4%

Question 1 of 25

1. Do you enjoy drinking now and then?

Question 1 of 25

Question 2 of 25

2. Do you feel you are a normal drinker? ("normal" - drink as much or less than most other people)

Question 2 of 25

Question 3 of 25

3. Have you ever awakened the morning after some drinking the night before and found that you could not remember a part of the evening?

Question 3 of 25

Question 4 of 25

4. Does your wife, husband, a parent, or other near relative ever worry or complain about your drinking?

Question 4 of 25

Question 5 of 25

5. Can you stop drinking without a struggle after one or two drinks?

Question 5 of 25

Question 6 of 25

6. Do you ever feel guilty about your drinking?

Question 6 of 25

Question 7 of 25

7. Do friends or relatives think you are a normal drinker?

Question 7 of 25

Question 8 of 25

8. Are you able to stop drinking when you want to?

Question 8 of 25

Question 9 of 25

9. Have you ever attended a meeting of Alcoholics Anonymous (AA)?

Question 9 of 25

Question 10 of 25

10. Have you gotten into physical fights when drinking?

Question 10 of 25

Question 11 of 25

11. Has you drinking ever created problems between you and your wife, husband, a parent, or other relative?

Question 11 of 25

Question 12 of 25

12. Has your wife, husband (or other family members) ever gone to anyone for help about your drinking?

Question 12 of 25

Question 13 of 25

13. Have you ever lost friends because of your drinking?

Question 13 of 25

Question 14 of 25

14. Have you ever gotten into trouble at work or school because of drinking?

Question 14 of 25

Question 15 of 25

15. Have you ever lost a job because of drinking?

Question 15 of 25

Question 16 of 25

16. Have you ever neglected your obligations, your family, or your work for two or more days in a row because you were drinking?

Question 16 of 25

Question 17 of 25

17. Do you drink before noon fairly often?

Question 17 of 25

Question 18 of 25

18. Have you ever been told you have liver trouble? Cirrhosis?

Question 18 of 25

Question 19 of 25

19. After heavy drinking have you ever had Delirium Tremens (D.T.s) or severe shaking, or heard voices, or seen things that are really not there?

Question 19 of 25

Question 20 of 25

20. Have you ever gone to anyone for help about your drinking?

Question 20 of 25

Question 21 of 25

21. Have you ever been in a hospital because of drinking?

Question 21 of 25

Question 22 of 25

22. Have you ever been a patient in a psychiatric hospital or on a psychiatric ward of a general hospital where drinking was part of the problem that resulted in hospitalization?

Question 22 of 25

Question 23 of 25

23. Have you ever been seen at a psychiatric or mental health clinic or gone to any doctor, social worker, or clergyman for help with any emotional problem, where drinking was part of the problem?

Question 23 of 25

Question 24 of 25

24. Have you ever been arrested for drunk driving, driving while intoxicated, or driving under the influence of alcoholic beverages? Check the number of times that apply.

Question 24 of 25

Question 25 of 25

25. Have you ever been arrested, or taken into custody even for a few hours, because of other drunk behavior? Please select the number of times that apply.

Question 25 of 25