COSIG CONFERENCE BROCHURE.pdf - Drexel University College ...

The following questionnaire is designed to identify how you personally feel about your drinking
right now. Please think about your current situation and drinking habits, even if you have given up
drinking completely. Read each question below carefully, and then decide whether you agree or
disagree with the statements. Please tick the answer of your choice to each question. If you have
any problems, please ask the questionnaire administrator.
Your answers are completely private and confidential
Key: SD = Strongly Disagree D = Disagree U = Unsure A = Agree SA = Strongly Agree
SD D U A SA For office
use only
1. There is no need for me to _____ _____ _____ _____ _____ PC
change my drinking habits.
2. I enjoy my drinking, but _____ _____ _____ _____ _____ C
sometimes I drink too
much.
3. I have reached the stage _____ _____ _____ _____ _____ PA
where I should seriously
think about giving up or
drinking less alcohol.
4. I am trying to stop drinking _____ _____ _____ _____ _____ A
or drink less than I used to.
5. I was drinking too much at _____ _____ _____ _____ _____ M
one time, but now I've
managed to cut down (or
stop) my drinking.
6. It's a waste of time thinking _____ _____ _____ _____ _____ PC
about my drinking because
I do not have a problem.
7. Sometimes I think I should _____ _____ _____ _____ _____ C
quit or cut down on my
drinking.
8. I have decided to do _____ _____ _____ _____ _____ PA
something about my
drinking.
9. I know that my drinking _____ _____ _____ _____ _____ A
has caused problems, and
I'm now trying to correct
this.
10. I have changed my _____ _____ _____ _____ _____ M
drinking habits (either cut
down or quit), and I'm
trying to keep it that way.
11. There is nothing seriously _____ _____ _____ _____ _____ PC
wrong with my drinking.
12. My drinking is a problem _____ _____ _____ _____ _____ C
sometimes.
13. I'm preparing to change _____ _____ _____ _____ _____ PA
my drinking habits (either
cut down or give up
completely).
14. Anyone can talk about _____ _____ _____ _____ _____ A
wanting to do something
about their drinking, but I
am actually doing
something about it.
15. It is important for me to _____ _____ _____ _____ _____ M