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Alcohol Questionnaire
Who advised you to take this test?
Myself
GP
Relative
Other Health Professional
Police/probation
Other
Tell us about yourself:
Area (required field)
North East Lincolnshire
North Lincolnshire
East Riding of Yorkshire
Rotherham
Doncaster
Hull
Other
Age
19 and under
20 - 29
30 - 39
40 - 49
50 - 59
60 - 64
64 +
Gender
Male
Female
Question 1(of 10)
How often do you have a drink?
Never
Monthly or Less
2 - 4 times per month
2 - 3 times per week
4+ times per week
Question 2(of 10)
How many standard alcoholic drinks do you have on a typical day when you are drinking?
1-2
3-4
5-6
7-9
10+
Question 3(of 10)
How often do you have 6 or more standard drinks on one occasion?
Never
Less than monthly
Monthly
Weekly
Daily or Almost Daily
Question 4(of 10)
How often during the last year have you found that you were not able to stop drinking once you had started?
Never
Less than monthly
Monthly
Weekly
Daily or Almost Daily
Question 5(of 10)
How often in the last year have you failed to do what was expected of you because of drinking?
Never
Less than monthly
Monthly
Weekly
Daily or Almost Daily
Question 6(of 10)
How often in the last year have you needed an alcoholic drink in the morning to get you going?
Never
Less than monthly
Monthly
Weekly
Daily or Almost Daily
Question 7(of 10)
How often in the last year have you had a feeling of guilt or regret after drinking?
Never
Less than monthly
Monthly
Weekly
Daily or Almost Daily
Question 8(of 10)
How often in the last year have you not been able to remember what happened when drinking the night before?
Never
Less than monthly
Monthly
Weekly
Daily or Almost Daily
Question 9(of 10)
Have you or someone else been injured as a result of your drinking?
No
Yes, but not in the last year
Yes, during the last year
Question 10(of 10)
Has a relative or friend or a doctor or another health worker been concerned about your drinking or suggested you cut down?
No
Yes, but not in the last year
Yes, during the last year