4% Question 1 of 25 1. Do you enjoy drinking now and then?YesNoQuestion 1 of 25Question 2 of 25 2. Do you feel you are a normal drinker? ("normal" - drink as much or less than most other people)YesNoQuestion 2 of 25Question 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?YesNoQuestion 3 of 25Question 4 of 25 4. Does your wife, husband, a parent, or other near relative ever worry or complain about your drinking?YesNoQuestion 4 of 25Question 5 of 25 5. Can you stop drinking without a struggle after one or two drinks?YesNoQuestion 5 of 25Question 6 of 25 6. Do you ever feel guilty about your drinking?YesNoQuestion 6 of 25Question 7 of 25 7. Do friends or relatives think you are a normal drinker?YesNoQuestion 7 of 25Question 8 of 25 8. Are you able to stop drinking when you want to?YesNoQuestion 8 of 25Question 9 of 25 9. Have you ever attended a meeting of Alcoholics Anonymous (AA)?YesNoQuestion 9 of 25Question 10 of 25 10. Have you gotten into physical fights when drinking?YesNoQuestion 10 of 25Question 11 of 25 11. Has you drinking ever created problems between you and your wife, husband, a parent, or other relative?YesNoQuestion 11 of 25Question 12 of 25 12. Has your wife, husband (or other family members) ever gone to anyone for help about your drinking?YesNoQuestion 12 of 25Question 13 of 25 13. Have you ever lost friends because of your drinking?YesNoQuestion 13 of 25Question 14 of 25 14. Have you ever gotten into trouble at work or school because of drinking?YesNoQuestion 14 of 25Question 15 of 25 15. Have you ever lost a job because of drinking?YesNoQuestion 15 of 25Question 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?YesNoQuestion 16 of 25Question 17 of 25 17. Do you drink before noon fairly often?YesNoQuestion 17 of 25Question 18 of 25 18. Have you ever been told you have liver trouble? Cirrhosis?YesNoQuestion 18 of 25Question 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?YesNoQuestion 19 of 25Question 20 of 25 20. Have you ever gone to anyone for help about your drinking?YesNoQuestion 20 of 25Question 21 of 25 21. Have you ever been in a hospital because of drinking?YesNoQuestion 21 of 25Question 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?YesNoQuestion 22 of 25Question 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?YesNoQuestion 23 of 25Question 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.01234+Question 24 of 25Question 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.01234+Question 25 of 25 Loading...