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Questionnaire template

Drinking Habits and Their Effects

Measures adults' drinking frequency, quantity, reasons, effects on daily life and help-seeking for alcohol use.

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Healthcare · Alcohol assessment. All Healthcare templates

Questions in this template

How Often and How Much

  1. Thank you for sharing your experiences with alcohol. Your answers are confidential and will support our research on drinking habits.

  2. How often do you drink alcohol these days?

    Choose one:

    • Every day or almost every day
    • Several times a week
    • About once a week
    • Two or three times a month
    • About once a month
    • Less than once a month
    • Never
  3. On a day when you drink, how many drinks do you usually have?

    Condition: Asked of people who drink

    Choose one:

    • 1-2
    • 3-4
    • 5-6
    • 7 or more

Reasons for Drinking

Condition: Asked of people who drink

  1. What are your main reasons for drinking? Select all that apply.

    Choose any that apply:

    • To socialise
    • To relax
    • To celebrate
    • To go with food
    • To cope with stress or low mood
    • Out of habit
    • Other
  2. What other reason do you have?

    Condition: Shown when Other was selected

    Open answer

Effects of Drinking

Condition: Asked of people who drink

  1. What effect does your drinking have on each of these?

    • Physical health
    • Mental wellbeing
    • Productivity at work
    • Relationships
    • Finances

    For each row: choose one:

    • Very negative
    • Somewhat negative
    • No effect
    • Somewhat positive
    • Very positive

Support

  1. Which statement best describes you regarding help with your drinking?

    Choose one:

    • I have sought help, and it was useful
    • I have sought help, but it was not useful
    • I have not sought help, but I have thought about it
    • I have not sought help and have not thought about it
  2. Is there anything else about your drinking that would help us understand it better? (optional)

    Open answer