Male Questionnaire
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The following questions deal with alcohol consumption, alcoholism and recovery from alcoholism.


What is your current average alcohol consumption? A standard drink contains half an ounce of alcohol. A standard drink of beer is 12 ounces (350ml), wine 4 ounces (120ml), and distilled spirits 1 ounce (30ml).
  • 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


How much beer/wine do you consume compared to distilled spirits such as whiskey, rum, brandy, gin, vodka or tequila?
  • Not applicable / 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


Do you become more sick after drinking wine than after other alcoholic beverages?
  • No / I don't drink wine / don't know
  • Mildly, but I'm usually fine
  • Moderately
  • Seriously
  • Severely - I can't tolerate wine at all


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


When drinking alcohol heavily, have you suffered blackouts (no memory of events)?
  • Not applicable / don't know
  • No, I have never blacked out after drinking
  • Yes, but it has only happened once or twice
  • Yes, I black out once in a while
  • Yes, I frequently black out


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


Recovery from alcoholism. If you have ever been an alcoholic, what is your status now?
  • I'm not an alcoholic / not applicable / don't know
  • Currently an alcoholic / not fully recovered
  • Fully recovered with no known consequences
  • Fully recovered with mild consequences
  • Fully recovered, but serious health consequences


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