Alcohol Use Questionnaire

This alcohol use questionnaire is usually used by counselors on alcohol addiction patients. It helps the counselor to understand the circumstances that led the patient to the addiction in the first place. Questions asked from this questionnaire are easy ways of making the patient tell the counselor more about himself without asking him/her directly. The questions asked in an alcohol use questionnaire also help the counselor to know the extent of the addiction and what type of treatment can be employed for the patient.

The alcohol use questionnaire can also be a point of realization for the patient as he may be asked some crucial questions he may have never asked him/herself.

Sample Alcohol Use Questionnaire

  1. Why do you drink alcohol?_____________________________________________
  2. When and how did you start drinking alcohol? Describe the circumstances which led to you starting the habit._______________________________________________________
  3. How do you feel after consuming alcohol?_____________________________________________
  4. Tell me something you know about alcohol and what you think about it.___________________________________________________________
  5. If you could, would ever you stop drinking alcohol?________________________________________________________
  6. Do you think you can survive without alcohol and live a normal life?________________________________________________________
  7. How much alcohol do you drink in day/week?______________________________________________
  8. What kind of fulfillment do you get from alcohol, do you think anything else can give you the same fulfillment?_______________________________________________________
  9. Have you ever thought about quitting alcohol or reducing the amounts you drink? If so what prompted you to do so?________________________________________________________
  10. Do you feel guilty ashamed of drinking alcohol?________________________________________
  11. What do you think other people say or think about you? Do you care about what they do or say?____________________________________________________________________
  12. Does alcohol help you to perform your daily duties or perform better at work? Do you use it to enhance your activity? ________________________________________________________

Category: Health Questionnaire

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