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Self-Assessment Tools: Alcohol Self-Screening

Alcohol screening instrument for self-assessment

for Faculty and Staff of the University of Wisconsin–Madison their immediate family members or significant others

Sponsored by the Employee Assistance Office

The following alcohol screening instrument is designed to assist you in understanding your use of alcohol.

No one has access to your results; it is for your purposes only. The instrument itself is a composite of two alcohol screening instruments: the Alcohol Use Disorders Identification Test (AUDIT) developed by the World Health Organization and the CAGE questionnaire developed by researchers at the University of North Carolina. Both instruments are widely respected alcohol screening tools. There is no computer-related interactive component to this instrument so that your anonymity is protected.

Directions

Number a sheet of paper from 1–12. Read each question, one at a time, and simply choose one of the responses that fits your circumstance. Each response is weighted from 0–4 as indicated in parentheses. Place the score that appears in the parenthesis as the end of the response you’ve chosen next to the number of the question on your sheet of paper.

  1. How often do you have a drink containing alcohol?
    1. never (0)
    2. monthly or less (1)
    3. two or four times/month (2)
    4. two or three times/week (3)
    5. four or more times/week (4)
  2. How many drinks containing alcohol do you have on a typical day when you are drinking?
    1. 1 or 2 (0)
    2. 3 or 4 (1)
    3. 5 or 6 (2)
    4. 7 to 9 (3)
    5. 10 or more (4)
  3. How often do you have six or more drinks on one occasion?
    1. never (0)
    2. less than monthly (1)
    3. monthly (2)
    4. weekly (3)
    5. daily or almost daily (4)
  4. How often during the last year have you been unable to remember what happened the night before because of drinking?
    1. never (0)
    2. less than monthly (1)
    3. monthly (2)
    4. weekly (3)|
    5. daily or almost daily (4)
  5. How often during the last year have you found that you were not able to stop drinking once you started?
    1. never (0)
    2. less than monthly (1)
    3. monthly (2)
    4. weekly (3)
    5. daily or almost daily (4)
  6. How often during the last year have you failed to do what is normally expected from you because of drinking (e.g., missed deadlines, poor work attendance, failed committee responsibilities, inconsistent work patterns?)
    1. never (0)
    2. less than monthly (1)
    3. monthly (2)
    4. weekly (3)
    5. daily or almost daily (4)
  7. Have you or someone else been injured as a result of your drinking?
    1. no (0)
    2. yes, but not in last year (2)
    3. yes, during last year (4)
  8. Has a relative or friend or doctor or other health worker been concerned about your drinking or suggested you cut down?
    1. no (0)
    2. yes, but not in last year (2)
    3. yes, during last year (4)
  9. How often in the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?
    1. never (0)
    2. less than monthly (1)
    3. monthly (2)
    4. weekly (3)
    5. daily or almost daily (4)
  10. How often during the past year have you had feelings of guilt or remorse after drinking?
    1. never (0)
    2. less than monthly (1)
    3. monthly (2)
    4. weekly (3)
    5. daily or almost daily (4)
  11. Have people annoyed you by criticizing your drinking?
    1. no (0)
    2. yes, but not in last year (2)
    3. yes, during last year (4)
  12. Have you ever felt that you should cut down on your drinking?
    1. no (0)
    2. yes, but not in last year (2)
    3. yes, during last year (4)

Please keep in mind that this is not an interactive form. The computer will not offer a response based on what your score.

Scoring

After you have finished, total your individual item scores into one composite score for all 12 questions. Next, total your individual item scores for the last four questions only (#9-12). You should now have two composite scores - one for all twelve questions and one for the last four questions.

Interpretation

A score of 8 or more for all twelve questions indicates that a harmful level of alcohol consumption is likely. The last four questions (9, 10, 11, 12) are considered a separate “sub-assessment” embedded into the entire self-administered instrument. On only the last four items, a total score of 1 - 2 indicates that you may have a drinking problem. A score of 3 or more indicates there is a significant possibility that you have a problem with alcohol. If your score exceeds the cut-off values on either instrument, you should seek help.

Questions?

If you have any questions about your or someone else’s alcohol usage, please contact the Employee Assistance Office at 263-2987 to schedule an appointment with one of our staff members.

The CAGE is reprinted with the permission of John A. Ewing and the University of North Carolina Medical School Copyright, 1993 Helen Dwight Educational Foundation.