1. Do you feel you are a normal drinker? (No, 2 points)
2. Have you ever awakened the morning after some drinking the night before and
found that you could not remember a part of the evening? (Yes, 2 points)
3. Does your wife, husband, a parent, or other near relative ever worry or complain
about your drinking? (Yes, 1 point)
4. Can you stop drinking without a struggle after one or two drinks? (No, 2 points)
5. Do you ever feel guilty about your drinking? (Yes, 1 point)
6 Do friends or relatives think you are a normal drinker? (No, 2 points)
7. Are you able to stop drinking when you want to? (No, 2 points)
8. Have you ever attended a meeting of Alcohol Anonymous (AA)? (Yes, 5 points)
9. Have you ever gotten into physical fights when drinking? (Yes, 1 point)
10. Has drinking ever created problems between you and your wife, husband, a
parent, or other near relative? (Yes, 2 points)
11. Has your wife, husband, a parent, or other near relative ever gone to anyone for
help about your drinking? (Yes, 2 points)
12. Have you ever lost friends or intimates because of your drinking? (Yes, 2
points)
13. Have you ever gotten into trouble at work because of your drinking? (Yes, 2
points)
14. Have you ever lost a job because of your drinking? (Yes, 2 points)
15. Have you ever neglected your obligations, your family, or your work for two or
more days in a row because you were drinking? (Yes, 2 points)
16. Do you drink before noon fairly often? (Yes, 1 point)
17. Have you ever been told you have liver trouble? Cirrhosis? (Yes, 2 points)
18. After heavy drinking have you ever had delirium tremens (DTs) or severe
shaking, or heard voices or seen things that weren’t really there? (Yes, 2
points)
19. Have you ever gone to anyone for help about your drinking? (Yes, 5 points)
20. Have you ever been in a hospital because of drinking? (Yes, 5 points)
21. 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? (Yes, 2 points)
22. 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? (Yes, 2 points)
23. Have you ever been arrested for drunken driving, driving while intoxicated, or
driving under the influence of alcoholic beverages? (Yes, 2 points)
24. Have you ever been arrested, even for a few hours, because of other drunken
behavior? (Yes, 2 points)
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