undefined
HomeAll templatesself assessmentsalcohol addiction survey

Alcohol addiction survey

The purpose of this survey is to gather information about people's experiences with alcohol addiction. The survey will ask about your personal experiences with alcohol addiction, as well as your thoughts on the causes, treatments, and consequences of addiction.

Time to complete

1 minute

Eligibility

There are no specific eligibility criteria to fill the Alcohol Addiction Survey. However, the survey is designed to collect feedback from individuals who have recently received treatment for alcohol addiction from a healthcare provider.

undefined

Questions for Alcohol addiction survey

1.

How often do you drink alcohol?

The answer should be a single choice:
  1. Never
  2. Rarely
  3. Occasionally
  4. Monthly
  5. Weekly
  6. Daily
2.

How many drinks do you usually have when you drink alcohol?

The answer should be a single choice:
  1. 1-2
  2. 3-4
  3. 5-6
  4. more than 7
3.

How long have you been drinking alcohol?

The answer should be a single choice:
  1. Less than 6 months
  2. 6 months to 1 year
  3. 1-2 years
  4. 3-5 years
  5. More than 5 years
4.

Do you feel that you need to drink alcohol in order to feel happy or relaxed?

The answer should be a single choice:
  1. Yes
  2. No
5.

Have you ever tried to quit drinking alcohol but found that you couldn’t?

The answer should be a single choice:
  1. Yes
  2. No
6.

Do you ever drink more alcohol than you intended to?

The answer should be a single choice:
  1. Yes
  2. No
7.

Do you ever drink alcohol even though you know it’s going to make you feel worse?

The answer should be a single choice:
  1. Yes
  2. No
8.

Do you ever drink alcohol to relieve stress or anxiety?

The answer should be a multiple choice:
  1. Never
  2. Sometimes
  3. Always
9.

How often during the past year have you failed to do what was normally expected from you because of drinking?

The answer should be a multiple choice:
  1. Never
  2. Weekly
  3. Less than monthly
  4. Almost daily
10.

Do you ever drink alcohol even though you know it’s going to make you feel tired and sluggish the next day?

The answer should be a multiple choice:
  1. Never
  2. Sometimes
  3. Always

Similar Ideas

  • Drug addiction survey
  • Substance addiction survey
  • Porn addiction survey

Here are some FAQs and additional information
on Alcohol addiction survey

What is an alcohol addiction survey?

An alcohol addiction survey is a questionnaire that is used to collect information about someone’s alcohol use. It is used to assess whether someone has an alcohol problem and to determine the severity of the problem.

What is the alcohol addiction rate?

More than 6 percent of adults in the U.S. have an alcohol use disorder, about 1 in 12 men and 1 in 25 women. An additional 623,000 people between the ages of 12 and 17 have alcohol use disorders.

How long does it take to complete an alcohol addiction survey?

The length of time it takes to complete an alcohol addiction survey can vary depending on the survey. However, most surveys can be completed in less than 10 minutes.

Want to use this template?

Loved by people at home
and at work

undefined
“BlockSurvey is a simple, effective, and scalable tool for creating surveys for leadership and learning assessment. It's one of this year's best buying choices. Each month, it keeps improving and strives to serve its customers needs.”
Nelson Emilio
Personal Branding Strategist
undefined
“I use BlockSurvey to get feedback about all my activities and events. It is really easy to get started and create my first surveys! Then I could see how easy it was to share them. Now I am thinking to use BlockSurvey also within my creative process as an author in order to listen and engage with my audience, knowing that anonymity provides the most sincere and reliable answers.”
Georgina García-Mauriño
Author & Designer
BlockSurvey social proof
G2 Crowd
4.8 Star Rating
BlockSurvey social proof
Dapp.com
Editor's choice
BlockSurvey social proof
Capterra
4.9 Star Rating

What's next? Try out templates like
Alcohol addiction survey

1000+ Templates, 50+ Categories

Explore more
undefined
Healthy Eating Assessment
The Healthy Eating Assessment is a tool used to evaluate an individual's diet and nutrition habits. This assessment can help identify areas for improvement and can provide guidance on how to make healthier eating choices. 
undefined
Financial Wellbeing Scale
The Financial Wellbeing Scale is a tool used to measure a person's overall financial health. It is designed to assess the level of financial wellbeing an individual is experiencing in their current financial situation. 
undefined
Time Management Scale
The Time Management Scale is a tool used to measure an individual’s self-reported ability to manage their time effectively. It assesses the individual’s ability to prioritize tasks, plan ahead, and stay organized. The scale consists of items that measure the individual’s attitude toward time management, their control over their time, their ability to plan and execute tasks, and how they manage their time in different contexts.
undefined
Mindful Attention Awareness Scale
The MAAS is a 15-item scale designed to assess a core characteristic ofdispositional mindfulness. The scale shows strong psychometric propertiesand has been validated with college, community, and cancer patient samples. 
undefined
Coping Self Efficacy Scale
The Coping Self-Efficacy Scale (CSES) is a self-report measure designed to assess an individual's perceived ability to use effective coping strategies. 
undefined
Hoffman Male Gender Scale
The Hoffman Male Gender Scale is a psychological assessment tool used to measure the degree to which an individual identifies with traditionally masculine attributes.
undefined
SCOFF Questionnaire
The SCOFF questionnaire is a screening tool developed in 1999 to help identify adolescents and adults who may be at risk for eating disorders.
undefined
Zung Self Rating Depression Scale
The Zung Self Rating Depression Scale is a psychological assessment tool used to measure the severity of depression in individuals. It consists of 20 items that measure different aspects of depression such as mood, feelings of worthlessness, lack of activity, sleep disturbances, and thoughts of death or suicide. 
undefined
Dr Neffs Self Compassion Scale
Dr. Neff’s Self-Compassion Scale (SCS) is a psychometric measure designed to measure the construct of self-compassion. It is a self-report measure, consisting of 26 items that assess three components of self-compassion: Self-kindness, Common Humanity, and Mindfulness.
undefined
Novaco Anger Scale
The Novaco Anger Scale is a self-reported measure of anger and related emotion developed by psychologist Raymond Novaco.  The Novaco Anger Scale is used to assess the frequency, intensity, and duration of angry feelings, as well as the cognitive and physiological responses associated with anger. 
undefined
The holmes rahe life stress inventory
The Holmes-Rahe Life Stress Inventory is a questionnaire designed to measure the amount of stress in a person's life. The questionnaire lists 43 life events, each of which is assigned a certain number of life change units.
undefined
Epworth Sleepiness Scale
The Epworth Sleepiness Scale is widely used in the field of sleep medicine as a subjective measure of a patient's sleepiness.
undefined
Mood Disorder Assessment
The goal of the assessment is to identify the underlying cause of the individual's mood disorder and to determine the best treatment approach.
undefined
The Procrastination Test
The Procrastination Test helps people identify and overcome their procrastination habits. Take the test today to start your journey to becoming a more productive and successful person.
undefined
Zung Self Rating Anxiety Scale
The Zung Self-Rating Anxiety Scale was designed to quantify the level of anxiety of patients experiencing anxiety-related symptoms. 
undefined
Evaluative Belief Scale
The Evaluative Beliefs Scale (EBS) measures negative personal evaluations, a key class of beliefs within cognitive psychotherapy and thought to be closely linked to emotional disturbance.
undefined
Beck Hopelessness Scale
The Beck Hopelessness scale is a powerful indicator of eventual suicide. It examines an individual's thoughts and beliefs about the future, loss of motivation and expectation.
undefined
Beck Scale For Suicide Ideation
The Beck Scale for Suicidal Ideation is a self-report measure based on the semi-structured interview, the Scale for Suicidal Ideation or SSI. The SSI was developed for use with adult psychiatric patients.
undefined
Holland Codes RIASEC Test
The Holland Code (RIASEC) refers to both career theory and professional choice based on personality types. It was created by a well-known American scientist, psychologist, John L. Holland.
undefined
Schein Career Anchors Test
The Career Anchors method was developed in the mid-1970s by Edgar Schein - a leading organizational psychologist and specialist in corporate culture. It aims to determine the main professional motives, study a person's system of value orientations, their social attitudes to career and work in general.
undefined
Rathus Assertiveness Schedule
In 1973, Spencer Rathus proposed his own questionnaire called the Rathus Assertiveness Schedule, or RAS.
undefined
Rational Experiential Inventory
The Rational Experiential Inventory (REI) was published by Pacini & Epstein in 1999. The theoretical basis for this questionnaire is Epstein’s theoretical work, known as the Cognitive Experiential Self Theory (CEST). According to this theory, each person to some extent uses two conceptually different thinking styles: a preconscious experiential system (fast intuitive automatic) and a conscious rational system (slower logical)
undefined
Perfectionism Test
In the modern world, people are more and more striving to achieve success in all areas of life. According to psychologists, this desire for self-improvement and achieving the ideal can be described as perfectionism. This test is designed to identify your problem with perfection. Through this test, you will gain insight into how perfectionistic tendencies may be impacting your life and relationships.
undefined
Imposter Syndrome Test
This test will help you find out how much you tend to question your abilities and achievements.
undefined
UCLA Loneliness Scale
The UCLA Loneliness Scale is the most widely used technique for diagnosing a person's subjective feelings of loneliness and social isolation.
undefined
Autism Spectrum Quotient Test
In 2001, Simon Barron-Cohen and his colleagues at the Cambridge Autism Research Centre developed the Autism-Spectrum Quotient Test (AQ) questionnaire to measure ASD propensity. 
undefined
Eating Attitudes Test
The Eating Attitudes Test (EAT-26) was developed in 1982 by Garner, Olmsted, Bohr, and Garfinkel and is by far the most widely used tool for identifying the risk of eating disorders.
undefined
Five Facet Mindfulness Questionnaire
In 2006, Ruth A. Baer and colleagues developed this questionnaire to measure the tendency to be mindful in daily life.
undefined
Binge Eating Scale
The BES is a 16-item questionnaire assessing the presence of certain binge eating behaviors which may be indicative of an eating disorders.
undefined
Oxford Happiness Questionnaire
The test was originally supposed to be used only within the walls of Oxford, but it quickly became popular and ceased to be a tool for internal use.
undefined
Social Phobia Inventory
The Social Phobia Inventory (abbreviated as SPIN) is a 17-item questionnaire developed by the Psychiatry and Behavioral Sciences Department at Duke University. It is effective in screening for, and measuring the severity of social anxiety disorder.
undefined
Diagnostic Screen for Gambling Disorders
The is a rapid screening test for adult pathological gambling problems.
undefined
CAGE Alcohol Questionnaire
The CAGE (acronym) is a 4-item questionnaire that can indicate potential problems with alcohol abuse.
undefined
Bergen Shopping Addiction Scale
The Bergen Shopping Addiction Scale (BSAS) is a self-report scale designed to measure the severity of shopping addiction. The BSAS can help to identify individuals at risk of developing a shopping addiction and can be used to track the progress of treatment.
undefined
Bipolar Disorder Survey
The Bipolar Disorder Survey is designed to help individuals better understand their condition and identify potential treatments. The survey covers topics such as symptoms, diagnosis, and treatment options. It also includes questions about how the disorder has impacted the individual's life.
undefined
Instagram Addiction Test
The Instagram Addiction Test is a simple self-assessment test that will help you determine if you are addicted to using Instagram.
undefined
Anxiety Evaluation Form
An anxiety evaluation form is a form that is used to evaluate a person's level of anxiety. It is a form that is used to help determine if a person has an anxiety disorder and to what extent.
undefined
Becks Anxiety Inventory Form
The Beck Anxiety Inventory Form is a tool that can be used to help identify the presence and severity of symptoms of anxiety.
undefined
Binge Eating Disorder Survey
Binge eating disorder (BED) is a type of eating disorder characterized by episodes of binge eating followed by a feeling of guilt or shame. People with BED often eat large amounts of food in a short period of time, even when they are not hungry.
undefined
Attention Deficit Disorder Survey
The Attention Deficit Disorder Survey is a tool that can be used to help diagnose attention deficit disorder. It is a self-report measure that asks questions about symptoms of inattention, hyperactivity, and impulsivity. The survey can be used by parents, teachers, or mental health professionals to help identify individuals who may have attention deficit disorder.
undefined
Eating Disorder Survey
The Eating Disorder Survey is used to help individuals suffering from an eating disorder to better understand their condition and to find effective treatment options. The survey asks questions about the frequency and severity of symptoms, as well as the impact of the disorder on daily life.
undefined
Self evaluation form
A self-evaluation form individuals to assess their own performance over a period of time. This form can be used by employees, students, or anyone else who wants to reflect on their progress and identify areas in which they need to improve. The form should include questions that cover a variety of topics, such as work habits, attitude, and skills.
undefined
Wellness Evaluation Form
A wellness evaluation form is used to assess an individual's physical and mental well-being. The form can be used by healthcare professionals, employers, or individuals themselves. The purpose of a wellness evaluation form is to help identify areas of improvement for an individual's overall health and wellbeing. It can be used to set health goals, make lifestyle changes, or track progress over time.
undefined
Facebook addiction survey
Facebook addiction survey is a research survey that aims to study the prevalence of Facebook addiction and its effects on users. The survey will be conducted online and will be open to all Facebook users. The survey will ask questions about the frequency and duration of Facebook use, as well as the perceived effects of Facebook addiction on users' daily lives. The survey will also ask users to rate their level of agreement with a series of statements about Facebook addiction.
undefined
Technology addiction survey
Technology addiction survey is a tool that can be used to collect data about people's addiction to technology. It can be used to collect data about the extent of people's addiction, the types of technology they are addicted to, and the impact of technology addiction on their lives.
undefined
Gambling addiction survey
Gambling addiction survey is a questionnaire that is used to collect data about gambling addiction. The survey asks questions about the respondent's gambling habits, such as how often they gamble, how much money they spend on gambling, and whether they have ever experienced problems with gambling. The survey also asks questions about the respondent's personal life, such as their age, gender, and education level.
undefined
Food addiction survey
This survey is designed to help us understand how people feel about food addiction. The survey will ask about your thoughts and experiences with food addiction, as well as your current eating habits. The survey is anonymous and will take about 5 minutes to complete.
undefined
Cellphone addiction survey
This survey is designed to help us understand how people use their cellphones and how addicted they are to them. The survey will ask you questions about how often you use your cellphone, what you use it for, and how it affects your life.
undefined
Drug addiciton survey
The survey is designed to gather information about people's experiences with drug addiction. The survey will ask about your personal experiences with drug addiction, as well as your thoughts on the subject. The survey is anonymous and confidential, and your answers will be used to help researchers better understand drug addiction and its impact on people's lives.
undefined
Addiction severity index assessment form
The Addiction Severity Index (ASI) is a standardized assessment tool used to provide a multidimensional assessment of an individual's drug and alcohol problems, mental health problems, and social functioning. The ASI has been used extensively in research and clinical settings to evaluate the need for, and effectiveness of, treatment for substance use disorders.
undefined
Alcohol addiction survey
The purpose of this survey is to gather information about people's experiences with alcohol addiction. The survey will ask about your personal experiences with alcohol addiction, as well as your thoughts on the causes, treatments, and consequences of addiction.
undefined
Basic Computer Skills Self Assessment
Computers are an intrinsic part of most, if not all, jobs in the modern world. For this reason, most employers require their employees to have basic computer skills. But how do you know if you’ve acquired these skills? This self-assessment is designed to help you determine if you have the basic skills needed for today's increasingly technological workplace.
undefined
Video Game Addiction Test
Having a hobby is always a fun and refreshing thing in our stressful day-to-day life, but when you go too far with a hobby, and at some point in time, it becomes an addiction, that is the real problem. Video Game Addiction or “gaming disorder” is one such behavioral addiction. 
undefined
Internet Addiction Test
Tired of feeling like you are overworked, overwhelmed and at a loss for how to conquer your digital addiction? Or looking at starting the digital detox or simply want to know more?
undefined
SAST Sexual Addiction Screening Test
The Sexual Addiction Screening Test (SAST) is intended to assist in the detection of sexually compulsive or "addictive behavior. Established in collaboration with clinics, recovery facilities, private therapists, and community organizations, SAST offers a profile of responses that help to differentiate between addictive and non-addictive behavior.
undefined
Chen Internet Addiction Scale
The Chen Internet Addiction Test was developed by Dr. Chin-Yi Chen, MD, in order to determine internet addiction in students and young people. This tool is free for anyone who are interested in this kind of test!
undefined
Smart Phone Addiction Test
In this smartphone addiction test, you'll figure if you are addicted or not. Please read all the questions carefully and mark the answer that best suits you. Before choosing an answer, consider how frequently you experience the problems listed above.
undefined
Social Media Addiction Questionnaire
Social media addiction is nothing but a behavioral addiction diagnosed as overuse of social networking sites, an uncontrollable drive to log on to it, and spending more no—daily hours in social media, affecting other aspects of life.
undefined
PATHOS Sexual Addiction Screening Questionnaire
The PATHOS Sexual Addiction Screening Questionnaire is a tool designed to help identify individuals who may be struggling with sexual addiction. The questionnaire consists of 30 items, each of which is rated on a scale from 0 to 4. A total score of 30 or higher indicates a possible problem with sexual addiction.
undefined
Bergen Social Media Addiction Scale
The Bergen Social Media Addiction Scale is a tool used to measure an individual’s level of addiction to social media. It consists of six items that assess an individual’s level of preoccupation, withdrawal, tolerance, and negative consequences associated with social media use.

Want to create secure online forms and surveys?

Join BlockSurvey.

SHARE