Questionnaire template
Alcohol Withdrawal Experiences
Explores withdrawal symptoms, their severity and onset, and coping methods among people cutting down or stopping alcohol.
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Healthcare · Alcohol assessment. All Healthcare templates
Questions in this template
Symptoms After Cutting Down
Thank you for sharing your experience of cutting down or stopping alcohol. Taking part is voluntary and your answers are kept confidential.
Seizures, hallucinations or severe confusion after stopping alcohol can be dangerous. If you have these symptoms now, please seek medical help straight away.
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Since you reduced or stopped drinking, have you had any physical symptoms you think were caused by the change?
Choose one:
- Yes
- No
- Not sure
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Which of these symptoms have you had?
Asked only when
q_symptoms_noticed.outcome == 1Choose any that apply:
- Shaking hands
- Sweating
- Racing heart
- Trouble sleeping
- Nausea or vomiting
- Seeing or hearing things that were not there
- Seizures
- Something else
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What other symptoms did you have?
Asked only when
q_symptoms_noticed.outcome == 1 and q_symptoms_experienced.outcome is not None and q_symptoms_experienced.outcome & 128 != 0Open answer
Severity and Timing
Asked only when q_symptoms_noticed.outcome == 1
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At its worst, how severe was each symptom?
- Shaking hands
- Sweating
- Racing heart
- Trouble sleeping
- Nausea or vomiting
- Seeing or hearing things that were not there
- Seizures
For each row: choose one:
- Did not have this
- Mild
- Moderate
- Marked
- Severe
- Extreme
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How long after your last drink did the symptoms usually begin?
Choose one:
- Within 24 hours
- One to two days
- Three to seven days
- More than a week
- Don't know
Managing Symptoms
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What have you used to help you get through withdrawal?
Choose any that apply:
- Medication
- Counselling or therapy
- Peer support groups
- Complementary approaches such as meditation, yoga or herbal remedies
- Changes to diet
- Physical activity
- None of these
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How well did the approaches you selected work for you?
Asked only when
q_coping_strategies.outcome is not None and q_coping_strategies.outcome & 63 != 0Open answer
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Have any other habits or life changes helped you cope? Please describe them.
Open answer