Do you ever use alcohol for something other than a medical reason?
Yes
No
Do you use alcohol more than once per week?
Yes
No
Have you ever tried to stop using alcohol but couldn’t stay stopped?
Yes
No
Do you ever feel ashamed or guilty after using alcohol?
Yes
No
Have you ever lost a job due to alcohol use?
Yes
No
Do you find it challenging to control or reduce your alcohol use?
Yes
No
Have you experienced cravings or strong urges?
Yes
No
Does your alcohol use interfere with responsibilities at work, school, or home?
Yes
No
Do you spend a significant amount of time obtaining, using, or recovering from alcohol?
Yes
No
Have you given up activities you once enjoyed because of alcohol?
Yes
No
Do you experience withdrawal symptoms when not using alcohol?
Yes
No
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