Alcohol, Medication and Older Adults
For Those Who Care About or Care for an Older Adult

Module 7: Assessing a Problem - Page 3 of 5

Health Screening Survey (HSS), Revised - An Alcohol Screening Test

The revised Health Screening Survey is designed to assess how much alcohol a person drinks, how often a person drinks alcohol, and that person's perception of alcohol as a problem.

Check the appropriate answer.

In the last 3 months, have you been drinking alcoholic drinks at all (e.g., beer, wine, sherry, vermouth, or hard liquor)?

YES NO IF YES, ANSWER below.

  1. On average, how many days per week have you been drinking beer or wine coolers?
    None 1 - 2 3 - 4 5 - 6 Everyday
  2. On a day when you have had beer or wine coolers to drink, how many beers or wine coolers have you been drinking?
    1 - 2 3 - 4 5 - 8 9 - 14 15 or more AND
  3. On average how many days per week have you been drinking wine, sherry, or vermouth?
    None 1 - 2 3 - 4 5 - 6 Everyday
  4. On a day when you have had wine, sherry, or vermouth to drink, how many glasses have you been drinking?
    1 - 2 3 - 4 5 - 8 9 - 14 15 or more AND
  5. On average how many days per week have you been drinking liquor (gin, vodka, rum, brandy, whiskey, etc.)?
    None 1 - 2 3 - 4 5 - 6 Everyday
  6. On a day when you have had liquor to drink, how many single shots have you been drinking?
    1 - 2 3 - 4 5 - 8 9 - 14 15 or more

Do you think you currently have a drinking problem?

Definitely
Probably
No
Don't Know

Thinking back, would you say at any time in the past you had a drinking problem?

Definitely
Probably
No
Don't Know

Scoring: The HSS contains several subscales - one measuring amount of alcohol consumption, one for self-perception of current problem with alcohol, and one for self-perception of past problem with alcohol. For adults over age 65, recommended safe limits are not to exceed one alcoholic drink a day. Self perception of a present or past problem with alcohol indicates problem drinking.

Source: Fleming, M.F., and Barry, K.L. A three-sample test of a masked alcohol screening questionnaire. Alcohol and Alcoholism 26(1):81-91, 1991.

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