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 got into financial difficulties as a result of drinking?
  7. Do you turn to lower companions and an inferior environment when drinking?
  8. Does drink make you careless of your family welfare?
  9. Has your ambition decreased since drinking?
  10. Do you crave for a drink at a definite time daily?
  11. Do you want a drink the next morning?
  12. Does drinking cause you to have difficulty in sleeping?
  13. Has your efficiency decreased since drinking?
  14. Is drinking jeopardising your job or business?
  15. Do you drink to escape from worries or trouble?
  16. Do you drink alone?
  17. Have you ever had a complete loss of memory as a result of drinking?
  18. Has a physician ever treated you for drinking?
  19. Do you drink to build up your self-confidence?
  20. Have you ever been in a hospital or institution on account of drinking?