Appendix G

AL. ALCOHOL CONSUMPTION
AL1

In the last 12 months, in a typical week, about
how many alcoholic drinks did you consume? (A
drink is the equivalent of 1 bottle of beer, 1 glass
of wine, 1 can or bottle of wine cooler, 1 cocktail
or 1 shot or jigger of liquor). [MARK ONLY ONE]

9 1 DID NOT DRINK ANY ALCOHOL IN THE PAST
YEAR [SKIP TO “NH” SECTION]

9 2 LESS THAN 1 DRINK (DRANK SOME ALCOHOL IN
THE PAST YEAR, BUT LESS THAN ONCE A WEEK)

9 3 1-2 DRINKS PER WEEK
9 4 3-4 DRINKS PER WEEK
9 5 5-6 DRINKS PER WEEK
9 6 7-13 DRINKS PER WEEK (BETWEEN 1 AND 2
DRINKS A DAY)

AL2 During the last 12 months, about how

often did you drink five or more alcoholic
drinks in a single day? [MARK ONLY ONE]

91

NEVER IN THE PAST YEAR

92
93
94

1 OR 2 TIMES IN THE LAST 12 MONTHS
3 TO 6 TIMES IN THE LAST 12 MONTHS
7 TO 11 TIMES IN THE LAST 12
MONTHS

95
96

ONCE A MONTH
2 TO 3 TIMES A MONTH

97
98

ONCE A WEEK
2 TIMES A WEEK
3-4 TIMES A WEEK

99

9 7 14 OR MORE DRINKS PER WEEK (AT LEAST 2

9 10 NEARLY EVERY DAY
9 11 EVERY DAY

9 97

9 97 DON’T KNOW, NOT SURE, REFUSED

DRINKS A DAY)

DON’T KNOW, NOT SURE, REFUSED

YES

NO

DON’T
KNOW

REFUSED

9

9

9

9

9

9

9

9

9

9

9

9

9

9

9

9

b. ...find yourself shaking?

9

9

9

9

c. ...feel anxious or nervous when the effects of alcohol were wearing off?

9

9

9

9

d. ...feel more restless than usual, or find yourself sweating or your heart beating fast?

9

9

9

9

e. ...feel sick to your stomach or vomit when the effects of alcohol were wearing off?

9

9

9

9

f. ...have fits or seizures or see, feel or hear things that weren’t really there?

9

9

9

9

9

9

9

9

AL3

“I am going to read you a list of experiences that many people have reported in
connection with their drinking. As I read each experience, please tell me if this
has happened to you in the last 12 months, did you ...

a. ...find that your usual number of drinks had much less effect on you than it once did

or that you had to drink much more to get the effect you wanted?
b. ...more then once try or want to stop or cut down on our drinking, but found you

could not do it?
c. ...have a period when you ended up drinking more or longer than you meant to?
AL4 The next few questions are about the bad aftereffects of drinking that people
may have when the affects of drinking are wearing off or the morning after drinking. In
the last 12 months, did you...
a. ...have trouble falling asleep or staying asleep when the affects of alcohol were

wearing off?

AL5

...take a drink or use any drug or medicine, other than aspirin, Advil or Tylenol to

get over or keep from having any of these bad aftereffects of drinking?

YES

NO

DON’T
KNOW

REFUSED

AL6

...have period when you spent a lot of time drinking or being sick or getting over
the bad aftereffects of drinking?

9

9

9

9

A7

...give up or cut down on activities that were important to you or that you were
interested in, in order to drink – like work, school, or associating with friends or
relatives?

9

9

9

9

uninterested in things, or suspicious or distrustful of other people?

9

9

9

9

A9

...continue to drink even though you knew it was causing you a health problem
or making a health problem worse?

9

9

9

9

A10

...Have a period when you drinking or being sick from drinking often interfered
with taking care of your home or family?

9

9

9

9

A11

...have job or school troubles because of your drinking or being sick from
drinking – like missing too much work, not doing your work well or losing a job?

9

9

9

9

A12

...get into situations while drinking or after drinking that increased your chances
of getting hurt – like driving after drinking, using machinery, or walking in a
dangerous area or around heavy traffic?

9

9

9

9

family or friends?

9

9

9

9

A14

...get into physical fights while drinking or right after drinking?

9

9

9

9

A15

...get arrested, held at a police station, or have any other legal problems

9

9

9

9

[continuation] In the last 12 months, did you...

A8

A13

...continue to drink even though you knew it was making you feel depressed,

...continue to drink even though you knew it was causing you trouble with your

because of your drinking?