1. Does someone in your family undergo personality changes when he or she drinks to excess?

Yes No

2. Do you feel that drinking is more important to this person than you are?

Yes No

3. Do you feel sorry for yourself and frequently indulge/in self-pity because of what you feel alcohol is doing to your family?

Yes No

4. Has some family member's excessive drinking ruined special occasions?

Yes No

5. Do you find yourself covering up for the consequences of someone else's drinking?

Yes No

6. Have you ever felt guilty, apologetic, or responsible for the drinking of a member of your family?

Yes No

7. Does one of your family member's use of alcohol cause fights and arguments?

Yes No

8. Have you ever tried to fight the drinker by joining in the drinking?

Yes No

9. Do the drinking habits of some family members make you feel depressed or angry?

Yes No

10. Is your family having financial difficulties because of drinking?

Yes No

11. Did you ever feel as if you had an unhappy home life because of the drinking of some members of your family?

Yes No

12. Have you ever tried to control the drinker's behavior by hiding the car keys, pouring liquor down the drain, etc?

Yes No

13. Do you find yourself distracted from your responsibilities because of this person's drinking?

Yes No

14. Do you often worry about a family member's drinking?

Yes No

15. Are holidays more of a nightmare than a celebration because of a family member's drinking behavior?

Yes No

16. Are most of your drinking family member's friends heavy drinkers?

Yes No

17. Do you find it necessary to lie to employers, relatives, or friends in order to hide your partner's drinking?

Yes No

18. Do you find yourself responding differently to members of your family when they are using alcohol?

Yes No

19. Have you ever been embarrassed or felt the need to apologize for the drinker's actions?

Yes No

20. Does some family member's use of alcohol make you fear for your own safety or the safety of other members of your family?

Yes No

21. Have you ever thought that one of your family members had a drinking problem?

Yes No

22. Have you ever lost sleep because of a family member's drinking?

Yes No

23. Have you ever encouraged one of your family members to stop or cut down on his or her drinking?

Yes No

24. Have you ever threatened to leave home or to leave a family member because of his or her drinking?

Yes No

25. Did a family member ever make promises that he or she did not keep because of drinking?

Yes No

26. Did you ever wish that you could talk to someone who could understand and help the alcohol-related problems of a family member?

Yes No

27. Have you ever felt sick, cried, or had a "knot" in your stomach after worrying about a family member's drinking?

Yes No

28. Has a family member ever failed to remember what occurred during a drinking period?

Yes No

29. Does your family member avoid social situations where alcoholic beverages will not be served?

Yes No

30. Does your family member have periods of remorse after drinking occasions and apologize for his or her behavior?

Yes No