How to Coach Yourself and Others Empowering Coaching And Crisis Interventions | Page 166

This book is in B&W, not color - Print page in Grayscale for Correct view! 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