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FASA
About FASA
A Supervisor's Guide
Alcohol Screening Instrument
Wellness Programs
Special Project
Contact Us
Newsletters
Links and Resources
FASA Home
Alcohol Screening Instrument For Self-Assessment
The following alcohol screening instrument, developed by Dr. Jay Rathbun of the University of Michigan, is designed to assist you in understanding your use of alcohol. The instrument itself is a composite of two alcohol screening instruments: the Alcohol Use Disorders Identification Test (AUDIT) developed by the World Health Organization and the CAGE questionnaire developed by researchers at the University of North Carolina. Both instruments are widely respected alcohol screening tools. * There is no computer-related interactive component to this instrument so that your anonymity is protected. No one has access to your results; they are for your purposes only
Directions
Number a sheet of paper from 1-12. Read each question, one at a time, and simply choose one of the responses that fits your circumstance. Each response is weighted from 0 - 4 as indicated in parentheses. Place the score that appears in the parenthesis at the end of the response you've chosen next to the number of the question on your sheet of paper.
ALCOHOL SCREENING INSTRUMENT FOR SELF-ASSESSMENT
1. How often do you have a drink containing alcohol?
never (0)2. How many drinks containing alcohol do you have on a typical day when you are drinking?
monthly or less (1)
two or four times/month (2)
two or three times/week (3)
four or more times/week (4)
1 or 2 (0)3. How often do you have six or more drinks on one occasion?
3 or 4 (1)
5 or 6 (2)
7 - 9 (3)
10 or more (4)
never (0)4. How often during the last year have you been unable to remember what happened the night before because of drinking?
less than monthly (1)
monthly (2)
weekly (3)
daily or almost daily (4)
never (0)5. How often during the last year have you found that you were not able to stop drinking once you started?
less than monthly (1)
monthly (2)
weekly (3)
daily or almost daily (4)
never (0)
less than monthly (1)
monthly (2)
weekly (3)
daily or almost daily (4)
6. How often during the last year have you failed to do what is normally expected from you because of drinking (e.g., missed deadlines, poor classroom or work attendance, failed committee responsibilities, inconsistent work patterns?)
never (0)7. Have you or someone else been injured as a result of your drinking?
less than monthly (1)
monthly (2)
weekly (3)
daily or almost daily (4)
no (0)8. Has a relative or friend or doctor or other health worker been concerned about your drinking or suggested you cut down?
yes, but not in last year (2)
yes, during last year (4)
no (0)9. How often in the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?
yes, but not in last year (2)
yes, during last year (4)
never (0)10. How often during the past year have you had feelings of guilt or remorse after drinking?
less than monthly (1)
monthly (2)
weekly (3)
daily or almost daily (4)
never (0)11. Have people annoyed you by criticizing your drinking?
less than monthly (1)
monthly (2)
weekly (3)
daily or almost daily (4)
no (0)12. Have you ever felt that you should cut down on your drinking?
yes, but not in last year (2)
yes, during last year (4)
no (0)
yes, but not in last year (2)
yes, during last year (4)
Scoring
After you have finished, total your individual item scores into one composite score for all 12 questions.Next, total your individual item scores for the last four questions only (9 - 12).You should now have two composite scores - one for all twelve questions and one for the last four questions.
InterpretationA score of 8 or more for all twelve questions indicates that a harmful level of alcohol consumption is likely.
The last four questions (9,10,11,12) are considered a separate "sub-assessment" embedded into the entire self-administered instrument. On only the last four items, a total score of 1 - 2 indicates that you may have a drinking problem. A score of 3 or more indicates there is a significant possibility that you have a problem with alcohol.
If your score exceeds the cut-off values on either instrument, you should seek help.
Need Help?
If you have any questions about your score on this instrument or general questions/concerns about your or someone else's alcohol usage, please contact FASA and call for an appointment:Faculty and Staff Assistance
332 Sparks Hall
Phone: 404/413-3341
Fax: 404/413-3342
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