Is My Drinking A Problem?

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* 1. Do you have more than 1 drink per day?

Always

Sometimes

Never

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* 2. Does your usual number of drinks have less effect than before?

Always

Sometimes

Never

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* 3. The day after drinking do you experience anxiety?

Always

Sometimes

Never

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* 4. When alcohol wears off do you feel shakiness? Or Have you ever felt nauseated, clammy and or sweaty after a night of drinking?

Always

Sometimes

Never

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* 5. Have you ever set a limit to your drinking and ended up drinking more or longer than you intended?

Always

Sometimes

Never

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* 6. Have you tried to cut down or stop drinking but couldn’t stay on track with your goal for more than a few weeks or months?

Always

Sometimes

Never

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* 7. Do you drink only on the weekends but always too much or more than you would prefer?

Always

Sometimes

Never

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* 8. Have you been drinking for more than 5 years?

Always

Sometimes

Never

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* 9. Has your drinking been increasing over the past 1-3 years?

Always

Sometimes

Never

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* 10. Does it take 1-3 days to get over (feel better) the aftereffects of drinking?

Always

Sometimes

Never

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* 11. Do you hide alcohol? Or Do you hide how much alcohol you are consuming?

Always

Sometimes

Never

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* 12. Do you cancel plans because you would have to control your drinking? Or do you avoid events that don’t include alcohol?

Always

Sometimes

Never

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* 13. Have you stopped doing things you enjoy (recreation, exercise, outings) in order to drink?

Always

Sometimes

Never

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* 14. Have you continued to drink even though you know it contributing to your troubles with anxiety, depression, or other health issue?

Always

Sometimes

Never

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* 15. Do people ever ask you how you can tolerate the amount of alcohol you can seemingly consume without getting drunk?

Always

Sometimes

Never

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* 16. Do people ever ask you to moderate your drinking? Or Do people get upset with you about your drinking?

Always

Sometimes

Never

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* 17. Have you ever felt embarrassed after drinking?

Always

Sometimes

Never

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* 18. Have you ever felt guilty after drinking?

Always

Sometimes

Never

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* 19. send my results to the email below

Name *

Email Address *

Phone Number