About someone else, friend or loved one Please answer these questions open and honestly to give an accurate result. Results or answers are not saved or shared with any outside organisation and are fully confidential . In the last 6 months I have failed to attend an appointment or commitment at least once a week due to my drinking or using drugs?(Required) Strongly Disagree Disagree Neutral Agree Strongly Agree I cannot remember In the last 6 months I drank or used more then I was convinced and promised myself I would before I started drinking or using. This happens once a week?(Required) Strongly Disagree Disagree Neutral Agree Strongly Agree I cannot remember Do you need a drink or use before you start your day?(Required) No Unsure Yes In the last 6 months I have failed to attend an appointment or commitment at least once a month due to my drinking or using drugs?(Required) Strongly Disagree Disagree Neutral Agree Strongly Agree I cannot remember I am often dishonest to people about my drinking or using?(Required) Strongly Disagree Disagree Neutral Agree Strongly Agree In the past 12 months, how many occasions have I physically injured myself as a result of my drinking or using?(Required) 1-2 3-4 5-6 7-8 I cannot remember In the last 12 months I drank or used more then I was convinced and promised myself I would before I started drinking or using. This happens at least once a month?(Required) Strongly Disagree Disagree Neutral Agree Strongly Agree I cannot remember My drinking or using has negatively impacted me financially?(Required) Strongly Disagree Disagree Neutral Agree Strongly Agree In the past 12 months a doctor or health care professional has advised me to reduce or stop drinking or using?(Required) No Unsure Yes