NO.
QUESTION
YES
NO
1
Have you ever told yourself or family
that you would stop drinking for a week or even a few days,
but couldn't?
2
Do you wish people would just stop nagging
you about your drinking?
3
Have you ever switched from one kind of
drink or drug to another thinking that this would help you
get "in control of your life"?
4
Do you ever drink
or drug in the morning?
5
Do you envy people who can use alcohol
without getting in trouble?
6
Have you had problems connected with drinking
during the past few months?
7
Has your drinking caused trouble in your
family or at home?
8
Do you ever try to get "extra"
drinks at a party because you do not get enough?
9
Do you tell yourself you can stop using
alcohol or drugs any time you want?
10
Have you missed days of work or school
because of your using alcohol?
11
Do you have "blackouts" where
you cannot remember what you've done when you are drunk or
high?
12
Have you ever felt that your life would
be better if you did not use alcohol?
13
Does your wife, husband, a parent, or
other near relatives ever worry or complain about your drinking?
14
Have you ever felt defensive, guilty, or
ashamed about your using?
15
Have you gotten into verbal or physical
fights as a result of your drinking?
16
Have you ever lost friends because of your
drinking?
17
Has your wife, husband, parents, (or other
family members) ever gone to anyone for help about your drinking/drug
use?
18
Have you ever gotten into trouble at work
or school because of drinking?
19
Have you ever neglected your obligations,
your family, or your work for two or more days in a row because
you were drinking?
20
Have you ever gone to anyone for help about
your drinking?
