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Your Experiences with Alcohol

Alcohol abuse is the misuse of alcohol in a way that negatively affects your life. Alcohol abuse is typically characterized by binge drinking.

Alcoholism is an alcohol dependence. This is a chronic, and life long disease where the person feels a physical dependence to consume alcohol in order to feel "normal". A reduction in alcohol consumption can result in withdrawal symptoms and the person will need outside help to stop drinking.

Alcohol abuse is the misuse of alcohol in a way that negatively affects your life. Alcohol abuse is typically characterized by binge drinking.

Do you believe that you abuse alcohol?

Yes, daily

Yes, weekly

Yes, monthly

Other

Please Specify:

Do you believe that you have alcohol dependence/ alcoholism.

Yes

I am not sure

Is anyone in your family an alcoholic? (Select all that apply)

Biological Mother

Biological Father

Grandfather (Mom side)

Grandfather (Dad side)

Grandmother (Mom side)

Grandmother (Dad side)

Siblings

Spouse

If you chose anyone in the previous question, would you say that this has put any strain on your family or relationship with that family member?

Yes

N/A

Codependency is a psychological condition or relationship in which a person is controlled or manipulated by another person who is affected with alcoholism.

Being an enabler means that your behavior allows someone to continue their self- destructive patterns of behavior. Many people who are enablers typically do not do it intentionally.

Codependency is a psychological condition or relationship in which a person is controlled or manipulated by another person who is affected with alcoholism.

Being an enabler means that your behavior allows someone to continue their self- destructive patterns of behavior. Many people who are enablers typically do not do it intentionally.

Do you see yourself as being a codependent, or an enabler with someone who struggles with alcoholism?

Yes, a codependent

Yes, an enabler

Both

Neither

N/A

Other

Please Specify:

Do you believe that being an alcoholic is a choice or disease?

Choice

Disease

If you are an alcoholic, have you received treatment to stop drinking?

Yes, it worked

Yes, it did not work

N/A

Do you know someone that has received treatment for alcoholism?

Yes, it worked

Yes, it did not work

N/A

Other

Please Specify:

Do you find yourself being judgmental or supportive towards people that suffer from alcoholism?

Judgmental

Supportive

Other

Please Specify:

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