The Alcohol Use Disorders Identification Test: Self-Report Version
PATIENT: Because alcohol use can affect your health and can interfere with certain
medications and treatments, it is important that we ask some questions about
your use of alcohol. Your answers will remain confidential so please be honest.
Place an X in one box that best describes your answer to each question.
Questions 0 1 2 3 4
1. How often do you have Never Monthly 2-4 times 2-3 times 4 or more
a drink containing alcohol? or less a month a week times a week
2. How many drinks containing 1 or 2 3 or 4 5 or 6 7 to 9 10 or more
alcohol do you have on a typical
day when you are drinking?
3. How often do you have six or Never Less than Monthly Weekly Daily or
more drinks on one monthly almost
occasion? daily
4. How often during the last Never Less than Monthly Weekly Daily or
year have you found that you monthly almost
were not able to stop drinking daily
once you had started?
5. How often during the last Never Less than Monthly Weekly Daily or
year have you failed to do monthly almost
what was normally expected of daily
you because of drinking?
6. How often during the last year Never Less than Monthly Weekly Daily or
have you needed a first drink monthly almost
in the morning to get yourself daily
going after a heavy drinking
session?
7. How often during the last year Never Less than Monthly Weekly Daily or
have you had a feeling of guilt monthly almost
or remorse after drinking? daily
8. How often during the last year Never Less than Monthly Weekly Daily or
have you been unable to remem- monthly almost
ber what happened the night daily
before because of your drinking?
9. Have you or someone else No Yes, but Yes,
been injured because of not in the during the
your drinking? last year last year
10. Has a relative, friend, doctor, or No Yes, but Yes,
other health care worker been not in the during the
concerned about your drinking last year last year
or suggested you cut down?
Total
