| 1. Do you feel you are a normal drinker ("normal" - drink as much or less than most other people)? |
| 2. Have you ever awakened the morning after some drinking the night before and found that you could not remember a part of the evening? |
| 3. Does any near relative or close friend ever worry or complain about your drinking? |
| 4. Can you stop drinking without difficulty after one or two drinks? |
| 5. Do you ever feel guilty about your drinking? |
| 6. Have you ever attended a meeting of Alcoholics Anonymous (AA)? |
| 7. Have you ever gotten into physical fights when drinking? |
| 8. Has drinking ever created problems between you and a near relative or close friend? |
| 9. Has any family member or close friend gone to anyone for help about your drinking? |
| 10. Have you ever lost friends because of your drinking? |
| 11. Have you ever gotten into trouble at work because of drinking? |
| 12. Have you ever lost a job because of drinking? |
| 13. Have you ever neglected your obligations, your family, or your work for two or more days in a row because you were drinking? |
| 14. Do you drink before noon fairly often? |
| 15. Have you ever been told you have liver trouble such as cirrhosis? |
| 16. After heavy drinking have you ever had delirium tremens (D.T.'s), severe shaking, visual or auditory (hearing) hallucinations? |
| 17. Have you ever gone to anyone for help about your drinking? |
| 18. Have you ever been hospitalized because of drinking? |
| 19. Has your drinking ever resulted in your being hospitalized in a psychiatric ward? |
| 20. Have you ever gone to any doctor, social worker, clergyman or mental health clinic for help with any emotional problem in which drinking was part of the problem? |
| 21. Have you been arrested more than once for driving under the influence of alcohol? |
| 22. Have you ever been arrested, even for a few hours because of other behavior while drinking? (If Yes, how many times ________ ) |
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Scoring: Each question answered YES scores 1 point except for questions 1 & 4 which are 1 point for each NO answer.
- A score of two or less points indicates "No apparent problem."
- A score of three to five points indicates "Early or middle problem drinker."
- A score of six points or more points indicates "Problem drinker."
Regardless of your scores, please contact us if you have any questions or concerns. |
