1. Do you feel you are a normal drinker? ("normal" - drink as much or less than most other people)

2. Have you ever awakened the morning after some drinking the night before and found that you could not remember a part of the evening?

3. Does any near relative or close friend ever worry or complain about your drinking?

4. Can you stop drinking without difficulty after one or two drinks?

5. Do you ever feel guilty about your drinking?

6. Have you ever attended a meeting of Alcoholics Anonymous (AA)?

7. Have you ever gotten into physical fights when drinking?

8. Has drinking ever created problems between you and a near relative or close friend?

9. Has any family member or close friend gone to anyone for help about your drinking?

10. Have you ever lost friends because of your drinking?

11. Have you ever gotten into trouble at work because of drinking?

12. Have you ever lost a job because of drinking?

13. Have you ever neglected your obligations, your family, or your work for two or more days in a row because you were drinking?

14. Do you drink before noon fairly often?

15. Have you ever been told you have liver trouble such as cirrhosis?

16. After heavy drinking have you ever had delirium tremens (D.T.'s), severe shaking, visual or auditory (hearing) hallucinations?

17. Have you ever gone to anyone for help about your drinking?

18. Have you ever been hospitalized because of drinking?

19. Has your drinking ever resulted in your being hospitalized in a psychiatric ward?

20. Have you ever gone to any doctor, social worker, clergyman or mental health clinic for help with any emotional problem in which drinking was part of the problem?

21. Have you been arrested more than once for driving under the influence of alcohol?

22. Have you ever been arrested, even for a few hours because of other behavior while drinking?
(If Yes, how many times ________ )