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Alcohol Abuse Quiz Drug Abuse QuizCall Today (406) 453-5080

Home
About
Treatment Programs
Admissions
Resources
Blog
Contact
Contact

Alcohol Misuse Survey

Welcome To Your Alcohol Misuse Survey.
Please Choose the Answer That Best Describes You.

How often do you have a drink containing alcohol?*
- Never
- Monthly or less
- 2-4 times a month
- 2-3 times a week
- 4 or more times a week
How many standard drinks containing alcohol do you have on a typical day when you are drinking?*
- 1-2
- 3-4
- 5-6
- 7-9
- 10+
How often do you have six or more drinks on one occasion?*
- Never
- Monthly or less
- Two to four times a month
- Two to three times a week
- Four or more times a week
How often during the last year have you found that you were not able to stop drinking once you had started?*
- Never
- Monthly or less
- Two to four times a month
- Two to three times a week
- Four or more times a week
How often during the last year have you failed to do what was normally expected from you because of drinking?*
- Never
- Monthly or less
- Two to four times a month
- Two to three times a week
- Four or more times a week
How often during the last year have you had a feeling of guilt or remorse after drinking?*
- Never
- Monthly or less
- Two to four times a month
- Two to three times a week
- Four or more times a week
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
- Monthly or less
- Two to four times a month
- Two to three times a week
- Four or more times a week
How often during the last year have you been unable to remember what happened the night before because you had been drinking?*
- Never
- Monthly or less
- Two to four times a month
- Two to three times a week
- Four or more times a week
Have you or someone else been injured as a result of your drinking?*
- No
- Yes, But not in the last year
- Yes, During the last year
Has a relative or friend, or a doctor or other health worker been concerned about your drinking or suggested you cut down?*
- No
- Yes, But not in the last year
- Yes, During the last year
Name*
Email*
Phone*
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Contact:

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Fax Number: (406) 727-8172
Email: info@rehabrocky.com

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