Alcoholism Testing Form

Alcoholism Test Form

measures symptoms and severities
Do you ever use alcohol to relax or wind down?

Other
Do you ever use alcohol to cope with your feelings?

Other
Do you ever use alcohol to fit in with other people?

Other
Do you ever use alcohol to feel more comfortable during sex?

Other
Have you ever been late to work, school or important occasions because of alcohol?

Other
Do you ever hide your drinking or alcohol?

Other
Have you ever driven a motor vehicle under the influence of alcohol?

Other
Have you ever been arrested, detained, or ticketed as a result of drinking?

Other
Have you ever had a terrible hang over?

Other
Are people questioning or bothering you about your drinking?

Other
Do you drink every week or day?

Other
Is drinking a part of special occasions?

Other
Do you think or talk about drinking?

Other
Are you a heavy drinker?

Other
Can you stop drinking when you want to, every time that you want to?

Other
Do you have any past trauma?

Other
Do you count on a lot of people for favors?

Other
Do you ever change your drinking patterns or choice of drinks?

Other
Are you looking for the best way to manage your drinking?

Other
Do you ever crave a drink?

Other
Do most of your "good times" involve alcohol?

Other
Do you feel panic with the idea of never drinking again?

Other
Are you afraid to live without alcohol?

Other
Are you ready to quit but do not know how?

Other
Name

First NameLast Name
Email
example@example.com
By submitting I hereby confirm that the information I have given above is true, and that I will be receiving an email response to my submission and an invitation to discuss the results with a nonprofessional.
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Alcoholism Test Form