Alcohol survey

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Alcohol survey

1. Age _____
2. Gender
* Female
* Male
3. Have you ever consumed alcohol?
* Yes
* No
4. Have you ever gotten drunk?
* Yes
* No

5. Howold were you when you first consumed alcohol?
_____

6. Why did you first consume alcohol ?
* Peer pressure
* Curiosity
* Because you felt like it
* Influence of a friend

7. Howoften do you have a drink containing alcohol?
* Never
* Monthly or less
* 2 to 4 times in a month
* 2 to 3 times a week
* 4 or more times a week

8. How many drinks containing alcoholdo you have on a typical day when you are drinking?
* 1
* 2-3
* 4-5
* 5-6
* More than 6
9. How often do you have six or more drinks on one occasion?
* Never
* Less thanmonthly
* Monthly
* Weekly
* Daily or almost daily
10. Thinking about the past year, what is the greatest number of drinks you've had on any one occasion?
1 __4 __ 7__
2 __ 5__ 8__
3 __ 6 __9 or more__

11. How often during the last year have you found that you were not able to stop drinking once you had started?
* Never
* Monthly
* Less than monthly
* Weekly* Daily or almost daily

12. How often during the last year have you failed to do what was normally expected from you because of drinking?
* Never
* Monthly
* Less than monthly
*Weekly
* Daily or almost daily
13. How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?
* Never
* Monthly
*Less than monthly
* Weekly
* Daily or almost daily
14. How often during the last year have you had a feeling of guilt or remorse after drinking?
* Never
* Monthly
* Less than...
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