QUESTIONNAIRE

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1. Has anyone ever suggested to you that you should cut down on your drinking?

2. Is drinking making your home life unhappy?

3. Do you drink because you are shy with other people?        

4. Is drinking affecting your reputation?

5. Have you ever felt remorse after drinking?

6. Have you gotten into financial difficulties as a result of drinking?

7. Have you ever asked yourself the question – Do I have a problem with alcohol?          

8. Have you ever tried to cut down or stop drinking?

9. Has your ambition decreased since drinking?

10. Do you crave a drink at a definite time daily?

11. Do you drink in the mornings?

12. Does drinking cause you to have difficulty in sleeping?    

13. Has your efficiency decreased since drinking?

14. Is drinking jeopardizing your job or business?     

15. Do you drink to escape from worries or trouble?

16. Do you drink alone?

17. Have you ever had a loss of memory as a result of drinking?

18. Has your physician ever treated you for drinking?

19. Do you drink to build up self-confidence?

20. Have you ever been to hospital or an institution on account of drinking – physical illness,

      car crashes, accidents, fights?

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If you have answered YES to any one of the questions, there is a definite warning you MAY be an alcoholic. If you have answered YES to any two, CHANCES ARE that you are an alcoholic. If you have answered YES to three or more,

YOU ARE ALMOST CERTAINLY AN ALCOHOLIC.