| 1. How often do you have a drink
containing alcohol? |
| Never |
Monthly or less |
Two to four times a month |
Two to three times per
week |
Four or more times a week |
| 2. How many drinks containing alcohol do
you have on a typical day when you are drinking? |
| 1 or 2 |
3 or 4 |
5 or 6 |
7 to 9 |
10 or more |
| 3. How often do you have six or more
drinks on one occasion? |
| Never |
Less than monthly |
Monthly |
Two to three times per week |
Four or more times a week |
| 4. How often during the last year have
you found that you were not able to stop drinking once you had
started? |
| Never |
Less than monthly |
Monthly |
Two to three times per week |
Four or more times a week |
| 5. How often during the last year have
you failed to do what was normally expected from you because of
drinking?
|
| Never |
Less than monthly |
Monthly |
Two to three times per week |
Four or more times a week |
| 6. How often during the last year have
you needed a first drink in the morning to get yourself going after
a heavy drinking session? |
| Never |
Less than monthly |
Monthly |
Two to three times per week |
Four or more times a week |
| 7. How often during the last year have
you had a feeling of guilt or remorse after drinking? |
| Never |
Less than monthly |
Monthly |
Two to three times per week |
Four or more times a week |
| 8. How often during the last year have
you been unable to remember what happened the night before because
you had been drinking? |
| Never |
Less than monthly |
Monthly |
Two to three times per week |
Four or more times a week |
| 9. Have you or someone else been injured
as a result of your drinking? |
| No |
Yes, but not in the last year |
Yes, during the last
year |
| 10. Has a relative or friend, or a doctor
or other health worker been concerned about your drinking or
suggested you cut down? |
| No |
Yes, but not in the last year |
Yes, during the last
year |
|