Alcohol abuse Assessment Questionnaire

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

• 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