First Off - Do Not print this out and hand it to someone you think has a drinking problem, or might be an alcoholic. All that will accomplish is alienating that person. These questions are ONLY for people that wish to see them.

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 gotten into financial difficulties as a result of drinking?
7] Do you turn to lower companions and an inferior environment when drinking?
8] Does your drinking make you careless of your family's welfare?
9] Has your ambition decreased since drinking?
10] Do you crave 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 jeopardizing your job or business?
15] Do you drink to escape from worries or troulble?
16] Do you drink alone?
17] Have you ever had a complete loss of memory as a result of drinking?
18] Has your physician ever treated you for drinking?
19] Do you drink to build up your self-confidence?
20] Have you ever been to a hospital or institution on account of drinking?