AUD Assessment Quiz

1

info@searidge.org 902-906-9693 1-888-777-9972 SearidgeFoundation Our Locations Rehab Center 3289 Evangeline Trail Annapolis Royal, Nova Scotia B0S 1A0 Office 1701 Hollis Ave Suite 800 Halifax, Nova Scotia B3J 3M8

2

We have put together a short form you can fill out to assess your personal drinking habits. This form is not meant to take the place of a professional assessment, nor is it intended to replace consulting a health care professional or an addictions counsellor to discuss your concerns with your drinking habits.

The criteria/questions used in this quiz are based on findings from Babor, TF, Higgins-Biddle, JC, Saunders, JB, Monteiro, MG. The Alcohol Use Disorder Identification Test: Guidelines for Use in Primary Care, Second Edition. World Health Organization, 2001. Available at: (https://iris.who.int/bitstream/10665/67205/1/WHO_MSD_MSB_01.6a.pdf)

If you would like to speak with an intake counsellor at any time call our intake line at

1-888-777-9972

Please note this is not an emergency intake number. If this is an emergency situation call 911 to seek help.

3

Terms of use* This field is required.

4

What should we call you?* This field is required.We do not keep this data and you can use any name

*If you are considering rehab you may want to use your real name

5

How often do you have a drink containing alcohol?* This field is required.This includes any beverage that contains any amount of alcohol.

Never

Monthly or less

2-4 times a month

2 to 3 times a week

4 or more times a week

6

How many drinks containing alcohol do you have on a typical day when you are drinking?* This field is required.In a typical session, night out, after work gathering etc.

1

2-3

3-5

more than 5

7

How often do you have 5 or more drinks on one occasion?* This field is required.This total may include a pre-dinner drink, wine with dinner, and a nightcap if drinking is a strictly social activity.

Never

Monthly or less

2-4 times a month

2 to 3 times a week

4 or more times a week

8

How often during the last year have you found that you were not able to stop drinking once you had started?* This field is required.By this we mean times when YOU choose to continue to drink, either ordering more drinks or seeking to serve yourself more drinks as the occasion or evening progresses

Never

Monthly or less

2-4 times a month

2 to 3 times a week

4 or more times a week

9

How often during the last year have you failed to do what was normally expected of you because of drinking?* This field is required.This could include missing work, appointments with professionals or friends, or even an inability to attend to needed chores.

Never

Monthly or less

2-4 times a month

2 to 3 times a week

4 or more times a week

10

How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?* This field is required.If you on waking first reach for a Hair of the Dog approach to coping.

Never

Monthly or less

2-4 times a month

2 to 3 times a week

4 or more times a week

11

How often during the last year have you had a feeling of guilt or remorse after drinking?* This field is required.This can include times when you wake up feeling that something you did or said the day or night before you would not have done or said when sober.

Never

Monthly or less

2-4 times a month

2 to 3 times a week

4 or more times a week

12

How often during the last year have you been unable to remember what happened the night before because you had been drinking?* This field is required.his could include things like, not remembering the evening ending, how you got home, or going to/how you got to bed.

Never

Monthly or less

2-4 times a month

2 to 3 times a week

4 or more times a week

13

Have you or someone else been injured as a result of your drinking?* This field is required.This would apply to physical and/or emotional pain you have caused when under the influence.

Yes but not in the past year

Yes during the past year

No

14

Has a relative, a friend, a doctor, or another health worker been concerned about your drinking or suggested you cut down?* This field is required.Can include nonintervention types of conversations. Casual remarks on your general well being, or how you appear to others (observations about your general appearance/perceived state of health)

Yes but not in the past year

Yes during the past year

No

15

Based on your answers your AUD risk number is:Read the chart below to determine if you are at risk.

16

Thanks, for completing this little quiz, it helps us to assess if your drinking is something you need to be concerned about.

0 to 7 points:	Low risk of AUD
8 to 15 points:	Medium risk of AUD
16 to 19 points:	High risk of AUD
20 to 40 points:	Likely dealing with Alcohol Use Disorder

Low risk (0 to 7 points): You probably do not have a problem with alcohol.

Medium risk (8 to 15 points): You may drink too much on occasion. This may put you or others at risk. Try to cut down on alcohol or stop drinking completely.

High risk (16 to 19 points): Your drinking could lead to harm if it has not already. It is important that you cut down on alcohol or stop drinking completely. You can seek help from your healthcare provider to cut down or better yet stop drinking completely.

AUD is likely (20+ points): Your drinking is likely causing harm. Speak to your healthcare provider or call us today at 1-888-777-9972 to speak with a member of our intake team.

They can connect you with the right person to discuss individualized treatment options that can help you stop drinking.

If you are dependent on alcohol it is always best to discuss options for quitting drinking with a professional. Quitting COLD TURKEY can be dangerous for your health.

(criteria/questions used in this quiz are based on findings from Babor, TF, Higgins-Biddle, JC, Saunders, JB, Monteiro, MG. The Alcohol Use Disorder Identification Test: Guidelines for Use in Primary Care, Second Edition. World Health Organization, 2001. Available at: https://apps.who.int/iris/bitstream/handle/10665/67205/WHO_MSD_MSB_01.6a.pdf.)

17

Great news.

Based on the answers you provided in your assessment it is not likely that you have a problem with alcohol at all.

18

It is not very likely that you have any issues with alcohol at all, but if you do want to talk call us.

Good news.

Based on the answers you provided your assessment fell between (1 to 7 points) which is considered a low risk for AUD. So it is not likely that you have a problem with alcohol.

19

Based on your answers your consumption is considered a Medium risk:

(8 to 15 points): You may drink too much on occasion. This may put you or others at risk. Try to cut down on alcohol or stop drinking completely.

20

Based on your answers your consumption is considered a High risk:

Your score of 16 to 19 points shows that your drinking could lead to harm, if it has not already. It is important that you cut down on alcohol or stop drinking completely. Ask your healthcare provider for advice on how best to cut down.

21

Your AUD risk is higher than normal.

You may want to seek help from your healthcare provider.

Or you can call our intake team and discuss what options are available to you to address your consumption, we can help you determine if your usage makes you a good candidate for residential rehab for AUD.

22

Would you like a member of our intake team to contact you?If you are concerned about your drinking and are considering a life free of alcohol please reach out we are happy to contact you to help you make some choices about how you can change your life starting today.

YESNO

23

How would you like us to get in touch with you?

Email me

Phone me

Either works

24

Request a call back* This field is required.A member of our intake team would be happy to call you to discuss how Searidge can help you rediscover your life free of Alcohol

Format (###)-###-####

25

Request an Email* This field is required.Would you like us to email you with a brochure of our services?

you@example.com