Boston Counseling Therapy

1. How often do you have a drink that contains alcohol?

_____

(0) Never

(1) Monthly or less

(2) 2 to 4 times a month

(3) 2 to 3 times a week

(4) 4 or more times a week

2. When you drink, how many drinks do you normally have? (If you do not drink, score yourself as 0)

_____

(0) 1 or 2

(1) 3 or 4

(2) 5 or 6

(3) 7 to 9

(4) 10 or more

3. How often do you have six or more drinks within a five hour period?

_____

(0) Never

(1) Less than monthly

(2) Monthly

(3) Weekly

(4) Daily or almost daily

4. How often, during the last 12 months, have you felt you were unable to stop drinking once you had started?

_____

(0) Never

(1) Less than monthly

(2) Monthly

(3) Weekly

(4) Daily or almost daily

5. Over the last 12 months, How often have you failed to do what was normally expected of you, while you were drinking?

_____

(0) Never

(1) Less than monthly

(2) Monthly

(3) Weekly

(4) Daily or almost daily

6. How often do you experience wanting or needing a first drink in the morning to get yourself going?

_____

(0) Never

(1) Less than monthly

(2) Monthly

(3) Weekly

(4) Daily or almost daily

7. How often do you feel regret or shame after drinking?

_____

(0) Never

(1) Less than monthly

(2) Monthly

(3) Weekly

(4) Daily or almost daily

8. How often have you been unable to remember what happened the night before, when you had been drinking?

_____

(0) Never

(1) Less than monthly

(2) Monthly

(3) Weekly

(4) Daily or almost daily

9. Have you or someone else ever been physically injured as a consequence, or partial consequence, of your drinking?

_____

(0) No

(2) Yes, but not in the last year

(4) Yes, during the past year

10. Do you ever hide your alcohol, or the fact that you have been drinking?

(0) No

(2) Yes

11. Have you ever tried to quit drinking, or cut back on your drinking, and found it difficult or impossible?

(0) No

(2) Yes

12. Has anyone expressed concern about your drinking, or suggested you cut down the amount or frequency of alcohol use?

_____

(0) No

(2) Yes, but not in the last year

(4) Yes, during the past year

Please total your score here.

_____