Alcohol Checklist

1	Do you lose time from work due to drinking?	Yes	No
2	Is drinking making your home life unhappy?	Yes	No
3	Do you drink because you are shy with other people?	Yes	No
4	Is drinking affecting your reputation?	Yes	No
5	Have you ever felt remorse after drinking?	Yes	No
6	Have you ever got into financial difficulties as a result of drinking?	Yes	No
7	Do you turn to lower companions and an inferior environment when drinking?	Yes	No
8	Does drinking make you careless of your family's welfare?	Yes	No
9	Has your ambition decreased since drinking?	Yes	No
10	Do you crave for a drink at a definite time daily?	Yes	No
11	Do you want a drink the next morning?	Yes	No
12	Does drinking cause you to have difficulty in sleeping?	Yes	No
13	Has your efficiency decreased since drinking?	Yes	No
14	Is drinking jeopardizing your job or business?	Yes	No
15	Do you drink to escape from worries or trouble?	Yes	No
16	Have you ever had a complete loss of memory as a result of drinking?	Yes	No
17	Do you drink alone?	Yes	No
18	Has a physician ever treated you for drinking?	Yes	No
19	Do you drink to build up your self-confidence?	Yes	No
20	Have you ever been in a hospital or institution on account of drinking?	Yes	No