Drinking Habit SurveyDrinking Habit Survey

1. You are:

You are: Male

Female

2. How old are you?

How old are you? 17 and under

18-24

25-34

35 and over

3. How often do you drink?

How often do you drink? I don’t

Once a week

Twice a week

Three or four times a week

Almost every night

4. Have you ever tried to cut back?

Have you ever tried to cut back? Yes

5. If you’ve ever tried to stop drinking, what was your primary motivation?

If you’ve ever tried to stop drinking, what was your primary motivation? To feel physically healthier

To save money

I had a bad experience when I was drunk

I was worried I might have a problem

Other

6. Do you ever worry alcohol is negatively affecting your life?

Do you ever worry alcohol is negatively affecting your life? Yes

7. Have you ever done something you regret while drunk?

Have you ever done something you regret while drunk? Yes

8. If you have done something you regretted while drinking, what was it? (Choose all that apply)

If you have done something you regretted while drinking, what was it? (Choose all that apply) Told a secret I didn’t mean to

Slept with someone

Lost or broke something

Was hungover for an important work event

Got into a fight

9. How often, on average, do hangouts with friends involve drinking?

How often, on average, do hangouts with friends involve drinking? Pretty much all the time

Sometimes—itjust depends

Never

10. You’re heading out to the bar with a group of friends. How many drinks are you likely to have?

You’re heading out to the bar with a group of friends. How many drinks are you likely to have? 0

5 or more

11. How often do you have more than two drinks before you have sex?

How often do you have more than two drinks before you have sex? Pretty much all the time

Sometimes, like if it’s after a party

Almost never

Never

12. How does alcohol impact your sex life? (choose all that apply)

How does alcohol impact your sex life? (choose all that apply) It makes me less inhibited

It’s caused me to hook up with someone I wouldn’t have otherwise

It makes it more complicated

It makes it more fun

It doesn’t really do anything either way

13. In the past year, have you ever felt pressure from friends to drink more than you otherwise would?

In the past year, have you ever felt pressure from friends to drink more than you otherwise would? Yes

14. Before a stressful situation (like a blind date or meeting his parents) do you ever have a drink by yourself to loosen up?

Before a stressful situation (like a blind date or meeting his parents) do you ever have a drink by yourself to loosen up? Yes

I have sometimes, but not always

15. How likely are you to have a drink when you’re hanging out at home by yourself after work?

How likely are you to have a drink when you’re hanging out at home by yourself after work? Most of the time

Sometimes

Almost never

16. Aside from any physical symptoms, how do you normally feel after a heavy night of drinking?

Aside from any physical symptoms, how do you normally feel after a heavy night of drinking? Doesn’t apply—I don’t really drink

Happy—that was such an epic party!

Bummed—trying not to think about the way you acted

Pretty indifferent emotionally