What is your age?
What is your gender?
Do you currently drink alcohol?
How often do you consume alcohol?
Do you have a history of anxiety or mental health issues?
How many drinks containing alcohol do you have on a typical day when you are drinking?
How often do you have six or more drinks on one occasion?
How often during the last year have you found that you were not able to stop drinking once you had started?
How often during the last year have you failed to do what was normally expected of you because of drinking?
How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?
How often during the last year have you had a feeling of guilt or remorse after drinking?
How often during the last year have you been unable to remember what happened the night before because of your drinking?
Have you or someone else been injured because of your drinking?
Has a relative, friend, doctor, or another health worker been concerned about your drinking or suggested you cut down?
Feeling nervous, anxious, or on edge?
Not being able to stop or control worrying?
Worrying too much about different things?
Trouble relaxing?
Being so restless that it’s hard to sit still?
Becoming easily annoyed or irritable?
Feeling afraid as if something awful might happen?
How would you rate your quality of life?
How satisfied are you with your health?
How much do you enjoy life?
How well are you able to concentrate?
How safe do you feel in your daily life?
How healthy is your physical environment?
I believe that many people consume more alcohol than is healthy
I often worry about how alcohol affects the well-being of others
I think that alcohol has a negative impact on the physical health of many individuals
I believe that alcohol use increases anxiety or stress in some people
I think that alcohol is often used as a way to cope with emotional problems
I notice that alcohol consumption frequently leads to conflicts or tension in relationships
I believe that alcohol use negatively impacts the quality of life for many individuals
I feel that some people are unaware of how their drinking habits affect those around them
Doyouhaveahistoryofanxietyormentalhealthissues=No
Doyouhaveahistoryofanxietyormentalhealthissues=Yes