Resurrection Behavioral Health - Addiction Services


Choose the answer that most closely matches your situation. Answers are confidential.
One drink is defined as 12 ounces of beer, 5 ounces of wine or one standard cocktail (1.5 ounces of 80-proof liquor).

1. How often do you have a drink containing alchohol?
Never
Monthly or Less
2-4 times a month
2-3 times a week
4 or more times a week

2. How many drinks containing alchohol do you have on a typical day when you are drinking?
1 or 2
3 or 4
5 or 6
7 to 9
10 or more

3. How often do you have six or more drinks on one occasion?
Never
Less than monthly
Monthly
Weekly
Daily or almost daily

4. 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

5. 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

6. 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

7. 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

8. 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

9. Have you or someone else been injured because of your drinking?
No
Yes, but not in the last year
Yes, during the last year

10. Has a relative, friend, doctor or other health care worker been concerned about your drinking or suggested you cut down?
No
Yes, but not in the last year
Yes, during the last year

Call 877-RES-INFO for Nurse Advice, Doctor Referrals or Class Registration Monday - Friday 8 am to 8 pm • Weekends 8 am to 4pm

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