Self Screen for Alcohol Problems
I am a:
Male
Female
When drinking how many drinks do you usualy have in a typical day?
1
2
3
4
5
6 or more
In any one week in the past year what is the most number of drinks you have had?
1-6
7-13
14 or more
Has anyone ever told you, or have you ever felt you should cutdown on your drinking?
Yes
No
Have you ever become annoyed with anyone for talking about the amount you drink?
Yes
No
Have you ever felt guilty about your drinking?
Yes
No
Have you ever felt that you needed a drink first thing in the morning?
Yes
No