1.  Do you sometimes drink more than you planned to drink?

1. If I drink at all, I'll have only one or two before dinner.
2. I will occasionally skip or delay meals to have a couple more drinks.
3. Sometimes a 'few with the boys/girls' turns into an entire evening.
4. I have been on benders that lasted for days.

 2.  Have you ever tried to quit drinking and were unsuccessful?

1. I don't want to quit, I enjoy an occasional drink.
2. I've thought about quitting, but I just haven't gotten around to it.
3. I have tried to control my drinking, but it hasn't worked for very long.
4. I have tried to quit drinking many times.

 3.   How much time do you spend each week drinking?

1. I only drink on special occasions or only have one before dinner.
2. I only drink on weekends, but I drink almost every weekend.
3. I drink at least three nights a week.
4. I drink almost daily, as soon as I get off work.

 4.  Do you ever get an urge to drink or a craving for alcohol?

1. No, I can take it or leave it.
2. Sometimes if I have gone a few days without a drink, I'll get a desire to drink.
3. If I skip a day drinking, I'll have an urge to drink the next day.
4. I can't wait until happy hour every day.

 5.   Do you often miss work or school or obligations at home due to drinking?

1. I don't ever remember missing work because of drinking.
2. I have gone in late before because I was hungover.
3. Sometimes I call in sick when I'm really recovering from a night out.
4. I have lost jobs due to not showing up for work.

 6.  Has your drinking negatively affected your social or family relationships?

1. No, I rarely drink enough to become intoxicated.
2. Sometimes I have embarrassed myself while drinking.
3. I prefer to hang out with people who drink as much as I do.
4. I have lost friends or relationships due to my drinking.

 7.  Have you given up hobbies or activities you used to enjoy?

1. Alcohol doesn't interfere with my life.
2. I have skipped a few trips to the gym to drink with friends.
3. I rarely go to events where alcohol is not served.
4. Drinking is my hobby.

 8.  Have you given up hobbies or activities you used to enjoy?

1. When I drink, it is only at home.
2. I have had a couple of drinks at lunch before and returned to work.
3. I have driven after drinking before, but I was not really drunk.
4. I regularly drive home from the bar.

 9.  Has drinking caused you any persistent health problems?

1. I don't drink often enough for it to affect my health.
2. On days I drink, I don't sleep through the night.
3. I find that I don't get over morning-afters like I used to.
4. My doctor has told me I need to quit or cut down drinking.

 10.  Does alcohol still give you the same feeling?

1. One drink still helps me relax.
2. Three beers used to do it, but now it takes a six-pack.
3. I changed to liquor because wine wasn't giving me a buzz.
4. I rarely feel intoxicated any more no matter how much I drink.

 11.  When you go without alcohol, do you get withdrawal symptoms?

1. I don't feel any negative effects from drinking.
2. Sometimes I get a bit anxious, but a drink immediately calms me down.
3. When I go a day without drinking, it is hard to get to sleep.
4. If I don't get a drink by 5 P.M. I get the shakes.