- Do you lose time from work due to drinking?
Yes No - Is drinking making your home life unhappy?
Yes No - Do you drink because you are shy with other people?
Yes No - Is drinking affecting your reputation?
Yes No - Have you ever felt remorse after drinking?
Yes No - Have you ever got into financial difficulties as a result of drinking?
Yes No - Do you turn to lower companions and an inferior environment when drinking?
Yes No - Does drink make you careless of your family welfare?
Yes No - Has your ambition decreased since drinking?
Yes No - Do you crave for a drink at a definite time daily?
Yes No - Do you want a drink the next morning?
Yes No - Does drinking cause you to have difficulty in sleeping?
Yes No - Has your efficiency decreased since drinking?
Yes No - Is drinking jeopardising your job or business?
Yes No - Do you drink to escape from worries or trouble?
YesNo - Do you drink alone?
Yes No - Have you ever had a complete loss of memory as a result of drinking?
Yes No - Has a physician ever treated you for drinking?
Yes No - Do you drink to build up your self-confidence?
Yes No - Have you ever been in a hospital or institution on account of drinking?
Yes No