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Alcohol use disorder survey

The Alcohol Use Disorder Survey is a survey that was developed to assess an individual’s alcohol use and related problems. The survey is composed of questions that cover various aspects of alcohol use, including frequency of use, quantity consumed, and problems associated with alcohol use.

Time to complete

1 minute

Eligibility

There is no specific eligibility criterion to fill the Alcohol use disorder survey. However, it is advisable that the survey must be filled out by people who have consumed alcohol at some point in their lives.

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Questions for Alcohol use disorder survey

1.

Full Name

The answer should be a text input.
2.

Age

The answer should be a single choice:
  1. Under 18
  2. 18-24 years old
  3. 25-34 years old
  4. 35-44 years old
  5. 45-54 years old
  6. Over 55
3.

Gender

The answer should be a single choice:
  1. Male
  2. Female
  3. Other
  4. Prefer not to say
4.

Phone Number

The answer should be a phone number.
5.

Do you drink alcohol regularly?

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

How often do you drink alcohol?

The answer should be a single choice:
  1. Once a week
  2. 2-3 times a week
  3. 4-5 times a week
  4. Every day
7.

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

The answer should be a number input.
8.

What types of alcohol do you drink?

The answer should be a single choice:
  1. Beer
  2. Wine
  3. Spirits
9.

How do you feel after drinking alcohol?

The answer should be a single choice:
  1. Energized
  2. Relaxed
  3. Anxious
10.

Do you ever drink alcohol to cope with stress or other negative emotions?

The answer should be a single choice:
  1. Yes
  2. No
11.

Has drinking alcohol ever caused problems in your life?

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

Similar Ideas

  • Alcohol Use Disorders Identification Test (AUDIT)
  • Alcohol Problem Recognition Test (APRT)
  • Michigan Alcoholism Screening Test
  • Alcohol Dependence Scale (ADS)
  • Drug Abuse Screening Test (DAST)
  • Severity of Alcohol Dependence Questionnaire (SADQ)
  • Alcohol Smoking and Substance Involvement Screening Test (ASSIST)

Here are some FAQs and additional information
on
Alcohol use disorder survey

What is an alcohol use disorder?

An alcohol use disorder is a chronic and relapsing brain disease characterized by compulsive alcohol seeking and use, despite harmful consequences.

What percentage of the population has alcohol use disorder?

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. About 88,000 people die of alcohol-related causes every year in the United States.

What are the signs and symptoms of alcohol use disorder?

There are a variety of signs and symptoms associated with alcohol use disorder, including but not limited to drinking alcohol in excess, experiencing withdrawal symptoms when not drinking, blacking out or losing memory after drinking, continuing to drink despite negative consequences, and feeling a strong need or craving to drink.

What are the consequences of alcohol use disorder?

Alcohol use disorder can lead to a number of serious consequences, including but not limited to liver disease, pancreatitis, cancer, stroke, high blood pressure, heart disease, and problems with mental health.

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