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1. National Council on Alcoholism and Drug Abuse (Instrument #1) | 2. Johns Hopkins University Drinking Scale (Instrument #2)
3. Michigan Alcoholism Screening Test (MAST) (Instrument #3) | 4. 12 questions of Alcoholics Anonymous (Instrument #4)
Self Assessment Instrument #2

WHAT ARE THE SIGNS OF ALCOHOLISM?

by the Johns Hopkins University Drinking Scale

Ask yourself the following questions and answer them as honestly as you can
   
Yes
No
1.
Do you lose time from work due to drinking?
   
2.
Is drinking making your home life unhappy?
   
3.
Do you drink because you are shy with other people?
   
4.
Is drinking affecting your reputation?
   
5.
Have you ever felt remorse after drinking?
   
6.
Have you ever gotten into financial difficulties as a result of drinking?
   
7.
Do you turn to lower companions and an inferior environment while drinking?
   
8.
Does your drinking make you careless about your family's welfare?
   
9.
Has your ambition decreased since drinking?
   
10.
Do you crave a drink at a definite time, daily?
   
11.
Do you want a drink the next morning?
   
12.
Does your drinking cause you to have difficulties in sleeping?
   
13.
Has your efficiency decreased since drinking?
   
14.
Is your drinking jeopardizing your job or business?
   
15.
Do you drink to escape from worries and/or troubles?
   
16.
Do you drink alone?
   
17.
Have you ever had a complete loss of memory?
   
18.
Has your physician ever treated you for drinking?
   
19.
Do you drink to build your self confidence?
   
20.
Have you ever been to a hospital or institution on account of drinking?

Assessment Score: 
ASSESSMENT SCALE
Any "yes" answer indicates a probable symptom of alcoholism.
"Yes" answers to several questions indicate the following stages of alcoholism:

1 - 3 :   indicates a probable problem drinker

4 - 7:   indicates definite early alcoholism

7 - 10:   indicates an intermediate phase of alcoholism

10 - 20:   indicates advanced alcoholism

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Dita Teitelbaum, MSW LCSW
14440 SW 80th Avenue
Miami, FL 33158
Phone: 305-251-8609
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