| Select
either yes or no for each of the following items as
they apply to your life and your alcohol consumption.
|
| 1. |
Do
you feel you are a normal drinker?
1 yes
2 no
|
| 2. |
Have
you ever realized you don't remember periods of time
when you were drinking?
2 yes
1 no
|
| 3. |
Do
people close to you complain of your drinking?
2 yes
1 no
|
| 4. |
Do
you ever feel guilty about your drinking?
2 yes
1 no
|
| 5. |
Do
your friends or relatives think you are a normal drinker?
1 yes
2 no
|
| 6. |
Can
you stop drinking when you want to?
1 yes
2 no
|
| 7. |
Have
you ever been violent when drinking
2 yes
1 no
|
| 8. |
Has
drinking ever caused problems between you and your
family members?
2 yes
1 no
|
| 9. |
Has
any close relative gone to someone for help about
your drinking?
2 yes
1 no
|
| 10. |
Have
you ever lost friends because of your drinking?
2 yes
1 no
|
| 11. |
Have
you ever had problems at work because of your drinking?
2 yes
1 no
|
| 12. |
Have
you ever lost a job because of effects, or use, of
alcohol.
2 yes
1 no
|
| 13. |
Have
you ever neglected obligations, your family, or work
for 2 or more days because you were drinking?
2 yes
1 no
|
| 14. |
Do
you drink before noon fairly often?
2 yes
1 no
|
| 15. |
After
heavy drinking have you ever had DT's or severe shaking,
seen things or heard voices that weren't there?
2 yes
1 no
|
| 16. |
Have
you ever gone to anyone for help about your drinking?
2 yes
1 no
|
| 17. |
Have
you ever been in a hospital because of your drinking?
2 yes
1 no
|
| 18. |
Have
you ever sought professional help for an emotional
problem where drinking was part of the problem?
2 yes
1 no
|
| 19. |
Have
you ever been arrested for drunk driving while under
the influence of alcohol?
2 yes
1 no
|
| 20. |
Have
you ever been arrested or detained because of drunken
behavior?
2 yes
1 no
|
|
Add up your score and follow the links for a full
evaluation.
This scale
is for your entertainment only and is not to be
used as a diagnostic tool or in lieu of professional
help.
Add up your
score and Click here for results
|
