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ALCOHOLICS ANONYMOUS QUESTIONNAIRE
ARE YOU AN ALCOHOLIC?

To answer this question, ask yourself the following 20 questions and circle either "Yes" or "No". Answer each question as honestly as you can.
1 . Do you lose time from work due to drinking? Yes No
2 . Is drinking making your home life unhappy? Yes No
3 . Do you drink because you are shy with other people? Yes No
4 . Is drinking affecting your reputation? Yes No
5 . Have you ever felt remorse after drinking? Yes No
6 . Have you gotten into financial difficulties as a result of drinking? Yes No
7 . Do you turn to lower companions and an inferior environment when drinking? Yes No
8 . Does your drinking make you careless of your family's welfare? Yes No
9 . Has your ambition decreased since drinking? Yes No
10 . Do you crave a drink at a definite time daily? Yes No
11 . Do you want a drink the next morning? Yes No
12 . Does drinking cause you to have difficulty in sleeping? Yes No
13 . Has your efficiency decreased since drinking? Yes No
14 . Is drinking jeopardizing your job or business? Yes No
15 . Do you drink to escape from worries or trouble? Yes No
16 . Do you drink alone? Yes No
17 . Have you ever had a complete loss of memory as a result of drinking? Yes No
18 . Has your physician ever treated you for drinking? Yes No
19 . Do you, drink to buildup your self-confidence? Yes No
20 . Have you ever been to a hospital or institution on account of drinking? Yes No

If you have answered YES to-any of the questions there is a definite warning that you may be an alcoholic.
If you have answered YES to any two, the chances are that you are an alcoholic.
If you have answered YES to three or more, you are definitely an alcoholic

The foregoing Test questions are used by Johns Hopkins University Hospital, Baltimore, MD, to help in determining whether or not a patient is an alcoholic.