at any time?

    YesNo

    Can we leave a voicemail?

    YesNo

    Gender (Required)

    Ethnicity (Required)

    HEALTH INFORMATION

    What do you need help with? Select all that apply (Required)

    Drug use supportAlcohol use supportFamily supportOther

    What substances do you use? Select all that apply (Required)

    Heroin/opiatesCocaineCrack cocaineCannabisCrystal meth/methamphetamineAmphetamine/speedAlcoholSolventsNew psychoactive substancesPrescribed medications (e.g. Benzodiazepine, Gapapentin)Other Please give details including how much and how often the substance is being used:

    If you have completed an alcohol or drug audit, what is your score?

    Do you have access support needs e.g. mobility or interpreter requirements?

    Are you pregnant?


    Are you currently injecting substances.

    YesNo
    Have you been admitted to hospital in the last month?

    YesNo

    Is there anything else you would like to tell us?

    Personal information is important to us and we will keep it confidential. Occasions where we may need to share information are outlined in our privacy and confidentiality policy. You can read our privacy policy here, or alternatively you can ask for a copy from us.

    Submit this form and we will contact you to arrange an appointment.

    Thank you for reaching out to Cranstoun.

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