1) How often do you have a drink containing alcohol?

• Never [skip to questions 9-10]
• monthly or less
• 2 to 4 times a month
• 2 to 3 times a week
• 4 or more times a week

2) How many drinks containing alcohol do you have on a typical day when you are drinking?

• 1 or 2
• 3 or 4
• 5 or 6
• 7, 8, or 9
• 10 or more

3) How often do you have six (6) or more drinks on one occasion?

• never
• less than monthly
• monthly
• weekly
• daily or almost daily

4) How often during the last year have you found that you were not able to stop drinking once you started?

• never
• less than monthly
• monthly
• weekly
• daily or almost daily

5) How often during the last year have you failed to do what was normally expected from you because of drinking?

• never
• less than monthly
• monthly
• weekly
• daily or almost daily

6) How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?

• never
• less than monthly
• monthly
• weekly
• daily or almost daily

7) How often during the last year have you had a feeling of guilt or remorse after drinking?

• never
• less than monthly
• monthly
• weekly
• daily or almost daily

8) How often during the last year have you been unable to remember what happened the night before because you had been drinking?

• never
• less than monthly
• monthly
• weekly
• daily or almost daily

9) Have you or someone else been injured as a result of your drinking?

• no
• yes, but not in the last year
• yes, during the last year

10) Has a relative or friend or a doctor or another health worker been concerned about your drinking or suggested you cut down?

• no
• yes, but not in the last year
• yes, during the last year

Results: