In the past year, have you (check all that apply)
Felt guilty or embarrassed about your behavior during/after drinking?
Gotten annoyed or angry because someone criticized your drinking?
Taken a medication while drinking that should not have been mixed with alcohol?
During or after drinking, acted in a way that you ordinarily would not have? (been verbally abusive to your child or significant other, forgotten to accomplish an important task, etc.)
Lied to family, friends, a doctor or other health care professional about the amount of your drinking?
Had times when you ended up drinking more, or longer, than you intended?
Gotten into situations while or after drinking that increased your changes of getting hurt? (such as driving, swimming, using heavy machinery, leaving with strangers, having unsafe sex, falling asleep with a lit cigarette, etc.)
Injured yourself or been in an accident while under the influence of alcohol?
Continued to drink even though it was causing trouble with your family or friends?
Been physically abusive?
Missed work or arrived late to work because of your drinking? Or been at work while drinking?
Had to drink much more than you once did to get the effect that you want? Or found that your usual number of drinks had much less effect than before?
Continued to drink even though it was making you feel depressed or anxious, or adding to another health problem?
Been unable to remember what happened during and/or after an episode of drinking; or passed out?
Found that drinking – or being sick from drinking – interfered with your ability to take care of your children or manage other responsibilities?
Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
Gotten arrested, been held at a police station, or had other legal problems because of your drinking?
Received an ultimatum from a spouse, significant other, friend, or employer to reduce your alcohol use or face consequences?
Needed to have a drink first thing in the morning to steady your nerves or treat a hangover?
Found that, when the effects of alcohol were wearing off, you had withdrawal symptoms such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure?
