Questionnaire template
Community Drinking Habits
Measures how often community members drink, what and where they drink, and how alcohol affects their lives.
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Healthcare · Alcohol assessment. All Healthcare templates
Questions in this template
Your Drinking Habits
Thank you for taking part. This survey asks about alcohol use in our community. Your answers are confidential and will only be reported in summary form.
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How often do you have an alcoholic drink?
Choose one:
- Daily or almost daily
- At least once a week
- At least once a month
- Less than once a month
- Never
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Which kinds of alcoholic drinks do you usually have? Select all that apply.
Condition: Only for people who drink
Choose any that apply:
- Beer
- Wine
- Spirits
- Cocktails or mixed drinks
- Other
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What other kinds of drinks do you have?
Condition: Only when Other was selected
Open answer
Where and With Whom
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Where do you usually drink? Select all that apply.
Condition: Only for people who drink
Choose any that apply:
- At home
- At someone else's home
- Bars or pubs
- Restaurants
- Parties or events
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Who are you usually with when you drink?
Condition: Only for people who drink
Choose one:
- Mostly alone
- With a partner or family
- With friends
- With colleagues
- It varies
Effects on Your Life
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How much do you agree with each of these statements about your own drinking?
Condition: Only for people who drink
- I often end up drinking more than I meant to.
- Family or friends have told me they are worried about how much I drink.
- Drinking has caused problems in my work or studies.
- Drinking has caused problems with people close to me.
- I have tried to drink less at some point.
For each row: choose one:
- Strongly disagree
- Disagree
- Neither agree nor disagree
- Agree
- Strongly agree
Your Views
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Is there anything you would like to share about alcohol use, whether your own experience or ideas for the community? (optional)
Open answer