GROUP: _____________ ID: ____________ Attachment F: Activity Worksheet Profile of an Excessive Drinker
Form Approved
OMB No. 0920-xxxx
Expiration date: xx/xx/xxxx
What they’re thinking when drinking:
PROFILE OF A TYPICAL EXCESSIVE DRINKER
When NOT drinking?
When drinking?
What they’re doing…
How
they feel when
drinking:
(draw their face)
DEMOGRAPHICS
AGE: ________
Circle responses below
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Race/Ethnicity: |
White |
Black |
|
|
Hispanic |
Asian |
Other:_________ |
|
|
Gender: |
Male |
Female |
|
|
Married? |
Yes |
No |
|
|
Kids? |
Yes |
No |
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File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Caitlin Krulikowski |
File Modified | 0000-00-00 |
File Created | 2021-01-23 |