• Alcohol Use Screening Questionnaire

    Alcohol Use Screening Questionnaire

    AUDIT
  • Date of Birth:*
     / /
    2 digit month, 2 digit day, 4 digit year
  • Today's Date*
     / /
    2 digit month, 2 digit day, 4 digit year
  • 1. How often do you have a drink containing alcohol?*
  • 2. How many standard drinks containing alcohol do you have on a typical day when drinking?*
  • 3. How often do you have six or more drinks on one occasion?*
  • 4. During the past year, how often have you found that you were not able to stop drinking once you had started?*
  • 5. During the past year, how often have you failed to do what was normally expected of you because of drinking?*
  • 6. During the past year, how often have you needed a drink in the morning to get yourself going after a heavy drinking session?*
  • 7. During the past year, how often have you had a feeling of guilt or remorse after drinking?*
  • 8. During the past year, how often have you been unable to remember what happened the night before because you had been drinking?*
  • 9. Have you or someone else been injured as a result of your drinking?*
  • 10. Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested you cut down?*

  • Scoring Guideline:

    Total Score

    Risk
    0 Abstainer, never had problems with alcohol
    1-7 Low Risk
    8-14 Hazardous or harmful alcohol consumption
    15 or more Moderate-severe alcohol use disorder
  • Should be Empty: