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Alcohol Self Screening Test


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Alcohol Self Screening Test
Gender Male Female
Age
Ethnicity
Answer all the questions:
How often do you have a drink containing alcohol? 

Never
Monthly or less
2 to 4 times a month
2 or 3 times a week
4 or more times a week


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 to 9
10 or more 


How often do you have six or more drinks on one occasion? 

Never
Less than monthly 
Monthly
Weekly 
Daily or almost daily 


How often during the last year have you found that you were unable to stop drinking once you had started?  

Never
Less than monthly 
Monthly
Weekly 
Daily or almost daily 


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 


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
Monthly or less
2 to 4 times a month
2 or 3 times a week
4 or more times a week


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

1 or 2
3 or 4
5 or 6
7 to 9
10 or more 


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 


Have you or someone else been injured as the result of your drinking? 

Never
Yes, but not in the last year 
Yes, during the last year 


Has a relative, friend, or a doctor or other health worker been concerned about your drinking or suggested you cut down? 

Never
Yes, but not in the last year 
Yes, during the last year 

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Comments

dbhullar, India

It is a good tool for evaluation provided user answers honestly.


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