Alcohol Screening

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Alcohol Screening

Do you feel you are a normal drinker?	Yes	No
Have you ever awakened the morning after some drinking the night before and found that you could not remember part of the evening before?	Yes	No
Does your wife, husband or parents ever worry or complain about your drinking?	Yes	No
Can you stop drinking without a struggle after one or two drinks?	Yes	No
Do you ever feel bad about your drinking?	Yes	No
Do friends or relatives think you are a normal drinker?	Yes	No
Do you ever try to limit your drinking to certain times of the day or to certain places?	Yes	No
Are you always able to stop drinking when you want to?	Yes	No
Have you ever attended a meeting of Alcoholics Anonymous AA?	Yes	No
Have you gotten into fights when drinking?	Yes	No
Has drinking ever created problems with you and your wife, husband?	Yes	No
Has your wife, husband or other family member ever gone to anyone for help about your drinking?	Yes	No
Have you ever lost friends or girlfriends/boyfriends because of your drinking?	Yes	No
Have you ever gotten into trouble at work because of drinking?	Yes	No
Have you ever lost a job because of drinking?	Yes	No
Have you ever neglected your obligations, your family, or your work for 2 or more days in a row because you were drinking?	Yes	No
Do you ever drink before noon?	Yes	No
Have you ever been told you have liver trouble? Cirrhosis?	Yes	No
Have you ever had delirium tremens DTs, severe shaking, after heavy drinking?	Yes	No
Have you ever gone to anyone for help about your drinking?	Yes	No
Have you ever been in a hospital because of your drinking?	Yes	No
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?	Yes	No
Have you ever been seen at a psychiatric or mental health clinic, or gone to a doctor, social worker, or clergyman for help with an emotional problem in which drinking has played a part?	Yes	No
Have you ever been arrested, even for a few hours, because of drunk behavior?	Yes	No
Have you ever been arrested for drunk driving or driving after drinking?	Yes	No