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Alcohol Assessment Tools and Log Sheet

The document is an Alcohol Intake Log Sheet that instructs users to record daily alcohol consumption and includes a formula for calculating ethanol intake. It also features the AUDIT questionnaire to assess alcohol use patterns and the CAGE questionnaire for potential alcohol dependence. Interpretations for both questionnaires are provided to help users understand their drinking habits and risks.

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joshua katunzi
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5 views4 pages

Alcohol Assessment Tools and Log Sheet

The document is an Alcohol Intake Log Sheet that instructs users to record daily alcohol consumption and includes a formula for calculating ethanol intake. It also features the AUDIT questionnaire to assess alcohol use patterns and the CAGE questionnaire for potential alcohol dependence. Interpretations for both questionnaires are provided to help users understand their drinking habits and risks.

Uploaded by

joshua katunzi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Alcohol Intake Log Sheet

Instructions: Record your daily alcohol consumption below. Use the formula:

Ethanol (g) = Volume (mL) × Alcohol % × 0.8. One standard drink contains about 10 to 14 g of

ethanol.

Date Drink Type Volume (mL) % Alcohol Ethanol (g) Comments


AUDIT (Alcohol Use Disorders Identification Test)

1. How often do you have a drink containing alcohol?

[ ] Never [ ] Monthly or less [ ] 2-4 times/month [ ] 2-3 times/week [ ] Daily or almost daily

2. How many drinks containing alcohol do you have on a typical day when you are drinking?

[ ] Never [ ] Monthly or less [ ] 2-4 times/month [ ] 2-3 times/week [ ] Daily or almost daily

3. How often do you have six or more drinks on one occasion?

[ ] Never [ ] Monthly or less [ ] 2-4 times/month [ ] 2-3 times/week [ ] Daily or almost daily

4. How often during the last year have you found you were not able to stop drinking once you had

started?

[ ] Never [ ] Monthly or less [ ] 2-4 times/month [ ] 2-3 times/week [ ] Daily or almost daily

5. How often during the last year have you failed to do what was normally expected of you because

of drinking?

[ ] Never [ ] Monthly or less [ ] 2-4 times/month [ ] 2-3 times/week [ ] Daily or almost daily

6. How often during the last year have you needed a first drink in the morning to get yourself going?

[ ] Never [ ] Monthly or less [ ] 2-4 times/month [ ] 2-3 times/week [ ] Daily or almost daily

7. How often during the last year have you had a feeling of guilt or remorse after drinking?

[ ] Never [ ] Monthly or less [ ] 2-4 times/month [ ] 2-3 times/week [ ] Daily or almost daily

8. How often during the last year have you been unable to remember what happened the night

before?

[ ] Never [ ] Monthly or less [ ] 2-4 times/month [ ] 2-3 times/week [ ] Daily or almost daily

9. Have you or someone else been injured as a result of your drinking?

[ ] Never [ ] Monthly or less [ ] 2-4 times/month [ ] 2-3 times/week [ ] Daily or almost daily

10. Has a relative, friend, doctor, or health worker been concerned about your drinking?

[ ] Never [ ] Monthly or less [ ] 2-4 times/month [ ] 2-3 times/week [ ] Daily or almost daily
Interpretation:

0-7: Low risk

8-15: Hazardous use

16-19: Harmful use

20+: Possible dependence


CAGE Questionnaire

C: Have you ever felt you should Cut down on your drinking?

[ ] Yes [ ] No

A: Have people Annoyed you by criticizing your drinking?

[ ] Yes [ ] No

G: Have you ever felt Guilty about your drinking?

[ ] Yes [ ] No

E: Have you ever had a drink first thing in the morning (Eye-opener)?

[ ] Yes [ ] No

Interpretation:

Score 1 point for each 'Yes'. A score of 2 or more suggests possible alcohol dependence.

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