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Do you lose time from work due to your addiction/drinking?
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Is addiction/drinking making your home life unhappy?
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Do you use/drink because you are shy with other people?
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Is addiction/drinking affecting your reputation?
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Have you ever felt remorse after using/drinking?
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Have you gotten into financial difficulties as a result of your addiction/drinking?
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Do you turn to lower companions and an inferior environment when using/drinking?
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Does your addiction/drinking make you careless of your family's welfare?
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Has your ambition decreased since addiction/drinking?
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Do you crave a drug/drink at a definite time daily?
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Do you crave a drug/drink at a definite time daily?
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Do you crave a drug/drink at a definite time daily?
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Has your efficiency decreased since using/drinking?
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Is addiction/drinking jeopardizing your job or business?
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Do you use/drink to escape from worries or troubles?
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Do you use/drink alone?
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Have you ever had a complete loss of memory as a result of your using/drinking?
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Has your physician ever treated you for using/drinking?
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Do you use/drink to build up your self-confidence?
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Have you ever been in a hospital or institution on account of using/drinking?
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