AlcoRehab.org Alcohol Screening Questionnaire

Our alcohol screening can give you an idea of the severity of your drinking problem if you are:

  • male drinking more than 2 alcoholic beverages every month.
  • female drinking more than 1 alcoholic beverage every month.

Note: The information you submit during this quiz will not be saved and will never be shared with anyone.

Welcome to your Alcohol Addiction Screening. Please provide honest answers.

Q1. You are:

Q2. How often do you drink alcoholic beverages*?


 

*Here is what we mean by an alcoholic beverage. Please give an answer based on following standard drink sizes.
• Regular beer (12 ounces).
• Table wine (5 ounces).
• 80-proof Distilled spirits (1.5 ounces).
• Malt liquor (8-9 ounces)
This table will help you determine the standard size of different alcoholic beverages.



Q3. On a typical day when you're drinking, how many alcoholic drinks do you have?

Q4. How many times do you have 6 or more drinks in one sitting?

Q5. How often in the last 12 months did you end up drinking more than you intended?

Q6. How often in the last 12 months have you failed to fulfill your responsibilities because of drinking?

Q7. How often in the last 12 months you had to have a drink in the morning after a drinking session, just to keep yourself going?

Q8. In the last 12 months, how often have you felt guilty after drinking?

Q9. In the last 12 months, how often have you failed to remember what happened last night due to the hangover?

Q10. Have your drinking habits caused injury to you or anyone around?

Q11. Has there been an incidence where a friend, relative, healthcare worker or your doctor has suggested you to try to cut down on your drinking habit?


Name

Disclaimer: The information provided on this site is intended for your general knowledge only and is not a substitute for professional medical advice or treatment for specific medical conditions. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider.