| 1. How often do you have a drink containing alcohol? |
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| 2. How many drinks containing alcohol do you have on a typical day when you are drinking? |
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| 3. How often do you have six or more drinks on one occasion? |
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| 4. How often during the last year have you found that you were not able to stop drinking once you had started? |
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| 5. How often during the last year have you failed to do what was normally expected from you because of drinking? |
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| 6. How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session? |
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| 7. How often during the last year have you had a feeling of guilt or remorse after drinking? |
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| 8. How often during the last year have you been unable to remember what happened the night before because you had been drinking? |
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| 9. Have you or some one else been injured as a result of your drinking? |
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| 10. Has a relative or friend or a doctor or another health worker been concerned about your drinking or suggested you cut down? |
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