1. Yes
No
Do you ever drink heavily when you are disappointed, under pressure or have had a quarrel with someone?
2. Yes
No
Can you handle more alcohol now than when you first started to drink?
3. Yes
No
Have you ever been unable to remember part of the previous evening, even though your friends say you didn't pass out?
4. Yes
No
When drinking with other people, do you try to have a few extra drinks when others won't know about it?
5. Yes
No
Do you sometimes feel uncomfortable if alcohol is not available?
6. Yes
No
Are you in more of a hurry to get your first drink of the day than you used to be?
7. Yes
No
Do you sometimes feel a little guilty about your drinking?
8. Yes
No
Has a family member of close friend ever expressed concern or complained about your drinking?
9. Yes
No
Have you been having more memory "blackouts" recently?
10. Yes
No
Do you often want to continue drinking after your friends say they've had enough?
11. Yes
No
Do you usually have a reason for the occasions when you drink heavily?
12. Yes
No
When you're sober, do you sometimes regret things you did or said while drinking?
13. Yes
No
Have you tried switching brands or drinks, or following different plans to control your drinking?
14. Yes
No
Have you sometimes failed to keep promises you made to yourself about controlling or cutting down on your drinking?
15. Yes
No
Have you ever had a DWI (driving while intoxicated) or DUI (driving under the influence of alcohol) violation, or any other legal problem related to your drinking?
16. Yes
No
Do you try to avoid family or close friends while you are drinking?
17. Yes
No
Are you having more financial, work, school and/or family problems as a result of your drinking?
18. Yes
No
Has your physician ever advised you to cut down on your drinking?
19. Yes
No
Do you eat very little or irregularly during the periods when you are drinking?
20. Yes
No
Do you sometimes have the "shakes" in the morning and find that it helps to have a "little" drink, tranquilizer or medication of some kind?
21. Yes
No
Have you recently noticed that you can't drink as much as you used to?
22. Yes
No
Do you sometimes stay drunk for several days at a time?
23. Yes
No
After periods of drinking do you sometimes see or hear things that aren't there?
24. Yes
No
Have you ever gone to anyone for help about your drinking?
25. Yes
No
Do you ever feel depressed or anxious before, during or after periods of heavy drinking?
26. Yes
No
Have any of your blood relatives ever had a problem with alcohol?