Tools
you can use

Over the last 2 weeks, how often have you been bothered by any of the following problems?

1. 1.Little interest or pleasure in doing things

   Not at all Several days More than half the days Nearly every day

2. 2.Feeling down, depressed, or hopeless

   Not at all Several days More than half the days Nearly every day

3. 3.Trouble falling or staying asleep, or sleeping too much

   Not at all Several days More than half the days Nearly every day

4. 4.Feeling tired or having little energy

   Not at all Several days More than half the days Nearly every day

5. 5.Poor appetite or overeating

   Not at all Several days More than half the days Nearly every day

6. 6.Feeling bad about yourself — or that you are a failure or have let yourself or your family down

   Not at all Several days More than half the days Nearly every day

7. 7.Trouble concentrating on things, such as reading the newspaper or watching television

   Not at all Several days More than half the days Nearly every day

8. 8.Moving or speaking so slowly that other people could have noticed. Or the opposite — being so fidgety or restless that you have been moving around a lot more than usual

   Not at all Several days More than half the days Nearly every day

9. 9.Thoughts that you would be better off dead, or of hurting yourself in some way

   Not at all Several days More than half the days Nearly every day

Over the last 2 weeks, how often have you been bothered by any of the following problems?

1. 1.Feeling nervous, anxious, or on edge

   Not at all Several days More than half the days Nearly every day

2. 2.Not being able to stop or control worrying

   Not at all Several days More than half the days Nearly every day

3. 3.Worrying too much about different things

   Not at all Several days More than half the days Nearly every day

4. 4.Trouble relaxing

   Not at all Several days More than half the days Nearly every day

5. 5.Being so restless that it is hard to sit still

   Not at all Several days More than half the days Nearly every day

6. 6.Becoming easily annoyed or irritable

   Not at all Several days More than half the days Nearly every day

7. 7.Feeling afraid, as if something awful might happen

   Not at all Several days More than half the days Nearly every day

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

   Never Monthly or less 2–4 times a month 2–3 times a week 4 or more times a week

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

   1 or 2 3 or 4 5 or 6 7 to 9 10 or more

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

   Never Less than monthly Monthly Weekly Daily or almost daily

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

   Never Less than monthly Monthly Weekly Daily or almost daily

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

   Never Less than monthly Monthly Weekly Daily or almost daily

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

   Never Less than monthly Monthly Weekly Daily or almost daily

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

   Never Less than monthly Monthly Weekly Daily or almost daily

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

   Never Less than monthly Monthly Weekly Daily or almost daily

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

   No Yes, but not in the last year Yes, during the last year

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

    No Yes, but not in the last year Yes, during the last year