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COLLEGE STUDENT ALCOHOL USE QUESTIONNAIRE

This survey is designed to better understand the use of alcoholic
beverages among college students. Please be completely open and honest in
providing information about yourself and your use of alcohol. Your individual
responses will not be identified with you in any way. All answers will be
combined and only overall results reported.
1. Have you ever consumed alcoholic beverages?
___ Yes
___ No
If no, skip to question #51
2. Have you ever consumed five or more drinks in one sitting? For the purposes of this
study, a drink is defined as a bottle of beer, a glass of wine, a wine cooler, a shot
glass of liquor, a mixed drink, or a similar drink containing alcohol.
___ Yes
___ No
3. Think back over the last two weeks. How many times have you consumed five or
more drinks at one sitting?
___
4. What is the average number of drinks you consume in a week? ___
5. To what extent has your alcohol use changed within the last 12 months?
___ Increased
___ About the Same
___ Decreased
During the last 30 days, to what extent have you engaged in each of the
following behaviors? Fill in the blank. For example, if zero times put a 0, if one
time put a 1, if 10 times put a 10, and so on.
Number of Times
6. Refused an offer of alcohol?
___
7. Bragged about your alcohol use?
___
8. Heard someone else brag about his/her alcohol use?
___
9. Experienced peer pressure to drink?
___
10. Thought a sexual partner who was drunk was
not attractive?
___
11. Told a sexual partner who was drunk that they
were not attractive?
___

Please indicate how often you have experienced the following due to your
drinking during the last year (12 months)? Fill in the blank. For example, if zero
times put a 0, if one time put a 1, if 10 times put a 10, and so on.
Number of Times
12. Had a hangover?
___
13. Performed poorly on a test or important project?
___
14. Been in trouble with police, residence hall or
other college authorities?
___
15. Damaged property, pulled fire alarm, etc.?
___
16. Got into an argument or fight?
___
17. Got nauseated or vomited?
___
18. Driven a car or truck while under the influence?
___
19. Missed a class?
___
20. Been criticized by someone you know?
___
21. Thought you might have a drinking problem?
___
22. Experienced memory loss?
___
23. Done something you later regretted?
___
24. Been arrested for DUI/DWI?
___
25. Been taken advantage of sexually?
___
26. Have taken advantage of another sexually?
___
27. Tried unsuccessfully to stop drinking?
___
28. Seriously thought about suicide?
___
29. Seriously tried to commit suicide?
___
30. Been hurt or injured due to your drinking?
___
For each of the following statements, indicate whether or not you believe
alcohol has that effect? Circle the appropriate number.
31. Breaks the ice?
Strongly
Disagree

32. Enhances social activities?

Strongly
Disagree
1

Strongly
Agree

Strongly
Agree

33. Makes it easier to deal with stress?

Strongly
Disagree
1
2
3

Strongly
Agree

34. Makes a connection with peers easier?

Strongly
Disagree
1
2
3

Strongly
Agree

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35. Gives people something to talk about?
Strongly
Disagree
1
2
3

Strongly
Agree

36. Facilitates male bonding?

Strongly
Disagree
1

Strongly
Agree

37. Facilitates female bonding?

Strongly
Disagree
1

Strongly
Agree

Strongly
Agree

38. Enables people to have more fun?

Strongly
Disagree
1
2

39. Gives people something to do?

Strongly
Disagree
1
2

Strongly
Agree

40. Makes food taste better?

Strongly
Disagree
1

Strongly
Agree

41. Makes women sexier?

Strongly
Disagree
1

Strongly
Agree

42. Makes you sexier?

Strongly
Disagree

Strongly
Agree

Strongly
Agree

43. Improves sexual opportunities?

Strongly
Disagree
1
2

44. Interrupts your studying?

Strongly
Disagree
1

Strongly
Agree

45. Makes you feel unsafe?

Strongly
Disagree
1

Strongly
Agree

46. Messes up your physical living space (cleanliness, neatness, organization, etc.)?
Strongly
Strongly
Disagree
1
2
3
4
5
Agree

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47. Prevents you from enjoying events, such as concerts, sports, social activities, etc.?
Strongly
Strongly
Disagree
1
2
3
4
5
Agree
48. Interferes in other ways? If yes, please specify: ________________________
Strongly
Strongly
Disagree
1
2
3
4
5
Agree
Classification Questions
49. What is your classification?
___ Freshman
___ Sophomore
___ Junior

___ Senior
___ Graduate Student

50. What is your gender?

___ Female

___ Male

51. What is your age?

___

52. Binge drinking has been defined as consuming five or more drinks in one setting.
Have you ever consumed alcohol in a manner that meets this definition?
__ Yes
__ No
If yes:
a. Did you binge drink in high school?
__ Yes
__ No
b. Do you binge drink as a college student? __ Yes
__ No
53. What is your ethnic origin?
__ American Indian/Alaskan Native
__ Hispanic
__ Asian/Pacific

__ White (non-Hispanic)
__ Black (non-Hispanic)
__ Other (please specify) __________

54. What is your marital status?

__ Single
__ Divorced
__ Married
__ Living with a partner, but not married
__ Separated
__ Widowed
55. What is your parents annual income?
__ Less than $25,000
__ $25,001 - $50,000
__ $50,001 - $75,000
__ $75,001 - $100,000
__ $100,001 - $125,000
__ $125,001 - $150,000
__ $150,001 or higher
Thank you for your participation.