• Do you feel you are a normal drinker? [no] Y__ N__
• Does someone close to you worry about your drinking? [yes] Y__ N__
• Do you feel guilty about your drinking? [yes] Y__ N__
• Do friends/relatives think you're a normal drinker? [no] Y__ N__
• Can you stop drinking when you want to? [no] Y__ N__
• Have you ever attended an AA meeting? [yes] Y__ N__
• Has drinking created problems between you and a loved one/relative? [yes] Y__ N__
• Gotten in trouble at work because of drinking? [yes] Y__ N__
• Neglected obligations/family/work 2 days in a row because of drinking? [yes] Y__ N__
• Gone to anyone for help for your drinking? [yes] Y__ N__
• Ever been in a hospital because of drinking? [yes] Y__ N__
• Arrested for drunk driving or DUI? [yes] Y__ N__
• Arrested for other drunken behavior? [yes] Y__ N__
• Total =

Five or more positive items suggest alcohol problem.

(Positive answers are in brackets above) (Selzer 1975)

(Reprinted with permission from Journal of Studies on Alcohol, vol. 36, pp. 117–126, 1975. Copyright by Journal of Studies on Alcohol, Inc., Rutgers Center of Alcohol Studies, Piscataway, NJ 08854 and Melvin L. Selzer, MD)