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Hello:
You are invited to participate in our survey about Alcoholism. In this survey, approximately 30-50 people will be asked to complete a survey that asks questions about alcoholism.It will take approximately 10 minutes to complete the questionnaire.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact [Name of Survey Researcher] at [Phone Number] or by email at the email address specified below.

Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.

 
 
I drink alcohol on a regular basis (daily, every other day, weekends).
Strongly Disagree Disagree Neutral Agree Strongly Agree
 
 
 
Drinking alcohol is fine on special occasions (birthday, anniversary, etc.).
Strongly Disagree Disagree Neutral Agree Strongly Agree
 
 
 
There is nothing wrong with drinking alcohol every day of the week.
Strongly Disagree Disagree Neutral Agree Strongly Agree
 
 
 
I drink alcohol to cope with everyday life.
Strongly Disagree Disagree Neutral Agree Strongly Agree
 
 
 
I can resist the temptation of drinking alcohol.
Strongly Disagree Disagree Neutral Agree Strongly Agree
 
 
 
I doubt I could change even if I wanted to.
Strongly Disagree Disagree Neutral Agree Strongly Agree
 
 
 
I tend to act like those people that I spend the most time with.
Strongly Disagree Disagree Neutral Agree Strongly Agree
 
 
 
I have alot of willpower.
Strongly Disagree Disagree Neutral Agree Strongly Agree
 
 
 
I was born an alcoholic.
Strongly Disagree Disagree Neutral Agree Strongly Agree
 
 
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