1. Do you lose time from work due to drinking?
yes
no

2. Is drinking making your home life unhappy?
yes
no

3. Do you drink because you are shy with other people?
yes
no

4. Is drinking affecting your reputation?
yes
no

5. Have you ever felt remorse after drinking?
yes
no

6. Have you often gotten into financial difficulties as a result of drinking?
yes
no

7. Do you turn to lower companions and an inferior environment when drinking?
yes
no

8. Does your drinking make you careless of your family's welfare?
yes
no

9. Has your ambition decreased since drinking?
yes
no

10. Do you crave a drink at a definite time daily?
yes
no

11. Do you want a drink the next morning?
yes
no

12. Does drinking cause you to have difficulty in sleeping?
yes
no

13. Has your efficiency decreased since drinking?
yes
no

14. Is drinking jeopardizing your job or business?
yes
no

15. Do you drink to escape from worries or troubles?
yes
no

16. Do you ever drink alone?
yes
no

17. Have you ever had a complete loss of memory as a result of drinking?
yes
no

18. Has your physician ever treated you for drinking?
yes
no

19. Do you drink to build up your self-confidence?
yes
no

20. Have you ever been to a hospital or institution on account of drinking?
yes
no



Check your results below.