Assessment
Questionnaire

Have a symptom?
See what questions
a doctor would ask.
 

Alcohol abuse Assessment Questionnaire

Questions Your Doctor May Ask - and Why!

During a consultation, your doctor will use various techniques to assess the symptom: Alcohol abuse. These will include a physical examination and possibly diagnostic tests. (Note: A physical exam is always done, diagnostic tests may or may not be performed depending on the suspected condition) Your doctor will ask several questions when assessing your condition. It is important to openly share any pertinent information to help your doctor make an accurate diagnosis.

It is also very important to bring an up-to-date list of all of your all medical conditions, medications including dosages, and names of numbers of any specialist you see.

Create your printable checklist by answering questions that your doctor may ask below:

Privacy Statement
No private information is transferred over the internet. Do not use the "Browser back button", as this may cause data loss.

  1. Alcohol history

    Why: document age started drinking, type of alcohol preferred, daily alcohol consumption, days per week alcohol is consumed.

  2. If answer yes to two of the following 4 questions, suggestive of a problem drinker
    • 1. Have you ever felt you should cut down on your drinking?
    • 2. Have people annoyed you by criticising your drinking?
    • 3. Have you ever felt bad or guilty about your drinking?
    • 4. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?
    • Effect of alcohol abuse on relationships, occupation and finances?
    • Is there a history of absenteeism?
    • Is there a family history of alcohol problems?
    • Is there a family history of depression or anxiety?
    • Do you consume alcohol?

      Why: Sometimes the simplest of questions are a good way for your Health Professional to "unlock" the path to helping you with your problems.

    • How much alcohol do you consume, and when do you consume it?

      Why: This will communicate your pattern of alcohol drinking, and gives some indication as to whether your abuse alcohol or have alcohol dependence. They are two different things, and those who abuse alcohol are not necessarily "addicted" (dependent) to alcohol. Those however who have alcohol dependence may have or have had alcohol abuse issues.

    • How long have you been consuming alcohol in this way?

      Why: This may give an indication of how entrenched you alcohol abuse behavior is, and thus may affect the approach recommended by your Health Professional.

    • What do you like about your alcohol consumption? Now what do you not like about your alcohol consumption?

      Why: This technique is an active interviewing technique used by Health Professionals to assist in motivating you to engage in treatment for whatever problem you may be experiencing, i.e. smoking, drinking. For your management plan to be successful you must first want to make change happen, and realize that there you have a problem you want to "fix". Knowing you have a "problem" but not wanting to fix it imparts a low chance of success if a treatment strategy is embarked upon.

    • Can you identify any major effects that your alcohol has had on your friendships, relationships, family, work/study or criminal record?

      Why: These are all areas of one's life which can be negatively impacted by alcohol abuse.

    • Do you take any illegal drugs such as marijuana?

      Why: Those with alcohol abuse are more likely to be using illegal drugs and it is important for your health professional to know this.

    • Have you ever harmed yourself or others while drinking?

      Why: This question allows your health professional to asses the severity of alcohol abuse.

    • Have you ever missed work due to alcohol use?

      Why: Again this question can help determine the severity of alcohol abuse.

    • Have you found yourself being unusually tired or fatigued?

      Why: Chronic alcohol use can cause anemia.

    • Have you ever experiences any abdominal pain, nausea, vomiting (without or without blood) or jaundice -Chronic alcohol use is damaging to your stomach, liver and pancreas causing conditions such as: peptic ulcers disease, gastritis, acute hepatitis, cirrhosis and pancreatitis
    • Men: Have you experiences any testicular shrinkage or impotence? Women: Do you suffer form irregular periods?

      Why: Alcohol can have negative effects on hormone levels.

    • Do you have any painful joints?

      Why: Gout is strongly linked to alcohol abuse.

    • Have you ever had any numbness or tingling in your arms of legs?

      Why: Chronic alcohol consumption can cause peripheral neuropathy.

    • Have you ever had any chest pain?

      Why: High levels of alcohol use increase a person's risk of cardiovascular disease.

    1. Symptoms of withdrawal

      Why: e.g. tremor, hallucinations, delirium tremens.

    2. Tiredness

      Why: due to effect of alcohol itself, insomnia associated with alcohol or due to anemia.

    3. Heartburn or indigestion
    4. Abdominal pain

      Why: suggesting possible pancreatitis, alcoholic hepatitis, gastritis, reflux oesophagitis, peptic ulcers.

    5. Diarrhea

      Why: due to alcohol, fatty stools from alcoholic pancreatitis.

    6. Symptoms of heart disease as a complication of alcohol

      Why: e.g. arrhythmias, congestive cardiac failure.

    7. "Blackouts"
    8. Memory problems

      Why: suggestive of possible alcoholic dementia or pellagra.

    9. Impotence
    10. Leg numbness

      Why: suggesting peripheral neuropathy.

    11. Testicular atrophy in men
    12. Amenorrhea, infertility, spontaneous abortion in women
    13. Depressive symptoms
    14. Insomnia

Conditions listing medical symptoms: Alcohol abuse:

The following list of conditions have 'Alcohol abuse' or similar listed as a symptom in our database. This computer-generated list may be inaccurate or incomplete. Always seek prompt professional medical advice about the cause of any symptom.

Select from the following alphabetical view of conditions which include a symptom of Alcohol abuse or choose View All.

Conditions listing medical complications: Alcohol abuse:

The following list of medical conditions have 'Alcohol abuse' or similar listed as a medical complication in our database.

 

By using this site you agree to our Terms of Use. Information provided on this site is for informational purposes only; it is not intended as a substitute for advice from your own medical team. The information on this site is not to be used for diagnosing or treating any health concerns you may have - please contact your physician or health care professional for all your medical needs. Please see our Terms of Use.

Home | Symptoms | Diseases | Diagnosis | Videos | Tools | Forum | About Us | Terms of Use | Privacy Policy | Site Map | Advertise