Campral: About Campral - Self Assessment Questionaire

Self Assessment Questionnaire

Healthcare professionals use a number of different questionnaires to screen for alcohol dependence. This questionnaire is based on one designed many years ago and proven reliable and accurate for adults.¹

Answer each of the 4 questions below as honestly as possible. Once you've answered yes or no to all of them, you will receive an assessment of your responses in your web browser window. This assessment will evaluate your responses and suggest actions you might take to seek care for yourself or for your loved one.

	Do you think you drink too much and feel you should cut down on your drinking?	Yes No

	When people criticize your drinking do you get annoyed or angry?	Yes No

	Have you ever felt bad or guilty about your drinking?	Yes No

	Do you ever take a drink first thing in the morning (eye-opener) to steady your hand or get rid of a hangover?	Yes No

All fields are required.

¹ Ewing, JA. Detecting Alcoholism: The CAGE Questionnaire. JAMA 252: 1905-1907, 1984.