1. Do you occasionally drink heavily after a disappointment, a quarrel or when your boss gives you a hard time?
Yes    No

2. When you have trouble or feel under pressure, do you always drink more heavily than usual?
Yes    No

3. Have you noticed that you are able to handle more liquor than you did when you were first drinking?
Yes    No

4 .Did you ever wake up the morning after drinking and discover that you could not remember part of the evening before, even though your friends tell you that you did not pass out?
Yes    No

5 .When drinking with other people, do you try to have a few extra drinks when others will not know it?
Yes    No

6. Are there certain occasions when you feel uncomfortable if alcohol is not available?
Yes    No

7. Have you recently noticed that when you begin drinking you are in more of a hurry to get the first drink than you used to be?
Yes    No

8. Do you sometimes feel a little guilty about your drinking?
Yes    No

9. Are you secretly irritated when your family or friends discuss your drinking?
Yes    No

10. Have you recently noticed an increase in the frequency of your memory blackouts?
Yes    No

11. Do you often find that you wish to continue drinking after your friends say they have had enough?
Yes    No

12. Do you usually have a reason for the occasions when you drink heavily?
Yes    No

13. When you are sober, do you often regret things you have done or said while drinking?
Yes    No

14. Have you tried switching brands or following different plans for controlling your drinking?
Yes    No

15. Have you often failed to keep the promises you have made to yourself about controlling or cutting down on your drinking?
Yes    No

16. Have you ever tried to control your drinking by making a change in jobs, or by moving to a new location?
Yes    No

17. Do you try to avoid family or close friends while you are drinking?
Yes    No

18. Are you having an increasing number of financial and work problems?
Yes    No

19. Do more people seem to be treating you unfairly without good reason?
Yes    No

20. Do you eat very little or irregularly when you are drinking?
Yes    No

21. Do you sometimes have the "shakes" in the morning and find that it helps to have a little drink?
Yes    No

22. Have you recently noticed that you cannot drink as much as you once did?
Yes    No

23. Do you sometimes stay drunk for several days at a time?
Yes    No

24. Do you sometimes feel very depressed and wonder whether life is worth living?
Yes    No

25. Sometimes after periods of drinking, do you see or hear things that aren't there?
Yes    No

26. Do you get terribly frightened after you have been drinking heavily?
Yes    No