Lifetime Alcohol Use History Questionnaire
Please answer the following questions about your lifetime experience with alcohol. This form is anonymous and does not collect sensitive personal identifiers.
What is your age group?
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Please Select
Under 18
18-24
25-34
35-44
45-54
55-64
65 or older
At what age did you first consume an alcoholic beverage (more than a few sips)?
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How often have you consumed alcohol during your lifetime?
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Never
Rarely (a few times/year)
Occasionally (monthly)
Regularly (weekly)
Frequently (most days)
Which types of alcoholic beverages have you consumed? (Select all that apply)
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Beer
Wine
Spirits (e.g., vodka, whiskey, rum)
Cider
Other
On a typical drinking occasion, how many standard drinks do you usually consume?
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Have you ever had periods of abstinence from alcohol for 6 months or longer?
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Yes
No
If yes, how many separate periods of 6 months or longer have you had?
Has your pattern of alcohol use changed significantly over your lifetime?
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Yes
No
If yes, please briefly describe how your alcohol use has changed.
Is there anything else you would like to share about your lifetime alcohol use history?
Submit
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