AUDIT - Interview Version

1

Unique Number

2

Email* This field is required.

example@example.com

3

How often do you have a drink containing alcohol?* This field is required.

Never

Monthly or less

2 to 4 times a month

2 to 3 times a week

4 or more times a week

6

How often during the last year have you found that you were not able to stop drinking once you had started?

Never

Less than Monthly

Monthly

Weekly

Daily or almost daily

7

How often during the last year have you failed to do what was normally expected of you because of drinking?

Never

Less than Monthly

Monthly

Weekly

Daily or almost daily

8

How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?

Never

Less than Monthly

Monthly

Weekly

Daily or almost daily

9

How often during the last year have you had a feeling of guilt or remorse after drinking?

Never

Less than Monthly

Monthly

Weekly

Daily or almost daily

10

How often during the last year have you been unable to remember what happened the night before because of your drinking?

Never

Less than Monthly

Monthly

Weekly

Daily or almost daily

11

Have you or someone else been injured because of your drinking?* This field is required.

No

Yes, but not in the last year

Yes, during the last year

12

Has a relative, friend, doctor, or other health care worker been concerned about your drinking or suggested you cut down?* This field is required.

No

Yes, but not in the last year

Yes, during the last year

13

Total Score* This field is required.