Screening Methodology for Detecting Alcoholism Test - the question form
Questions: 22 · 5 minutes
1. I sometimes vomit or cough up phlegm.
Yes
No
2. There have been times when I could not remember what was going on around me.
Yes
No
3. There have been times in your life when your level of activity suddenly dropped and later you could not understand why.
Yes
No
4. I have a persistent cough.
Yes
No
5. You enjoy heated arguments, even if they sometimes upset other people.
Yes
No
6. At home, you follow table manners less than when you are a guest.
Yes
No
7. You can always obtain alcohol.
Yes
No
8. You have noticed that your hands tremble when you are doing something.
Yes
No
9. Your friends and relatives think that you drink in moderation.
Yes
No
10. Sometimes you feel guilty about your drinking.
Yes
No
11. I have been detained by the police for being drunk.
Yes
No
12. Have you ever had delirium tremens (DTs)?
Yes
No
13. Sometimes I drink in the morning.
Yes
No
14. Have you ever heard voices or seen unusual things after drinking heavily the day before?
Yes
No
15. I have lost friends because of my drinking.
Yes
No
16. Your spouse or parents have expressed concern about your drinking.
Yes
No
17. There have been times when you drank for several days in a row, neglecting your work and family responsibilities.
Yes
No
18. Sometimes you have had problems at work because of drinking alcohol.
Yes
No
19. I have asked someone for help to stop drinking too much.
Yes
No
20. Your spouse, friends, or relatives have tried to help you stop drinking.
Yes
No
21. You have seen a neurologist or psychiatrist about problems that may have been caused, in part, by alcohol misuse.
Yes
No
22. You have received treatment for chronic alcoholism.
Yes
No