| INSTRUCTIONS: Please read the following
statements carefully. Each one describes a way that you might (or
might not) feel about your drinking. For each statement, circle one
number from 1 to 5, to indicate how much you agree or disagree with
it right now. Please circle one and only one number for every
statement. |
|
NO!
Strongly Disagree |
No
Disagree |
?
Undecided or Unsure |
Yes
Agree |
YES!
Strongly Agree |
| 1. I really want to make changes in my
drinking. |
1 |
2 |
3 |
4 |
5 |
| 2. Sometimes I wonder if I am an
alcoholic. |
1 |
2 |
3 |
4 |
5 |
| 3. If I don't change my drinking soon,
my problems are going to get worse. |
1 |
2 |
3 |
4 |
5 |
| 4. I have already started making some
changes in my drinking. |
1 |
2 |
3 |
4 |
5 |
| 5. I was drinking too much at one time,
but I've managed to change my drinking. |
1 |
2 |
3 |
4 |
5 |
| 6. Sometimes I wonder if my drinking is
hurting other people. |
1 |
2 |
3 |
4 |
5 |
| 7. I am a problem drinker. |
1 |
2 |
3 |
4 |
5 |
| 8. I'm not just thinking about changing
my drinking, I'm already doing something about it. |
1 |
2 |
3 |
4 |
5 |
| 9. I have already changed my drinking,
and I am looking for ways to keep from slipping back to my old
pattern. |
1 |
2 |
3 |
4 |
5 |
| 10. I have serious problems with
drinking. |
1 |
2 |
3 |
4 |
5 |
| 11. Sometimes I wonder if I am in
control of my drinking. |
1 |
2 |
3 |
4 |
5 |
| 12. My drinking is causing a lot of
harm. |
1 |
2 |
3 |
4 |
5 |
| 13. I am actively doing things now to
cut down or stop drinking. |
1 |
2 |
3 |
4 |
5 |
| 14. I want help to keep from going back
to the drinking problems that I had before. |
1 |
2 |
3 |
4 |
5 |
| 15. I know that I have a drinking
problem. |
1 |
2 |
3 |
4 |
5 |
| 16. There are times when I wonder if I
drink too much. |
1 |
2 |
3 |
4 |
5 |
| 17. I am an alcoholic. |
1 |
2 |
3 |
4 |
5 |
| 18. I am working hard to change my
drinking. |
1 |
2 |
3 |
4 |
5 |
| 19. I have made some changes in my
drinking, and I want some help to keep from going back to the way I
used to drink. |
1 |
2 |
3 |
4 |
5 |
| For scoring and interpretation information of
SOCRATES:
Click here |
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