Do you feel you are a
normal drinker? (By normal we mean you drink less than or as much as most other
people.) |
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Have you ever awakened
the morning after some drinking the night before and found that you could not
remember a part of the evening? |
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Does your wife,
husband, a parent, or other near relative ever worry or complain about your
drinking?
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Can you stop drinking
without a struggle after one or two drinks? |
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Do you ever feel
guilty about your drinking?
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Do friends or
relatives think you are a normal drinker? |
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Are you always able
to stop drinking when you want? |
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Have you ever
attended a meeting of Alcoholics Anonymous (AA)? |
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Have you gotten into
physical fights when drinking?
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Has your drinking
ever created problems between you and your wife, husband, a parent, or other
relative? |
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Has your wife,
husband, (or other family members) ever gone to anyone for help about your
drinking?
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Have you ever lost
friends because of your drinking? |
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Have you
ever gotten into trouble at work or school because of drinking?
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Have you ever lost a
job because of drinking? |
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Have you ever
neglected your obligations, your family, or your work for two or more days in a
row because you were drinking?
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Do you drink before
noon often? |
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Have you ever been
told you have liver trouble? Cirrhosis? |
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After heavy drinking,
have you ever had Delirium Tremens (D.T.'s) or severe shaking or heard voices
or seen things that really weren't there? |
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Have you ever gone to
anyone for help about your drinking? |
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Have you ever been in
a hospital because of drinking? |
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Have you ever been a
patient in a psychiatric hospital or on a psychiatric ward of a general
hospital when drinking was part of the problem that resulted in
hospitalization? |
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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? |
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Have you ever been
arrested for drunk driving, driving while intoxicated, or driving under the
influence of alcoholic beverages?
If yes, how many times
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Have you ever been
arrested, or taken into custody, even for a few hours, because of other drunk
behavior?
If yes, how many times
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