Original | 6. Is your father a drunkard? _____ Yes _____ No |
G1 | Question
6a: How frequently is your father inebriated on a weekly basis? A. Never B. 1-2 times a week C. 3-5 times a week D. 6-7 times a week E. More than once per day Question 6b: Do you believe that your father has alcoholism or other alcohol abuse issues? A. Yes B. No |
G2 | 4.
4a. If applicable, how often would you say your mother drinks alcoholic
beverages? _____Everyday _____ 3-5 times a week _____1-2 times a week _____2 to 3 times a month _____Once a month _____3 to 11 times in the past year _____1 or 2 times in the past year _____Never _____Not applicable 4b. If applicable, how often would you say your father drinks alcoholic beverages? _____Everyday _____ 3-5 times a week _____1-2 times a week _____2 to 3 times a month _____Once a month _____3 to 11 times in the past year _____1 or 2 times in the past year _____Never _____Not applicable |
G3 | 12.
Check one option below that best describes your father’s drinking
frequency. _____ He never drinks. _____ He seldom drinks. _____ He often drinks. _____ He drinks a lot. _____ He habitually drinks. _____ I don’t know. _____ Not applicable. (eg. I do not have a father) |
G4 | 5.
Does your father drink alcohol? _____ Yes _____ No 5b. If yes to 5, how many alcoholic drinks does he consume in an average drinking session? _____ 1-2 _____ 3-4 _____ 5 or more |
G5 | 3.
Does anyone in your family struggle with alcohol dependence/addiction? _____ Yes _____ No 3A. IF YES: which family member(s)? Check all that apply. _____ Parent(s) _____ Sibling _____ Grandparent(s) _____ Aunt/Uncle _____ Cousin(s) |