auditscreen.org
Open in
urlscan Pro
182.160.160.10
Public Scan
URL:
https://auditscreen.org/check-your-drinking/
Submission: On May 30 via manual from IN — Scanned from AU
Submission: On May 30 via manual from IN — Scanned from AU
Form analysis
1 forms found in the DOMPOST https://auditscreen.org/check-your-drinking/?num=19
<form method="post" action="https://auditscreen.org/check-your-drinking/?num=19">
<!--
<div class="form-group">
<div class="btn-group" data-toggle="buttons">
<label class="btn btn-default active">
<input type="radio" name="gender" id="option1" autocomplete="off" value="" checked="checked" > Please select
</label>
<label class="btn btn-primary">
<input type="radio" name="gender" id="option2" autocomplete="off" value="male" > Male
</label>
<label class="btn btn-primary">
<input type="radio" name="gender" id="option3" autocomplete="off" value="female"> Female
</label>
</div>
</div>
-->
<div class="form-group">
<p class="lead">Please select your gender.</p>
<div class="radio"><label>
<input type="radio" name="gender" id="gendera" value="male"> Male </label></div>
<div class="radio"><label>
<input type="radio" name="gender" id="gendebr" value="female"> Female </label></div>
</div>
<div class="form-group">
<p class="lead">1. How often do you have a drink containing alcohol?</p>
<div class="radio"><label>
<input type="radio" name="question1" id="question1a" value="0"> Never </label></div>
<div class="radio"><label>
<input type="radio" name="question1" id="question1b" value="1"> Monthly or less </label></div>
<div class="radio"><label>
<input type="radio" name="question1" id="question1c" value="2"> 2-4 times a month </label></div>
<div class="radio"><label>
<input type="radio" name="question1" id="question1d" value="3"> 2-3 times a week </label></div>
<div class="radio"><label>
<input type="radio" name="question1" id="question1e" value="4"> 4 or more times a week </label></div>
</div>
<div class="form-group">
<p class="lead">2. How many standard drinks containing alcohol do you have on a typical day when drinking?</p>
<div class="radio"><label>
<input type="radio" name="question2" id="question21" value="0"> 1 or 2 </label></div>
<div class="radio"><label>
<input type="radio" name="question2" id="question22" value="1"> 3 or 4 </label></div>
<div class="radio"><label>
<input type="radio" name="question2" id="question23" value="2"> 5 or 6 </label></div>
<div class="radio"><label>
<input type="radio" name="question2" id="question24" value="3"> 7 to 9 </label></div>
<div class="radio"><label>
<input type="radio" name="question2" id="question25" value="4"> 10 or more </label></div>
</div>
<div class="form-group">
<p class="lead">3. How often do you have six or more drinks on one occasion?</p>
<div class="radio"><label>
<input type="radio" name="question3" id="question3a" value="0"> Never </label></div>
<div class="radio"><label>
<input type="radio" name="question3" id="question3b" value="1"> Less than monthly </label></div>
<div class="radio"><label>
<input type="radio" name="question3" id="question3c" value="2"> Monthly </label></div>
<div class="radio"><label>
<input type="radio" name="question3" id="question3d" value="3"> Weekly </label></div>
<div class="radio"><label>
<input type="radio" name="question3" id="question3e" value="4"> Daily or almost daily </label></div>
</div>
<div class="form-group">
<p class="lead">4. During the past year, how often have you found that you were not able to stop drinking once you had started?</p>
<div class="radio"><label>
<input type="radio" name="question4" id="question1a" value="0"> Never </label></div>
<div class="radio"><label>
<input type="radio" name="question4" id="question1b" value="1"> Less than monthly </label></div>
<div class="radio"><label>
<input type="radio" name="question4" id="question1c" value="2"> Monthly </label></div>
<div class="radio"><label>
<input type="radio" name="question4" id="question1d" value="3"> Weekly </label></div>
<div class="radio"><label>
<input type="radio" name="question4" id="question1e" value="4"> Daily or almost daily </label></div>
</div>
<div class="form-group">
<p class="lead">5. During the past year, how often have you failed to do what was normally expected of you because of drinking?</p>
<div class="radio"><label>
<input type="radio" name="question5" id="question1a" value="0"> Never </label></div>
<div class="radio"><label>
<input type="radio" name="question5" id="question1b" value="1"> Less than monthly </label></div>
<div class="radio"><label>
<input type="radio" name="question5" id="question1c" value="2"> Monthly </label></div>
<div class="radio"><label>
<input type="radio" name="question5" id="question1d" value="3"> Weekly </label></div>
<div class="radio"><label>
<input type="radio" name="question5" id="question1e" value="4"> Daily or almost daily </label></div>
</div>
<div class="form-group">
<p class="lead">6. During the past year, how often have you needed a drink in the morning to get yourself going after a heavy drinking session?</p>
<div class="radio"><label>
<input type="radio" name="question6" id="question1a" value="0"> Never </label></div>
<div class="radio"><label>
<input type="radio" name="question6" id="question1b" value="1"> Less than monthly </label></div>
<div class="radio"><label>
<input type="radio" name="question6" id="question1c" value="2"> Monthly </label></div>
<div class="radio"><label>
<input type="radio" name="question6" id="question1d" value="3"> Weekly </label></div>
<div class="radio"><label>
<input type="radio" name="question6" id="question1e" value="4"> Daily or almost daily </label></div>
</div>
<div class="form-group">
<p class="lead">7. During the past year, how often have you had a feeling of guilt or remorse after drinking?</p>
<div class="radio"><label>
<input type="radio" name="question7" id="question1a" value="0"> Never </label></div>
<div class="radio"><label>
<input type="radio" name="question7" id="question1b" value="1"> Less than monthly </label></div>
<div class="radio"><label>
<input type="radio" name="question7" id="question1c" value="2"> Monthly </label></div>
<div class="radio"><label>
<input type="radio" name="question7" id="question1d" value="3"> Weekly </label></div>
<div class="radio"><label>
<input type="radio" name="question7" id="question1e" value="4"> Daily or almost daily </label></div>
</div>
<div class="form-group">
<p class="lead">8. During the past year, how often have you been unable to remember what happened the night before because you had been drinking?</p>
<div class="radio"><label>
<input type="radio" name="question8" id="question1a" value="0"> Never </label></div>
<div class="radio"><label>
<input type="radio" name="question8" id="question1b" value="1"> Less than monthly </label></div>
<div class="radio"><label>
<input type="radio" name="question8" id="question1c" value="2"> Monthly </label></div>
<div class="radio"><label>
<input type="radio" name="question8" id="question1d" value="3"> Weekly </label></div>
<div class="radio"><label>
<input type="radio" name="question8" id="question1e" value="4"> Daily or almost daily </label></div>
</div>
<div class="form-group">
<p class="lead">9. Have you or someone else been injured as a result of your drinking?</p>
<div class="radio"><label>
<input type="radio" name="question9" id="question1a" value="0"> No </label></div>
<div class="radio"><label>
<input type="radio" name="question9" id="question1b" value="2"> Yes, but not in the past year </label></div>
<div class="radio"><label>
<input type="radio" name="question9" id="question1c" value="4"> Yes, during the past year </label></div>
</div>
<div class="form-group">
<p class="lead">10. Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested you cut down?</p>
<div class="radio"><label>
<input type="radio" name="question10" id="question1a" value="0"> No </label></div>
<div class="radio"><label>
<input type="radio" name="question10" id="question1b" value="2"> Yes, but not in the past year </label></div>
<div class="radio"><label>
<input type="radio" name="question10" id="question1c" value="4"> Yes, during the past year </label></div>
</div>
<div class="form-group">
<label for="spam">SPAM Check</label>
<div class="g-recaptcha" data-theme="light" data-sitekey="6Lcg69QUAAAAAEFrKy4KS8Khmq8xv3mBEd2efM9U">
<div style="width: 304px; height: 78px;">
<div><iframe title="reCAPTCHA"
src="https://www.google.com/recaptcha/api2/anchor?ar=1&k=6Lcg69QUAAAAAEFrKy4KS8Khmq8xv3mBEd2efM9U&co=aHR0cHM6Ly9hdWRpdHNjcmVlbi5vcmc6NDQz&hl=en&v=CDFvp7CXAHw7k3HxO47Gm1O9&theme=light&size=normal&cb=f5lnjpslgxss"
width="304" height="78" role="presentation" name="a-1ft0f1rmc1d2" frameborder="0" scrolling="no" sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox"></iframe>
</div><textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response"
style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
</div><iframe style="display: none;"></iframe>
</div>
</div>
<div class="form-group">
<button type="submit" name="survey_submitted" value="1" class="btn btn-primary">Submit</button>
</div>
</form>
Text Content
Toggle navigation * About AUDIT * Background * Scoring the AUDIT * Utility in Various Settings * AUDIT Derivatives * AUDIT Decision Tree * FAQs * Check Your Drinking * Translations * Validation Studies * About Validation Studies * Primary Publications * Systematic and Other Reviews * AUDIT Derivatives * Validation in Different Populations * Comparison with Other Instruments * Drink-Less Program CHECK YOUR DRINKING: AN INTERACTIVE SELF-TEST The AUDIT questionnaire is designed to help in the self-assessment of alcohol consumption and to identify any implications for the person's health and wellbeing, now and in the future. It consists of 10 questions on alcohol use. The responses to these questions can be scored and the total score prompts feedback to the person and in some cases offers specific advice. Conduct a quick self-test with the AUDIT below. Click on “submit” at the end for an instant assessment. Please select your gender. Male Female 1. How often do you have a drink containing alcohol? Never Monthly or less 2-4 times a month 2-3 times a week 4 or more times a week 2. How many standard drinks containing alcohol do you have on a typical day when drinking? 1 or 2 3 or 4 5 or 6 7 to 9 10 or more 3. How often do you have six or more drinks on one occasion? Never Less than monthly Monthly Weekly Daily or almost daily 4. During the past year, how often have you found that you were not able to stop drinking once you had started? Never Less than monthly Monthly Weekly Daily or almost daily 5. During the past year, how often have you failed to do what was normally expected of you because of drinking? Never Less than monthly Monthly Weekly Daily or almost daily 6. During the past year, how often have you needed a drink in the morning to get yourself going after a heavy drinking session? Never Less than monthly Monthly Weekly Daily or almost daily 7. During the past year, how often have you had a feeling of guilt or remorse after drinking? Never Less than monthly Monthly Weekly Daily or almost daily 8. During the past year, how often have you been unable to remember what happened the night before because you had been drinking? Never Less than monthly Monthly Weekly Daily or almost daily 9. Have you or someone else been injured as a result of your drinking? No Yes, but not in the past year Yes, during the past year 10. Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested you cut down? No Yes, but not in the past year Yes, during the past year SPAM Check Submit For further information contact: JOHN B. SAUNDERS, MD, FRACP, FAFPHM, FAChAM, FRCP Professor and Consultant Physician in Internal Medicine and Addiction Medicine. Email: office@jbsaunders.net | Visit: jbsaunders.net Website by Toledoh / Blue Bay