8/3/2019 Alcohol Consumption Question a Ire
1/3
ALCOHOL CONSUMPTION QUESTIONAIRE
Name: Year Level:Age: College:Gender: ( ) male ( ) female Birth Order:
No. of siblings:
1. Whattype ofalcohol do you drink?Beer Brandy Gin or Vodka( ) San Miguel ( ) Gran Matador ( ) GSM Blue( ) San Mig Light ( ) Emperador ( ) Cosack Vodka( ) Redhorse ( ) Fundador ( ) The Bar
( ) Colt 45 ( ) Tres Cepas( ) Beer na beer ( ) Generoso( ) Gold eagle beer( ) Cervesa Negra
Forthe question number 2,pleasecheckthecolumns that bestapplyto you.(1) Always(2) Often
(3) Sometimes
(4) Seldom(5) Never
2. How often do you haveBeer? 1 2 3 4 5
San Miguel
San Mig Light
Redhorse
Colt 45
Beer na beer
Gold eagle beer
Cervesa Negra
Brandy?
Gran Matador
Emperador
Fundador
Tres Cepas
Generoso
Gin or Vodka?
GSM Blue
Cosack Vodka
The Bar
3. Where do you drink?( ) Bars ( ) Athome
( ) Restaurants ( ) Ata friends house( ) Boarding house ( ) ClubsOthers please specify
4. Whom do you drinkwith?( ) Classmates ( ) Professors( ) Friends ( ) Athletic Team( ) Family ( ) Social Organization (clubs, etc.)( ) Relatives
Others please specify
8/3/2019 Alcohol Consumption Question a Ire
2/3
5. Who initiates? Pleasecheckthecolumns that bestapplyto you.(1) Always(2) Often(3) Sometimes
(4) Seldom(5) Never
1 2 3 4 5
I
Friends
Classmates
Family
Relatives
Professors
Athletic Team
Social Organization
Others please specify
6. Areyou ableto resist invitations to drinking?( ) Yes ( ) NoIfyes, how often?
(1) Always(2) Often(3) Sometimes(4) Seldom(5) Never
7. Why do you drink? Pleasecheckthecolumns that bestapplyto you.
(1) Always
(2) It is often a reason(3) Sometimes(4) It is Seldom a reason(5) Never or notatall
8. Where do you getthe money for drinking?
1 2 3 4 5
(Because) I am bored.
(Because) I wantto relax.
I am sad/lonely.
I wantto have fun.
I am angry or irritated.
I likethephysicaleffects.
I wantto escape or forget
I wantto be more sociable.
I am stressed of schoolworks.
Thepeople I am withare drinking.
I am stressed about mypersonallife.I wantto change mypersonality(i.e. act differently).
I wantto increasechances for sexual opportunities.
To bewarm when theweather is cold.
To gain selfconfidence.
To gain friends.
To feel grown up.
8/3/2019 Alcohol Consumption Question a Ire
3/3
( ) Allowance( ) Extraallowance( ) Parttime income( ) Ask from parentsOthers please specify
9. Do you get drunk?( ) Yes ( ) No
Ifyes, how often?( ) Always( ) Often( ) Sometimes( ) Seldom( ) Never
10. Do you cometo school intoxicated?( ) Yes ( ) NoIfyes, how often?( ) Always( ) Often( ) Sometimes( ) Seldom( ) Never
11. Whataretheeffects of getting drunk?( ) Hangover( ) Motoraccident( ) Gotten into fight( ) Gotten nauseated and vomited( ) Damaged aproperty, pulled a false firealarm, or other such behavior( ) gotten into troublewith schooladministration because of behavior resulting from drinking too much.Others please specify
12. How do you dealwithhangover?( ) Sleep( ) Drinkcoffee( ) Eat salty foods( ) Takeacold shower( ) Take B-complex(vitamins)( ) Cold drinks (iced tea, softdrinks, etc.)( ) Drinkalittleaamount ofalcohol(sundot)
( ) Eat foods rich in potassium (banana, apple, etc.)( ) Engage in physicalactivities whichelicitperspiration
13. Whataretheconsequences of getting drunk?( ) Getting late( ) Getting absent( ) Getting failing grades( ) Scolded byparents( ) Willlead to familyproblemOthers please specify
14. What do youperceiveas benefits in drinking?( ) Enjoyment ( ) Toprove masculinity
( ) Relaxation ( ) Increase sexual opportunities
( ) Itavoids boredom ( ) It is awayto escapeproblems
( ) Easilyto get sleep ( ) It increases courageand confidence
( ) Gaining new friends ( ) It increases menstrual flow(forwomen)15. Who among your family drinkalcohol?
( ) Father ( ) Sister
( ) Mother ( ) None
( ) Brother
16. Atwhatageyou start drinking?