CDAD-Dentist Health & Wellness Committee
24-hour
Hotline: (800) 468-2004
Disclaimer: The following two assessment questionnaires are intended to help you learn more about your use of alcohol and other drug. They are not intended to diagnose or treat any medical or emotional condition. CDAD strongly advises that you consult your physician with any concerns regarding your answers to these screening tests.
Michigan Alcoholism Screening Test Questionnaire
Measures of the Recovery Process
1. Have you ever thought about CUTTING down on your drinking? On your drug use?
2. Have you ever been ANNOYED by peoples’ criticism of your drinking? Of your drug use?
3. Have you ever felt GUILTY about your drinking? About your drug use?
4. Have you ever drunk alcohol to get you going in the morning or to treat your hangover (EYE OPENER)? Have you used drugs to get you going?
POSITIVE SCORE: 2 of 4 affirmative answers.
B/ Test #2 (adapted from the Michigan Alcoholism Screening Test Questionnaire):
1. Do you feel you are a normal drinker/(drug) user? (By normal we mean you drink less than or as much as most other people). Scoring: No=2*
2. Have you ever awaken the morning after some drinking/using (drugs) the night before and found that you could not remember a part of the evening? Scoring: Yes=2
3. Does your spouse, significant other, a parent or other near relative ever worry and/or complain about your drinking/using? Scoring: Yes=2
4. Can you stop drinking/using without a struggle after one or two? Scoring: No=2
5. Do you ever feel guilty about your drinking/using? Scoring: Yes=1
6. Do friends or relatives think you are a normal drinker/user? Scoring: No=2
7. Are you always able to stop drinking/using when you want to? Scoring: No=2
8. Have you ever attended a meeting of Alcoholics Anonymous (AA)? Scoring: Yes=5
9. Have you gotten into physical fights when drinking/using? Scoring: Yes=1
10. Has drinking/using ever created problems between you and your spouse, significant other, a parent or other near relative? Scoring: Yes=2
11. Has your spouse, significant other, a parent or a near relative ever gone to anyone for help about your drinking/using? Scoring: Yes=2
12. Have you ever lost boyfriends or girlfriends because of drinking/using? Scoring: Yes=2
13. Have you ever gotten into trouble at work because of your drinking/using? Scoring: Yes=2
14. Have you ever lost a job or quit before you were fired because of drinking/using? Scoring: Yes=2
15. Have you ever neglected your obligations, your family or your work for two or more days in a row because you were drinking/using? Scoring: Yes=2
16. Do you drink/use before noon fairly often? (i.e., weekends). Scoring: Yes=1
17. Have you ever been told you have liver trouble? Cirrhosis? Scoring: Yes=2
18. After heavy drinking/using, have you ever had delirium tremens (D.T.'s), severe shaking, heard voices, or seen things that weren't there? Scoring: Yes=2
19. Have you ever gone to anyone for help about your drinking/using? Scoring: Yes=5
20. Have you ever been in a hospital because of drinking/using? Scoring: Yes=5
21. Have you ever been in a psychiatric hospital or ward where drinking/using were part of the problem that resulted in hospitalization? Scoring: Yes=2
22. Have you ever been seen at a psychiatric hospital or mental health clinic or gone to a doctor, social worker, or clergyman for help with an emotional problem in which drinking/drugs were part of the problem? Scoring: Yes=2
23. Have you ever been arrested for drunken driving, driving while intoxicated, or driving under the influence of alcoholic beverages or drugs? Scoring: Yes=2
24. Have you ever been arrested, even for a few hours, because of drinking/using related behavior (e.g. disorderly conduct)? Scoring: Yes=2
*SCORES:
0-4= non-alcoholic/drug dependent
5-6= suggestive of alcoholism/drug dependency
7= alcoholism/drug dependency
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Frequently Asked Questions about Substance Use Disorders
D/ Measures of the Recovery Process (from the University of Rhode Island Website on Transtheoritical Model):
a/ Test #1: Decisional Balance (Alcohol and Drug Use).
b/ Test #2: Self-Efficacy (Alcohol).
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