Skip to content
Askalot

← All Healthcare templates

Questionnaire template

Alcohol Use and Attitudes

Measures adults' drinking frequency, quantity, settings, motives, perceived effects and harms, and interest in getting help.

Preview

Healthcare · Alcohol assessment. All Healthcare templates

Questions in this template

Your Drinking Habits

  1. Thank you for taking part in this survey about alcohol. Your answers will help us better understand drinking habits and respond to alcohol-related problems.

  2. How often do you have a drink that contains alcohol?

    Choose one from a list:

    • Daily
    • Weekly
    • Monthly
    • Rarely
    • Never
  3. On a typical occasion when you drink, how many drinks do you have?

    Asked only when q_drink_frequency.outcome is not None and q_drink_frequency.outcome != 5

    Choose one:

    • 1 to 2
    • 3 to 4
    • 5 to 6
    • 7 or more
  4. Which kinds of alcoholic drink do you have most often?

    Asked only when q_drink_frequency.outcome is not None and q_drink_frequency.outcome != 5

    Choose any that apply:

    • Beer
    • Wine
    • Spirits
    • Cocktails
    • Something else
  5. What else do you usually drink?

    Asked only when q_drink_frequency.outcome is not None and q_drink_frequency.outcome != 5 and q_beverage_types.outcome is not None and q_beverage_types.outcome & 16 != 0

    Open answer

  6. How often do you drink in each of these settings?

    Asked only when q_drink_frequency.outcome is not None and q_drink_frequency.outcome != 5

    • At home
    • At parties
    • At dinners or other social events
    • In bars or pubs

    For each row: choose one:

    • Never
    • Rarely
    • Sometimes
    • Often
    • Always

How You See Your Drinking

  1. How satisfied are you with the amount you currently drink?

    Choose one:

    • Very satisfied
    • Satisfied
    • Neither satisfied nor dissatisfied
    • Dissatisfied
    • Very dissatisfied
  2. What leads you to have a drink?

    Choose any that apply:

    • Pressure from other people
    • To unwind or ease stress
    • To enjoy social occasions
    • Out of habit
    • Something else
  3. What else leads you to drink?

    Asked only when q_drinking_motives.outcome is not None and q_drinking_motives.outcome & 16 != 0

    Open answer

  4. How much does alcohol affect your everyday life?

    Choose one:

    • Not at all
    • Slightly
    • Moderately
    • Significantly
    • Extremely
  5. In what ways does it affect your everyday life?

    Asked only when q_daily_life_effect.outcome is not None and q_daily_life_effect.outcome >= 2

    Open answer

  6. Have you noticed any effects of drinking on your body or your mind? Please describe them.

    Open answer

Health and Well-being

  1. Have you ever had any of the following because of drinking?

    Choose any that apply:

    • A hangover
    • A memory blackout
    • An injury
    • Problems in a relationship
    • Problems at work or school
    • None of these
  2. Do you think the way you drink has affected your health?

    Choose one:

    • Yes
    • No
  3. How has your health been affected?

    Asked only when q_health_impacted.outcome == 1

    Open answer

  4. How often do you think about getting help to cut down or stop drinking?

    Choose one from a list:

    • Always
    • Often
    • Sometimes
    • Rarely
    • Never

About This Survey

  1. What made you decide to take part in this survey?

    Open answer

  2. How could we make this survey better?

    Open answer