Appendix D

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The AUDIT: Self-Report Version

Because alcohol use can affect your health and can interfere with certain medications and treatments, it is important that we ask you some questions about your use of alcohol. Your answers will remain confidential. We would like you to say how it really is.

QUESTIONS

1. How often do you have a drink containing alcohol?	Never (Skip to Qs. 9 & 10)	Monthly or Less	2-4 times a month	2 to 3 times a week	4 or more times a week
Each one of these drinks is equivalent to one standard drink	1 middy/pot standard beer 285 mls	1 schooner light beer 425 mls	1 glass of wine 100 mls	1 glass of sherry or port 60 mls	1 nip of spirits 30 mls
2. How many drinks containing alcohol 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 6 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	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
					Total Items 1 to 10 >>
Score Qs 11 and 12 'a' to 'e' and write response in shaded box
11. Do you think you presently have a problem with drinking?	(a) No	(b) Probably not	(c) Unsure	(d) Possibly	(e) Definitely
12. In the next three months, how difficult would you find it to cut down or stop drinking?	(a) Very easy	(b) Fairly easy	(c) Neither difficult nor easy	(d) Fairly difficult	(e) Very difficult