¹
Yes
No
1
Do you feel you are a normal drinker?
2
Do friends or relatives think you are a normal drinker?
3
Have you ever attended a meeting of Alcoholics Anonymous (AA)?
4
Have you ever lost friends or girlfriends/boyfriends because of drinking?
5
Have you ever gotten into trouble at work because of drinking?
6
Have you ever neglected your obligations, your family or your work for two or more days in a row because you were drinking?
7
Have you ever had delirium tremens (DTs), severe shaking, heard voices or seen things that weren't there after heavy drinking?
8
Have you ever gone to anyone for help about your drinking?
9
Have you ever been in a hospital because of drinking?
10
Have you ever been arrested for drunk driving after drinking?
The presented answer sheet is not an original form and is not intended for printing or use as a handout.