| Circle the best answer for each question: | 0 points | 1 point | 2 points | 3 points | 4 points | 
| 1. How often do you have a drink containing alcohol? | Never* | Monthly or less | 2 to 4 times a month | 2 to 3 times a week | 4 or more times a week | 
| * If answer if never, skip to questions 9-10 | |||||
| 2. How many drinks containing alcohol do you have on a typical day when you are drinking? | 1 or 2 | 3 or 4 | 5 or 6 | 7, 8, or 9 | 10 or More | 
| 3. How often do you have six or more drinks on one occasion? | Never* | Less than monthly | Monthly | Weekly | Daily or almost daily | 
| * If your answers to 2 and 3 are "1 or 2" and "Never" skip to questions 9-10 | |||||
| 4. How often during the lest year have you found that you were unable to stop drinking once you had started? | Never* | Less than monthly | Monthly | Weekly | Daily or almost daily | 
| 5. How often during the lest year have you failed to do what was normally expected of you because of drinking? | Never* | Less than monthly | Monthly | Weekly | Daily or almost daily | 
| 6. How often in the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session? | Never* | Less than monthly | Monthly | Weekly | Daily or almost daily | 
| 7. How often in the last year have you had a feeling of guilt or remorse after drinking? | Never* | Less than monthly | Monthly | Weekly | Daily or almost daily | 
| 8. How often during the last year have you been unable to remember what happened the night before because you had been drinking? | Never* | Less than monthly | Monthly | Weekly | Daily or almost daily | 
| 9. Have you or someone else been injured as a result of your drinking? | No | Yes, but not in the last year | Yes, in the last | ||
| 10. Has a relative, friend, doctor or other health worker been concerned with your drinking or suggested you cut down? | No | Yes, but not in the last year | Yes, in the last | ||
| Total Score: | |||||
| Score | Interpretation | 
| 0-7 | No to low risk of harmful alcohol use | 
| 8 | Low level of hazardous and harmful alcohol use and possibly alcohol dependence | 
| 
			 9-15  | 
			Medium level of hazardous and harmful alcohol use and possible alcohol dependence | 
| 16 and above | High level of alcohol use and dependence problems |