Alcohol Addiction Questionnaire

An alcohol addiction questionnaire is aimed at getting information from an alcohol addict without making him feel embarrassed. This questionnaire helps the counselor to build a conversation with the patient.

The alcohol addiction questionnaire serves as a tool for the counselor to unravel the history of the addict, such as; how and why he consumes excessive alcohol, what fulfillment he gets from alcohol and even why he has been unable to break the habit.

With the guidance of the alcoholic addiction questionnaire the counselor can get crucial information from the patient that may help him to employ effective rehabilitation or treatment.

Sample Alcohol Addiction Questionnaire

  1. Do you think you have reached an alcohol addiction level?______________________________________
  2. How do you feel after you have had alcohol?______________________________________________
  3. Do you think you can survive without alcohol and go about your daily routine normally?________________________________________
  4. When and how did you start drinking alcohol? Describe the circumstances which led to you to start the habit._________________________________________________
  5. Does alcohol help you perform your daily duties or perform better at work? Do you use it to enhance your activity?____________________________________________________
  6. If you got help to stop drinking alcohol, would you consider taking the offer?________________________________________________________
  7. What kind of fulfillment do you get from alcohol, do you think anything else can give you the same fulfillment.____________________________________________________________
  8. Have you ever thought about quitting alcohol or reducing the amounts you drink? If so what prompted you to do so?__________________________________________________________
  9. What do you think other people say or think about you? Do you care about what they do or say of your addiction? ________________________________________________________________

Category: Health Questionnaire

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