Alcohol Use Questionnaire

Alcohol Use Questionnaire

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College Student Alcohol Use Questionnaire

This survey is designed to better understand the use of alcoholic beverages among college students. Please be completely open and honest in providing information about yourself and your use of alcohol. Your individual responses will not be identified with you in any way. All answers will be combined and only overall results reported.

  1. Have you ever consumed alcoholic beverages?

___ Yes___ NoIf no, skip to question #51

  1. Have you ever consumed five or more drinks in one sitting? For the purposes of this study, a drink is defined as a bottle of beer, a glass of wine, a wine cooler, a shot glass of liquor, a mixed drink, or a similar drink containing alcohol.

___ Yes___ No

  1. Think back over the last two weeks. How many times have you consumed five or more drinks at one sitting? ___
  1. What is the average number of drinks you consume in a week?___
  1. To what extent has your alcohol use changed within the last 12 months?

___ Increased

___ About the Same

___ Decreased

During the last 30 days, to what extent have you engaged in each of the following behaviors? Fill in the blank. For example, if zero times put a 0, if one time put a 1, if 10 times put a 10, and so on.

Number of Times

  1. Refused an offer of alcohol?___
  2. Bragged about your alcohol use?___
  3. Heard someone else brag about his/her alcohol use?___
  4. Experienced peer pressure to drink?___
  5. Thought a sexual partner who was drunk was

not attractive?___

  1. Told a sexual partner who was drunk that they

were not attractive?___

Please indicate how often you have experienced the following due to your drinking during the last year (12 months)? Fill in the blank. For example, if zero times put a 0, if one time put a 1, if 10 times put a 10, and so on.

Number of Times

  1. Had a hangover?___
  2. Performed poorly on a test or important project?___
  3. Been in trouble with police, residence hall or

other college authorities?___

  1. Damaged property, pulled fire alarm, etc.?___
  2. Got into an argument or fight?___
  3. Got nauseated or vomited?___
  4. Driven a car or truck while under the influence?___
  5. Missed a class?___
  6. Been criticized by someone you know?___
  7. Thought you might have a drinking problem?___
  8. Experienced memory loss?___
  9. Done something you later regretted?___
  10. Been arrested for DUI/DWI?___
  11. Been taken advantage of sexually?___
  12. Have taken advantage of another sexually?___
  13. Tried unsuccessfully to stop drinking?___
  14. Seriously thought about suicide?___
  15. Seriously tried to commit suicide?___
  16. Been hurt or injured due to your drinking?___

For each of the following statements, indicate whether or not you believe alcohol has that effect? Circle the appropriate number.

  1. Breaks the ice?

StronglyStrongly

Disagree12345Agree

  1. Enhances social activities?

StronglyStrongly

Disagree12345Agree

  1. Makes it easier to deal with stress?

StronglyStrongly

Disagree12345Agree

  1. Makes a connection with peers easier?

StronglyStrongly

Disagree12345Agree

  1. Gives people something to talk about?

StronglyStrongly

Disagree12345Agree

  1. Facilitates male bonding?

StronglyStrongly

Disagree12345Agree

  1. Facilitates female bonding?

StronglyStrongly

Disagree12345Agree

  1. Enables people to have more fun?

StronglyStrongly

Disagree12345Agree

  1. Gives people something to do?

StronglyStrongly

Disagree12345Agree

  1. Makes food taste better?

StronglyStrongly

Disagree12345Agree

  1. Makes women sexier?

StronglyStrongly

Disagree12345Agree

  1. Makes you sexier?

StronglyStrongly

Disagree12345Agree

  1. Improves sexual opportunities?

StronglyStrongly

Disagree12345Agree

  1. Interrupts your studying?

StronglyStrongly

Disagree12345Agree

  1. Makes you feel unsafe?

StronglyStrongly

Disagree12345Agree

  1. Messes up your physical living space (cleanliness, neatness, organization, etc.)?

StronglyStrongly

Disagree12345Agree

  1. Prevents you from enjoying events, such as concerts, sports, social activities, etc.?

StronglyStrongly

Disagree12345Agree

  1. Interferes in other ways? If yes, please specify: ______

StronglyStrongly

Disagree12345Agree

Classification Questions

  1. What is your classification?

___ Freshman___ Senior

___ Sophomore___ Graduate Student

___ Junior

  1. What is your gender?

___ Female___ Male

  1. What is your age?___
  1. Binge drinking has been defined as consuming five or more drinks in one setting. Have you ever consumed alcohol in a manner that meets this definition?

__ Yes__ No

If yes:

  1. Did you binge drink in high school? __ Yes__ No
  2. Do you binge drink as a college student? __ Yes__ No
  1. What is your ethnic origin?

__ American Indian/Alaskan Native__ White (non-Hispanic)

__ Hispanic__ Black (non-Hispanic)

__ Asian/Pacific__ Other (please specify) ______

  1. What is your marital status?

__ Single__ Divorced

__ Married__ Living with a partner, but not married

__ Separated__ Widowed

  1. What is your parent’s annual income?

__ Less than $25,000

__ $25,001 - $50,000

__ $50,001 - $75,000

__ $75,001 - $100,000

__ $100,001 - $125,000

__ $125,001 - $150,000

__ $150,001 or higher

Thank you for your participation.

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