| 1. |
Do you feel you are a normal drinker?
|
|
| 2. |
Have you ever awakened in the morning after
drinking the night before and found that you could not remember a part of the evening
before?
|
|
| 3. |
Does your spouse (or parents) ever worry or
complain about your drinking?
|
|
| 4. |
Can you stop drinking without a struggle after
one or two drinks?
|
|
| 5. |
Do you ever feel bad about your drinking?
|
|
| 6. |
Do friends or relatives think you are a normal
|
|
| 7. |
Do you ever try to limit your drinking to certain
times of the day or to certain places?
|
|
| 8. |
Are you always able to stop drinking when you
want to?
|
|
| 9. |
Have you ever attended a meeting of Alcoholics
Anonymous (AA)?
|
|
| 10. |
Have you gotten into fights while drinking?
|
|
| 11. |
Has drinking ever created problems with you and
your spouse?
|
|
| 12. |
Has your spouse (or other family members) ever
gone to anyone seeking help about your drinking?
|
|
| 13. |
Have you ever lost friends or girl friends/boy
friends because of drinking?
|
|
| 14. |
Have you ever gotten into trouble at work because
of drinking?
|
|
| 15. |
Have you ever lost a job because of drinking?
|
|
| 16. |
Have you ever neglected your obligations, your
family or your work for two or more days in a row because you were drinking?
|
|
| 17. |
Do you ever drink before noon?
|
|
| 18. |
Have you ever been told you have liver trouble?
Cirrhosis?
|
|
| 19. |
Have you ever had delirium tremens (DT's), severe
shaking, heard voices, had seizures or seen things that were not there after heavy
drinking?
|
|
| 20. |
Have you ever been in a hospital because of
drinking?
|
|
| 21. |
Have you ever gone to anyone for help about your
drinking?
|
|
| 22. |
Have you ever been a patient in a psychatric
hospital or in a psychiatric ward of a general hospital where drinking was a part of the
problem?
|
|
| 23. |
Have you ever been to a psychiatric or mental
health clinic or gone to a doctor, social worker, or clergyman for help with an emotional
problem in which drinking had played a part?
|
|
| 24. |
Have you ever been arrested, even for a few
hours, because of drunken behaviour?
|
|
| 25. |
Have you ever been arrested for drunken driving
or driving after drinking? |
|
