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Are you dependent on alcohol questionnaire?

Assess the level of your alcohol dependence and get advice at Findrehab24.com on what this means.

Complete the following questionnaire selecting one of the four options for each question.

Q1:  Please indicate below the physical symptoms that you have experienced first thing in the morning during typical periods of heavy alcohol drinking.

ZERO POINTS ONE POINT TWO POINTS THREE POINTS
I wake up feeling sweaty:
Almost never 1 (0) Sometimes 1 (1) Often 1 (2) Nearly Always 1 (3)
My hands shake first thing in the morning:
Almost never 1 (0) Sometimes 1 (1) Often 1 (2) Nearly Always 1 (3)
My whole body shakes violently first thing in the morning if I don’t have a drink:
Almost never 1 (0) Sometimes 1 (1) Often 1 (2) Nearly Always 1 (3)
I wake up absolutely drenched in sweat:
Almost never 1 (0) Sometimes 1 (1) Often 1 (2) Nearly Always 1 (3)
TOTAL SCORE FOR Q1:  ……………………………………………………………………………………………………….
Q2:  The following statements refer to moods and state of mind experienced during these periods of heavy alcohol drinking.

ZERO POINTS ONE POINT TWO POINTS THREE POINTS
I dread waking up in the morning:
Almost never 1 (0) Sometimes 1 (1) Often 1 (2) Nearly Always 1 (3)
I am afraid of meeting people first thing in the morning:
Almost never 1 (0) Sometimes 1 (1) Often 1 (2) Nearly Always 1 (3)
I feel at the edge of despair when I first wake up:
Almost never 1 (0) Sometimes 1 (1) Often 1 (2) Nearly Always 1 (3)
I feel very frightened when I wake up:
Almost never 1 (0) Sometimes 1 (1) Often 1 (2) Nearly Always 1 (3)
TOTAL SCORE FOR Q2:  ……………………………………………………………………………………………………….
Q3:  The following statements refer to morning drinking habits during any recent period when you were drinking alcohol heavily:

ZERO POINTS ONE POINT TWO POINTS THREE POINTS
I like to have a drink in the morning:
Almost never 1 (0) Sometimes 1 (1) Often 1 (2) Nearly Always 1 (3)
I always gulp my first few morning drinks down as quickly as possible:
Almost never 1 (0) Sometimes 1 (1) Often 1 (2) Nearly Always 1 (3)
I drink in the morning to get rid of the shakes:
Almost never 1 (0) Sometimes 1 (1) Often 1 (2) Nearly Always 1 (3)
I have a very strong craving for a drink when i wake up:
Almost never 1 (0) Sometimes 1 (1) Often 1 (2) Nearly Always 1 (3)
TOTAL SCORE FOR Q3:  ……………………………………………………………………………………………………….
Q4:  The following statements refer to a degree of alcohol consumption during any recent period of heavy drinking and periods like it.

ZERO POINTS ONE POINT TWO POINTS THREE POINTS
I drink more than a quarter of a bottle of spirits per day i.e.  4 doubles or 1 bottle of wine or 4 pints of beer / lager:
Almost never 1 (0) Sometimes 1 (1) Often 1 (2) Nearly Always 1 (3)
I drink more than half a bottle of spirits per day or 2 bottles of wine or 8 pints of beer / lager:
Almost never 1 (0) Sometimes 1 (1) Often 1 (2) Nearly Always 1 (3)
I drink more than one bottle of spirits per day or 4 bottles of wine or 15 pints of beer / lager:
Almost never 1 (0) Sometimes 1 (1) Often 1 (2) Nearly Always 1 (3)
I drink more than two bottles of spirits per day or 8 bottles of wine or 30 pints of beer / lager:
Almost never 1 (0) Sometimes 1 (1) Often 1 (2) Nearly Always 1 (3)
TOTAL SCORE FOR Q4:  ……………………………………………………………………………………………………….
Q5:  Imagine the following situations.  You have been off drink for a few weeks then drink very heavily for two days.  How would you feel the morning after those two days?

ZERO POINTS ONE POINT TWO POINTS THREE POINTS
I would start to sweat:
Almost never 1 (0) Sometimes 1 (1) Often 1 (2) Nearly Always 1 (3)
My hands would shake:
Almost never 1 (0) Sometimes 1 (1) Often 1 (2) Nearly Always 1 (3)
My body would shake:
Almost never 1 (0) Sometimes 1 (1) Often 1 (2) Nearly Always 1 (3)
I would be craving for a drink:
Almost never 1 (0) Sometimes 1 (1) Often 1 (2) Nearly Always 1 (3)
TOTAL SCORE FOR Q5:  ……………………………………………………………………………………………………….
Now add up the total scores from questions 1, 2, 3, 4 and 5.  The maximum possible score is 60.  Scores above 4 indicate likely physical dependence to alcohol, scores above 10 indicate definite physical dependence to alcohol and score above 30 indicate severe physical dependence to alcohol.  Any total score above 4 should lead you to include a medicated detoxification as part of your plan to cease alcohol use.

TOTAL SCOREQ1 + Q2 + Q3 + Q4 + Q5 =
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