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1.Do you feel you are a normal drinker? (By normal we mean you drink less than or as much as most other people.) *
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? *
3.Does your wife, husband, a parent , or other near relative ever worry or complain about your drinking? *
4.Can you stop drinking without a struggle after one or two drinks? *
5.Do you ever feel guilty about your drinking? *
6.Do friends or relatives think you are a normal drinker? *
7.Are you able to stop drinking when you want to? *
8.Have you ever attended a meeting of Alcoholics Anonymous (AA)? *
9.Have you gotten into physical fights when drinking? *
10.Has your drinking ever created problems between you and your wife, husband, a parent, or other relative? *
11.Has your wife, husband (or other family members) ever gone to anyone for help about your drinking? *
12.Have you ever lost friends because of drinking? *
13.Have you ever gotten into trouble at work or school because of drinking? *
14.Have you ever lost a job because of drinking? *
15.Have you ever neglected your obligations, your family or your work for two or more days in a row because you were drinking? *
16.Do you drink before noon fairly often? *
17.Have you ever been told you have liver trouble? Cirrhosis? *
18.After heavy drinking have you ever had Delirium Tremens (D.T.s) or severe shaking, or heard voices or seen things that really were not there? *
19.Have you ever gone to anyone for help about your drinking? *
20.Have you ever been in a hospital because of drinking? *
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? *
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 an emotional problem, where drinking was part of the problem? *
23.Have you ever been arrested for drunk driving, driving while intoxicated, or driving under the influence of alcoholic beverages? *
24.Have you ever been arrested, or taken into custody even for a few hours, because of other drunk behavior? *