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* 1. Please enter you details

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* 2. How often during the last year have you found that you were not able to stop drinking once you started?

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* 3. How often during the last year have you failed to do what was normally expected from you because of your drinking?

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* 4. How often during the last year have you needed an alcoholic drink in the morning to get yourself going after a heavy drinking session?

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* 5. How often in the last year have you had a feeling of guilt or remorse after drinking?

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* 6. How often during the last year have you been unable to remember what happened the night before because you had been drinking?

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* 7. Have you or somebody else been injured as a result of your drinking

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* 8. Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested that you cut down?

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