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H2. In the period of your life when you drank the most, about how much alcohol did you drink? <br /> a. I never drank alcohol <br /> b. Less than 1 drink a week <br /> c. 1-2 drinks a week <br /> d. 3-5 drinks a week <br /> e. 1-2 drinks a day <br /> f. 3-5 drinks a day <br /> g. 6 or more drinks a day <br /> • H3. Have you ever been intoxicated? <br /> a. No <br /> b. Yes • <br /> H4. About how often do you have 6 or more alcoholic drinks in a single afternoon or evening? <br /> a. Never <br /> b. About once a year, or less <br /> c. A few times a year <br /> d. About every other month <br /> e. About once a month <br /> f. A few times a month <br /> g. About once a week <br /> h. Afewtimesaweek <br /> i. Almost every day <br /> H5. How many drinks does it take before you feel the first effects of alcohol (feel"high", <br /> "woozy", etc.)?(COUNT ONE DRINK FOR EACH 12 OZ. BOTTLE OF BEER,4 OZ GLASS OF WINE,OR <br /> 1 OZ SHOT OF LIQUOR.) <br /> a. I don't drink alcohol <br /> b. 1-2 drinks <br /> c. 3-5 drinks <br /> d. 6-11 drinks <br /> e. 12 drinks or more <br /> H6. How many drinks does it take before you are intoxicated, drunk, or impaired?(couNT ONE <br /> DRINK FOR EACH 12 OZ.BOTTLE OF BEER,4 OZ GLASS OF WINE,OR 1 OZ SHOT OF LIQUOR.) <br /> a. I don't drink alcohol <br /> b. 1-2 drinks <br /> c. 3-5 drinks <br /> d. 6-11 drinks <br /> e. 12 drinks or more <br /> Have you ever had any of the following experiences after consuming alcohol: <br /> H7. ... blackouts(loss of recall for events that occurred while intoxicated)? <br /> a. No <br /> b. Yes <br /> H8. ... marital or family difficulties? <br /> a. No <br /> b. Yes <br /> H9. ... missed work? <br /> a. No <br /> b. Yes <br /> PSS/LEPS PLLC 77 <br />