AUDIT-C and DUDIT-C Assessment Form
Client's First Name:
Client's Last Name:
How often do you have a drink containing alcohol?
--None--
Never
Monthly or less
2 - 4 times a month
2 - 3 times a week
4+ times a week
How many drinks containing alcohol do you have on a typical day when you are drinking?
--None--
1 or 2
3 or 4
5 or 6
7 to 9
10 or more
How often do you have six or more drinks on one occasion?
--None--
Never
Less than monthly
Monthly
Weekly
Daily or almost daily
How often do you use a drug other than alcohol?
--None--
Never
Monthly or less
2 - 4 times a month
2 - 3 times a week
4+ times a week
How often do you use more than one drug on the same occasion?
--None--
Never
Monthly or less
2 - 4 times a month
2 - 3 times a week
4+ times a week
How many times do you take drugs on a typical day when you use drugs?
--None--
0
1 or 2
3 or 4
5 or 6
7 or more
How often are you influenced heavily by drugs?
--None--
Never
Less than monthly
Monthly
Weekly
Daily or almost daily
Submit