2720 E. Thomas Rd., Suite B-190
Phoenix, Arizona 85016
(tel) 602.535.6468
(fax) 602.595.8968
Phoenix, Arizona 85016
(tel) 602.535.6468
(fax) 602.595.8968
Alcohol Counselor Phoenix, Arizona
Alcohol Questionnaire
1) Do you feel you are a normal drinker? ("normal" is defined as drinking as much or less than most other people) ___yes ___no
2) Have you ever awakened the morning after drinking the night before and found you could not remember a part of the evening? ___yes ___no
3) Has a relative or close friend ever worried or complained about your drinking? ___yes ___no
4) Can you stop drinking without difficulty after one or two drinks? ___yes ___no
5) Do you ever feel guilty about your drinking? ___yes ___no
6) Have you ever attended a meeting of Alcoholics Anonymous (AA)? ___yes ___no
7) Have you ever gotten into physical fights when drinking? ___yes ___no
8) Has drinking ever created problems between you and a relative or close friend? ___yes ___no
9) Has a family member or close friend gone to anyone for help about your drinking? ___yes ___no
10) Have you ever lost friends because of your drinking? ___yes ___no
11) Have you ever gotten into trouble at work because of drinking? ___yes ___no
12) Have you ever lost a job because of drinking? ___yes ___no
13) Have you ever neglected your obligations, family, or work for two or more days in a row because you were drinking? ___yes ___no
14) Do you drink before noon or fairly often? ___yes ___no
15) Have you ever been told you have liver trouble, such as cirrhosis? ___yes ___no
16) After heavy drinking, have you ever had delirium tremens (DT's), severe shaking, visual, or auditory (hearing) hallucinations? ___yes ___no
17) Have you ever gone to anyone for help about your drinking? ___yes ___no
18) Have you ever been hospitalized because of your drinking? ___yes ___no
19) Has your drinking ever resulted in you being hospitalized in a psychiatric ward? ___yes ___no
20) Have you ever gone to a doctor, social worker, clergy, or mental health clinic for help with any emotional problem in which drinking was part of the problem? ___yes ___no
21) Have you ever been arrested more than once for driving under the influence of alcohol? ___yes ___no
22) Have you ever been arrested or detained by an official for a few hours, because of other behavior while drinking? ___yes ___no
Scoring
0 to 2: No apparent problem
3 to 5: Early to middle problem drinker
6 or More: Problem drinker
(Source: The MAST (Michigan Alcohol Screening Test) is one of the most widely used measures for assessing alcohol abuse. The measure is designed to provide a rapid and effective screening for lifetime alcohol-related problems and alcoholism. The MAST has been productively used in a variety of settings with varied populations)
If you or someone you know is struggling with an alcohol issue, please Stonewall Institute at 602-535-6468