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1. Do you lose time from work due to drinking?
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2. Is drinking making your home life unhappy?
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3. Do you drink because you are shy with other people?
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4. Is drinking affecting your reputation?
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5. Have you ever felt remorse after drinking?
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6. Have you gotten into financial difficulties as a result of your drinking?
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7. Do you turn to lower companions and an inferior enviornment when drinking?
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8. Does your drinking make you careless of your family's welfare?
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9. Has your ambition decreased since drinking?
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10. Do you crave a drink at a definite time daily?
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11. Do you want a drink the next morning?
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12. Does your drinking cause you to have difficulties in sleeping?
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13. Has your efficiency decreased since drinking?
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14. Is your drinking jeopardizing your job or business?
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15. Do you drink to escape from worries or troubles?
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16. Do you drink alone?
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17. Have you ever had a complete loss of memory?
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18. Has your physician ever treated you for drinking?
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19. Do you drink to build your self confidence?
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20. Have you ever been in a hospital or institution on account of drinking?