AUDIT

Alcohol screening questionnaire (AUDIT)
Drinking alcohol can affect your health and some medications you may take. Please help us provide you with the best medical care by answering the questions below.

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Patient name or initial
Gender
Drinking alcohol can affect your health and some medications you may take. Please help us provide you with the best medical care by answering the questions below.
Never (0)Monthly or less (1)2 - 4 times a month (2)2 - 3 times a week (3)4 or more times a week (4)
1. How often do you have a drink containing alcohol?
Never (0)
Monthly or less (1)
2 - 4 times a month (2)
2 - 3 times a week (3)
4 or more times a week (4)
(AUDIT)
0 -23 or 45 or 67 - 910 or more
2. How many drinks containing alcohol do you have on a typical day when you are drinking?
0 -2
3 or 4
5 or 6
7 - 9
10 or more
(AUDIT)
NeverLess thanMonthlyWeeklyDaily or almost daily
3. How often do you have five or more drinks on one occasion?
Never
Less than
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
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
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
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
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
Weekly
Daily or almost daily
(AUDIT)
No-Yes, but not in the last year-Yes, in the last year
9. Have you or someone else been injured because of your drinking?
No
-
Yes, but not in the last year
-
Yes, in 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, in the last year
(AUDIT)
NeverCurrentlyIn the past
Have you ever been in treatment for an alcohol problem?
Never
Currently
In the past