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1. Do
you spend all your time drinking and never on school or
work?
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Yes
No
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2. Do
you drink to “loosen yourself up” when around people?
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Yes
No
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3. Do
you drink to build up your self-esteem?
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Yes
No
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4. Do
you drink alone?
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Yes
No
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5. Do
YOU think you have problems controlling your liquor?
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Yes
No
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6. Do
you think that anyone who takes an anti-alcohol stand is
“stupid” or is “immature?”
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Yes
No
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7.
Have you even passed out from drinking?
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Yes
No
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8. If
yes, have you ever woken up not remembering anything?
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Yes
No
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9. Do
you drink more than three nights a week?
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Yes
No
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10.
Have you ever been to a hospital for alcohol poisoning?
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Yes
No
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11.
Have you been caught for DUI?
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Yes
No
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12. Do
your friends and peers drink less than you do?
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Yes
No
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13. Do
you feel guilty after drinking?
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Yes
No
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14.
Have you lost friends after you started drinking?
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Yes
No
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15.
Does it bother you if someone tells you that you drink too
much?
|
Yes
No
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16. Do
you feel a sense of power when you drink?
|
Yes
No
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17. Do
all your problems “disappear” when you drink?
|
Yes
No
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18.
Have you started hanging only with people who drink?
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Yes
No
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19.
Have you gotten into financial troubles because of your
drinking?
|
Yes
No
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20.
Have you lost interest in other activities once you have
started drinking?
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Yes
No
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