Silence Hurts
Alcohol Abuse and Violence Against Women

Supplements

Assessment and Followup Screening Questions on Alcohol Use

  1. I would like to ask you some questions about your use of alcoholic beverages, like beer, wine, wine coolers, and hard liquor such as vodka, gin, and whiskey. Have you had a drink of alcohol in the past year?
    • No (interview ends) - 1
    • Yes (skip to 2) - 5
    • Unable to answer (interview ends) - 8
    • Refused to answer - 9

  3. During the last week, did you have any drink containing alcohol?
    • No (skip to 3) - 1
    • Yes - 5

    I would like to know the number of alcoholic drinks you've had each day in the last week. Today is ________________________. Let's begin with yesterday.

    How many drinks of beer, wine, or liquor did you have on (NAME DAY OF WEEK)?

    Number of Drinks

    Sunday

    		 ____
    Monday ____
    Tuesday ____
    Wednesday ____
    Thursday ____
    Friday ____
    Saturday ____
    Sunday ____

    Fill in the number of drinks consumed on each of the 7 days prior to the interview. The total represents the total number of drinks per week.

    Note:

    		 A single mixed drink = 1 drink
      A 12 oz. beer = 1 drink
      A shot of hard liquor = 1 drink
      A pint of hard liquor = 11 drinks
      A fifth of hard liquor = 18 drinks
      A 4 oz. glass of wine = 1 drink
      A pint of wine = 5 drinks
      A bottle of wine (40 oz.) = 8 drinks

  5. During the last 3 months, on days that you drank any alcohol, how many times did you drink four or more drinks in one day? ____

Source: Barry, K.L., Oslin, D.W., and Blow, F.C. (2001). Alcohol problems in older adults: Prevention and management. New York: Springer Publishing.

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