How to Coach Yourself and Others Empowering Coaching And Crisis Interventions | Page 166
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The Alcohol Use Disorders Identification Test: Self-Report Version
PATIENT: Because alcohol use can affect your health and can interfere with certain medications and
treatments, it is important that we ask some questions about your use of alcohol. Your answers will remain
confidential so please be honest. Place an X in one box that best describes your answer to each question.
Questions
0
1
2
3
4
1. 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 + t.
a week
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 six or
more drinks on one occasion?
(for women: four or more)
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 monthly
what was normally expected