1. Do you enjoy drinking now and then?
2. Do you feel you are a normal drinker? ("normal" - drink as much or less than most other people)
3. Have you ever awakened the morning after some drinking the night before and found that you could not remember a part of the evening?
4. Does your wife, husband, a parent, or other near relative ever worry or complain about your drinking?
5. Can you stop drinking without a struggle after one or two drinks?
6. Do you ever feel guilty about your drinking?
7. Do friends or relatives think you are a normal drinker?
8. Are you able to stop drinking when you want to?
9. Have you ever attended a meeting of Alcoholics Anonymous (AA)?
10. Have you gotten into physical fights when drinking?
11. Has you drinking ever created problems between you and your wife, husband, a parent, or other relative?
12. Has your wife, husband (or other family members) ever gone to anyone for help about your drinking?
13. Have you ever lost friends because of your drinking?
14. Have you ever gotten into trouble at work or school because of drinking?
15. Have you ever lost a job because of drinking?
16. Have you ever neglected your obligations, your family, or your work for two or more days in a row because you were drinking?
17. Do you drink before noon fairly often?
18. Have you ever been told you have liver trouble? Cirrhosis?
19. After heavy drinking have you ever had Delirium Tremens (D.T.s) or severe shaking, or heard voices, or seen things that are really not there?
20. Have you ever gone to anyone for help about your drinking?
21. Have you ever been in a hospital because of drinking?
22. Have you ever been a patient in a psychiatric hospital or on a psychiatric ward of a general hospital where drinking was part of the problem that resulted in hospitalization?
23. Have you ever been seen at a psychiatric or mental health clinic or gone to any doctor, social worker, or clergyman for help with any emotional problem, where drinking was part of the problem?
24. Have you ever been arrested for drunk driving, driving while intoxicated, or driving under the influence of alcoholic beverages? (If YES, How many times?
25. Have you ever been arrested, or taken into custody even for a few hours, because of other drunk behavior?