Sometimes (or I do one of these things) C. Yes (I do one or more of these things) 5 Do you drink when stressed or as a response to stress? Medium risk (8 to 15 points): You may drink too much on occasion. 5. The questions are about your alcohol use over the last 12 months. Your feedback is important! Please note rejecting some cookies may affect the website’s performance and functionality. 10+ Question 3(of 10) How often do you have 6 or more standard drinks on one occasion? 1 0 obj This is a questionnaire for I’ve put together for all of the young people that do not drink alcohol. Monitoring alcohol consumption across a population is crucial to evaluating whether national policies and approaches are being effective in reducing alcohol-related harm (World Health Organization Regional Office for Europe, 2012; World Health Organization, 2010). Do you experience any type of alcohol withdrawal symptoms such as shaking, anxiety, depression, vomiting in the morning or when you don’t drink for a couple days? Thank you! Low Risk (0-7 points) You probably do not have a problem with alcohol. 5-6. We know that one in four adults in the UK are drinking harmful levels. Does the thought of a Sunday lunch and a log fire make you think of alcohol. Please provide as much information as possible. Severe Alcohol Use Disorders. Relative. <> Do you drink for the effects of alcohol without caring what the drink is? Take this quick questionnaire to give you an idea of what your use might mean. endobj 6. SC043163. How often do you have a drink containing alcohol? Having four or five symptoms indicates a moderate alcohol use disorder. The questions are about your alcohol use over the last 12 months. A free AUDIT manual with guidelines for use in primary care settings is available online at They measure not only the volume but also patterns of individual alcohol consumption (Worl… The aggregate results will be made available when the responses of all participants have been tabulated. ALCOHOL QUESTIONNAIRE: There are 8 questions in this survey. Do you often get drunk when you drink, even when you do not mean to The answers are nobody’s business but your own. * 1 or 2. 7. 1) What mistakes have you made while intoxicated? Do you feel you could stop or cut down if you really wanted to? To reflect drink serving sizes in the United States (14g of pure alcohol), the number of drinks in question 3 was changed from 6 to 5. Even in our small practice we have seen deaths directly due to alcohol and see a lot of disease related to alcohol such as liver disease, stomach problems and high blood pressure. Question 2 of 10. Alcohol Questionnaire . beer 5 oz. 2) How often do you drink? if so, do you feel the need to also drink when in their company? Do you think about travelling first class on the plane, and think about free drinks? Book a video physio assessment today. This may put you or others at risk. 2 - 3 times a week. Home / Resources / Assessments / Alcohol Use Questionnaire ... increased tolerance to alcohol, and salience of drink-seeking behavior. For example (approximate values): 1 x bottle of 12% wine = 9 units. If you find yourself regularly thinking about your next drink, or if you’ve tried to cut back on drinking and never quite succeeded, you may have an alcohol addiction. stream Below are the names of the NHIS core and supplement questionnaires that contain adult alcohol use and related questions. Medium Risk (8-15 points) You may drink too much on occasion. These tests can be found on a number of websites as well as in many healthcare facilities. 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