1. How often did you have a drink containing alcohol in the past year? Never Monthly or less Two to four times a month Two to three times a week Four or more times a week
2. How many drinks containing alcohol did you have on a typical day when you were drinking in the past year? 0 drinks 1 or 2 3 or 4 5 or 6 7 to 9 10 or more
How often did you have six or more drinks on one occasion in the past year? Never Less than monthly Monthly Weekly Daily or almost daily
Your Initials:
Gender Male Female