An alcohol dependence questionnaire helps the counselor to know and understand the patient they are dealing with better. This questionnaire gives in-depth information about the patient in a subtle manner without making him/her feel like his privacy is being invaded.

The way questions are framed in an alcohol dependence questionnaire do not embarrass or intimidate the patient hence he/she may speak with more sincerity and openness towards the counselor. The questions have a caring tone so the patient feels wanted and welcome as opposed to neglected.

The alcohol dependence questionnaire helps the counselor or doctor to come up with an effective rehabilitation program.

Sample Alcohol Dependence Questionnaire

  1. What would you say are your reasons for drinking alcohol?_____________________________________________________________________________________________________________________
  2. Who introduced you to alcohol and how did you feel the first time you took it? What led you to start using it more regularly?____________________________________________________
  3. Are you aware of the dangers of alcohol? If yes what stops you from getting over the addiction?______________________________________________________________
  4. What fulfillment do you derive from drinking alcohol? Describe the feeling that you experience after or while drinking alcohol._______________________________________________________
  5. Do you have any information about alcohol like its effects, how it is made its dangers etc.? If yes what do you think of the facts?________________________________________________________
  6. What would you prefer as an alternative to alcohol, something that would make you feel the same way alcohol does?_________________________________________________________
  7. What steps do you think you can take to stop drinking alcohol?__________________________________________________________________________________________________________________
  8. Do you think you have the ability to go a whole day without alcohol, If No explain what you would feel or happen to you if you didn’t drink alcohol for a day? __________________________________________________________________