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Alcohol Misuse Assessment

This questionnaire may be used to help identify alcohol dependence and specific consequences of harmful drinking. Please answer all questions as honestly and openly as possible and choose the following answers that best describe your feelings and situation in the past 30 days. If you are taking this on behalf of a loved one, please note that all of these questions will be phrased as if that person were taking this screening. If suggested, contact us as soon as you can.

Please note, this screening does not serve as a diagnosis tool but can aid your clinician in determining our recommended course of action.

SCORE

0 > None-minimal

ACTION – None

1 – 7 > Mild/Watchful

ACTION – Please schedule a consultation with Dr. Cruz or your physician.

8 – 40 > Moderate/Severe Treatment Recommended

ACTION – Please schedule a consultation with Dr. Cruz or your physician.

Sources

The World Health Organization (2001). The Alcohol Use Disorders Identification Test: Guidelines for use in primary care. (Second Edition).
Department of Mental Health and Substance Dependence: Geneva, Switzerland.