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Atlanta, GA 30322
404-727-4328

Alcohol Self-Assessment

This Alcohol Screening Instrument is a self-assessment tool that was developed by Dr. Jay Rathbun of the University of Michigan. This instrument is designed to enhance your understanding of your use or abuse of alcohol; thus, your candid response to each question is important.

The instrument itself is a composite of two alcohol screening instruments: the Alcohol Use Disorders Identification Test (AUDIT) developed by the World Health Organization, and the CAGE questionnaire developed by researchers at the University of North Carolina. Both instruments are widely respected alcohol screening tools.

Note: There is no computer-related interactive component to this instrument in an effort to protect your anonymity. No one has access to your results; they are for your review only.

Directions: Number a sheet of paper from 1–12. Read each question, one at a time, and simply choose one of the responses that fits your circumstance. Each response is weighted from 0–4 as indicated in the parentheses. Place the score that appears in the parentheses at the end of the response you’ve chosen next to the number of the question on your sheet. After you have finished, total your individual scores into one composite score for all 12 questions. Next, total your individual item scores for the last four questions only (9–12). You should have two composite scores, one for all 12 questions and one for the last 4 questions.

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

Never (0)
Once a month or less (1)
2-4 times per month (2)
2-3 times per week (3)
4 or more times per week (4)

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

1-2 (0)
3-4 (1)
5-6 (2)
7-9 (3)
10 or more (4)

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

Never (0)
Less than once a month (1)
Monthly (2)
Weekly (3)
Daily or almost daily (4)

4. How often during the last year have you been unable to remember what happened the night before because of drinking?

Never (0)
Less than once a month (1)
Monthly (2)
Weekly (3)
Daily or almost daily (4)

5. How often during the last year have you found you were not able to stop drinking once you started?

Never (0)
Less than once a month (1)
Monthly (2)
Weekly (3)
Daily or almost daily (4)

6. How often during the last year have you failed to do what is normally expected from you because of drinking (e.g., missed deadlines, poor classroom or work attendance, failed committee responsibilities, inconsistent work patterns)?

Never (0)
Less than once a month (1)
Monthly (2)
Weekly (3)
Daily or almost daily (4)

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

No (0)
Yes, but not in the last year (2)
Yes, in the last year (4)

8. Has a relative or friend or doctor or other health worker been concerned about your drinking or suggested you cut down?

No (0)
Yes, but not in the last year (2)
Yes, in the last year (4)

9. 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 (0)
Less than once a month (1)
Monthly (2)
Weekly (3)
Daily or almost daily (4)

10. How often during the past year have you had feelings of guilt or remorse after drinking?

Never (0)
Less than once a month (1)
Monthly (2)
Weekly (3)
Daily or almost daily (4)

11. Have people annoyed you by criticizing your drinking?

No (0)
Yes, but not in the last year (2)
Yes, in the last year (4)

12. Have you ever felt you should cut down on your drinking?

No (0)
Yes, but not in the last year (2)
Yes, in the last year (4)

Interpretation: A score of 8 or more for all twelve questions indicates that a harmful level of alcohol consumption is likely. Please contact FSAP for a more thorough assessment of your alcohol-use patterns. Based on this comprehensive assessment, strategies for enhancing for health and well being will be discussed.

Sub-Assessment: The last four questions (9, 10, 11, & 12) are considered a separate “sub-assessment” that is embedded into the entire self-administered instrument. On only the last four items, a total of 1 – 2 indicates that you may have a drinking problem. A score of 3 or more indicates there is a significant possibility that you have a problem with alcohol.

If your score exceeds the cut-off values on either instrument, you should seek help. FSAP is available to assist you. Help is only a call away.