Home
Public
Sign in
Sign up
21
more than 11y ago
Tags
alcohol
questionnaire
agression
divorce
difficulty
disorder
drinking
z4x0n
Report
Reported
Alcohol consumption Questionnaire
How often do you consume alcohol, do you think that alcohol causes difficulties in life?
The poll results are public
Please specify your gender
Male
Female
What is your marital status?
Single
In a relationship / Married / Partner / Boyfriend / Girlfriend
Divorced / Separated
Widow
How Old are you?
18 - 24
25 - 34
35 - 44
above 45
What is your Occupational Status?
Studying
Working
Unemployed
Quit job
retired
fired
Never worked in my life
How often do you have a drink containing alcohol?
I don't drink ( you can stop answering Questions )
Monthly or less
2-4 times a month
2-4 times a week
more than 5 times a week
Did you divorce / break up / separate because of drinking?
Yes
No
How many drinks do you have when you are drinking?
10 or more
7-9
4-6
2-3
only 1
how often do you have six or more drinks?
Daily
weekly
less than monthly
monthly
never
How often do you find it hard to stop drinking once you started?
Daily
weekly
less than monthly
monthly
never
How often did you fail to do what you were expected to do because of drinking?
Daily
weekly
less than monthly
monthly
never
How often did you forget what happened because of drinking?
Daily
weekly
less than monthly
monthly
never
when do you engage in a fight?
when you are under the effect of alcohol
whenever you feel like it
you are peaceful person/ never engage in fights
How often did you get into a fight because of drinking?
Daily
weekly
less than monthly
monthly
never
do you often find yourself engaging in fights with other people?
Yes
No
have you or someone else been injured because of drinking?
Yes
No
are other people worry because of your drinking?
Yes
No
Submit