Home | Help | Contact Us

 FEMALE QUESTIONNAIRE - PAGE 2(b) 

  < You are on page 2(b) of 9


The following questions deal with alcohol consumption, alcoholism and recovery from alcoholism.
201.  What is your current average alcohol consumption? A standard drink contains half an ounce of alcohol. A standard drink of beer is 12 ounces, wine 4 ounces, and distilled spirits 1 ounce.
Don't know
None at all
A few drinks per week or less
On average about one drink per day
On average, two or more drinks per day
202.  How much beer/wine do you consume compared to distilled spirits such as whiskey, rum, brandy, gin, vodka or tequila?
Don't know
Mainly beer, little or no hard liquor
Mainly wine, little or no hard liquor
I drink beer/wine AND hard liquor
Mainly hard liquor, little or no beer/wine
203.  Do you become sick after drinking wine, as opposed to other alcoholic beverages?
No / don't know
Mildly
Moderately
Seriously
Severely - I can't tolerate it at all
204.  When you get hangovers from drinking alcohol, how severe are they generally?
Not applicable / don't know
Very mild - almost nothing
Usually mild, sometimes quite bad
Usually quite bad, sometimes awful
Awful - I'm a complete wreck
205.  When drinking alcohol heavily, have you suffered blackouts (no memory of events)?
Doesn't apply / don't know
No, never
Probably
Occasionally
Frequently
206.  If you currently consume alcohol, do your friends think you have a problem with alcoholism?
No / not applicable / don't know
Probably
Yes, a moderate problem
Yes, a significant problem
Yes, a very serious problem
207.  Recovery from alcoholism. Are you...
Not applicable / don't know
Not fully recovered
Fully recovered with no known consequences
Fully recovered with mild consequences
Fully recovered, but serious health consequences
208.  If you are an alcoholic but not fully recovered, which statement is most true?
Not applicable / don't know
I don't want to quit
I am trying and it is not too difficult
I am trying, but am finding it difficult
I've tried, but gave up because it is too hard

Add any additional information here for the questions above:

Please mention the question number(s) if possible.

 


 


GLOSSARY

Hangover (Hangovers)
A commonly used nonmedical term for the disagreeable physical effects following excessive consumption of alcohol (or the use of other drugs).

Ounce (Ounces, oz)
Approximately 28 grams.





























 
Home | Help | Contact Us
Design by: RoyalWebHosting.com