|
Questions |
Yes |
No |
| 1. | Do you feel you are a drinking more than the average? |
1 | 0 |
| 2. | Does your wife, husband, a parent, or other near relative ever worry or complain about your drinking? |
1 | 0 |
| 3. | Do you ever feel guilty about your drinking? |
1 | 0 |
| 4. | Do friends or relatives think you are a normal drinker? |
0 | 1 |
| 5. | Are you able to stop drinking when you want to? |
0 | 1 |
| 6. | Have you ever attended a meeting of Alcoholics Anonymous (AA)? |
1 | 0 |
| 7. | Has your drinking ever created problems between you and your wife, husband, a parent, or near relative? |
1 | 0 |
| 8. | Have you ever gotten into trouble at work because of your drinking? |
1 | 0 |
| 9. | Have you ever neglected your obligations, your family, or your work for 2 or more days in a row because you were drinking? |
1 | 0 |
| 10. | Have you ever gone to anyone for help about your drinking? |
1 | 0 |
| 11. | Have you ever been in a hospital because of drinking? |
1 | 0 |
| 12. | Have you ever been arrested for drunken driving, driving while intoxicated, or driving under the influence of alcoholic beverages? |
1 | 0 |
| 13. | Have you ever been arrested, even for a few hours, because of other drunken behaviour? |
1 | 0 |
