Do You Have A Problem With Alcohol?
Reflecting on Alcohol's Impact on Your Well-Being
Email
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example@example.com
During the past year, have you had a feeling of guilt or remorse after drinking?
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YES
NO
Have you had to give up or cut back on activities that were important to you (such as work, social activities, gym time, hobbies, etc) because of drinking.
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YES
NO
Have you tried to cut down or stop drinking, but couldn’t?
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YES
NO
Has a relative, friend, or healthcare provider ever been concerned about your drinking and suggested you cut down or quit?
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YES
NO
When the effects of alcohol were wearing off, did you have withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure?
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YES
NO
Have you had times when you ended up drinking more than you planned or you couldn’t stop drinking once you started?
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YES
NO
Have you ever not remembered events of the day/night after drinking?
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YES
NO
Have you ever continued to drink even though it made you feel unwell, depressed, or anxious?
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YES
NO
SUBMIT
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