The Task Force on Recommended Alcohol Questions, a task force of NIAAA's Council met on October 15 and 16, 2003 in Bethesda Maryland to develop recommended minimum sets of downward compatible alcohol consumption questions, for researchers in other fields who only have resources to ask a limited number of alcohol-related questions. The recommended sets of 3, 4, 5 and 6 items presented here resulted from the work of that task force.

What Is The Minimum Number of Questions Which Should Be Recommended?

Research has shown the importance of learning about people's patterns of alcohol consumption, not just their average levels of consumption (e.g., average number of drinks consumed in a week). Patterns of alcohol consumption (that may include frequent regular drinking of small amounts, or infrequent episodes of consuming very large quantities all at one time) cannot be adequately described or differentiated by asking only two questions about drinking. Two questions can measure only averages (based on questions about typical drinking frequencies and quantities) or extreme patterns (such as abstinence and heavy episodic drinking). To more adequately capture the range of drinking patterns requires a minimum of three questions. Specifically, a measure of frequency of heavy drinking (5 or more standard drinks within a two-hour*  period for men (4 or more for women), and standard questions about frequency of alcohol use and typical number of drinks per day when alcohol is used, are necessary to adequately describe drinking patterns and total volume of alcohol consumed.

This recommendation is consistent with those in the International Guide for Monitoring Alcohol Consumption and Related Harm (WHO, 2000, pg 57). It is also based on recent epidemiological studies on alcohol intake and risks which have demonstrated that for estimating risk of mortality, morbidity (including injuries) and other problems including drunk driving and social harms, it is essential to assess heavy quantity consumption in addition to usual frequency and quantity of consumption. The most widely used, pattern measure of heavy consumption is "binge" defined by a Working Group of NIAAA's Council as a pattern of drinking alcohol that brings blood alcohol concentration (BAC) to 0.08 grams percent or above. For the typical adult this pattern corresponds to consuming 5 or more drinks (male) or 4 or more drinks (female) in about 2 hours.

Brief Overview of the 3, 4, 5 And 6 Item Sets of Recommended Questions

The 3 item set asks about the frequency of past 12 month drinking, the number of drinks consumed on a typical drinking day in the past 12 months and about the frequency of binge drinking in the past 12 months, in order to capture information about both level of consumption and drinking patterns, as recommended above. The 4 item set adds a question about the maximum number of drinks consumed in a 24-hour period in the past 12 months. This question is important because it provides additional information about drinking patterns and because it is highly correlated with alcohol use disorders. It is inserted before the binge drinking question which then becomes question 4 in the 4 item set. The 5 item set adds a question about maximum drinks in a 24 hour period in the respondent's lifetime, as the last question in the set. And finally, the 6 item set adds, as the fourth question immediately following the item about maximum drinks in a 24-hour period in the past 12 months, an item which asks about the frequency of consuming this maximum number of drinks in the past 12 months.

The Choice of the Past 12 Month Timeframe

It was the consensus of the task force that asking about alcohol consumption over the past 12 months was the best choice of timeframe, taking into account the issues of recall over the period and of infrequent drinkers, many of whom would be missed with a short timeframe. Missing infrequent drinkers could be especially problematic for studying the relationship between infrequent (which is often light to moderate) drinking and general health outcomes, a relationship which is the focus of many large epidemiological studies of adults.

However, when studying alcohol consumption among adolescents, other factors need to be considered. Due to the more sporadic, or opportunistic, nature of alcohol consumption among youth, and the possibility of generalizing from recent drinking episodes, a 30-day time window is frequently used for underage subjects. Using a 30-day time window for underage subjects will also facilitate comparisons with many other national survey studies of youth, which employ that timeframe.

Key references (selected):

Caetano, R., Tam, T., Greenfield, T. K., Cherpitel, C. J. and Midanik, L. T. (1997) DSM-IV alcohol dependence and drinking in the U.S. population: A risk analysis. Annals of Epidemiology 7, 542-549.

Cherpitel, C. J., Tam, T. W., Midanik, L. T., Caetano, R. and Greenfield, T. K. (1995) Alcohol and non-fatal injury in the U.S. general population: A risk function analysis. Accident Analysis and Prevention 27, 651-661.

Greenfield, T. K. and Rogers, J. D. (1999) Alcoholic beverage choice, risk perception, and self-reported drunk driving: effects of measurement on risk analysis. Addiction 94, 1735-1743.

Midanik, L. T., Tam, T. W., Greenfield, T. K. and Caetano, R. (1996) Risk functions for alcohol-related problems in a 1988 U.S. national sample. Addiction 91, 1427-1437.

Rehm, J. and Bondy, S. (1996) Risk functions, low risk drinking guidelines, and the benefits of moderate drinking. Addiction 91, 1439-1441.

Rehm, J., Greenfield, T. K. and Rogers, J. D. (2001) Average volume of alcohol consumption, patterns of drinking and all-cause mortality. Results from the U.S. National Alcohol Survey. American Journal of Epidemiology 153, 64-71.

Room, R., Bondy, S. and Ferris, J. (1995) The risk of harm to oneself from drinking, Canada 1989. Addiction 90, 499-513.

Question 1 - (asks about frequency of past 12 month drinking)

During the last 12 months, how often did you usually have any kind of drink containing alcohol? By a drink we mean half an ounce of absolute alcohol (e.g. a 12 ounce can or glass of beer or cooler, a 5 ounce glass of wine, or a drink containing 1 shot of liquor). Choose only one.
___ Every day
___ 5 to 6 times a week
___ 3 to 4 times a week
___ twice a week
___ once a week
___ 2 to 3 times a month
___ once a month
___ 3 to 11 times in the past year
___ 1 or 2 times in the past year
(IF RESPONDENT GIVES ANY OF THE ABOVE RESPONSES, GO TO QUESTION 2)
___ I did not drink any alcohol in the past year, but I did drink in the past
(GO TO QUESTION 1A)
___ I never drank any alcohol in my life
(GO TO QUESTION 1B)

1A - During your lifetime, what is the maximum number of drinks containing alcohol that you drank within a 24-hour period? (asked here only of those who did not drink any alcohol during the past 12 months)
___ 36 drinks or more
___ 24 to 35 drinks
___ 18 to 23 drinks
___ 12 to 17 drinks
___ 8 to 11 drinks
___ 5 to 7 drinks
___ 4 drinks
___ 3 drinks
___ 2 drinks
___ 1 drink
(DONE WITH ALCOHOL QUESTIONS)

1B - So you have never had a drink containing alcohol in your entire life. (asked only of those who say they never drank alcohol in their lives)
___ Yes, I never drank.
(DONE WITH ALCOHOL QUESTIONS)
___ No, I did drink
(GO BACK TO QUESTION 1 AND REPEAT)

Question 2 - (asks about number of drinks on typical drinking day in past 12 months)

During the last 12 months, how many alcoholic drinks did you have on a typical day when you drank alcohol?

___ 25 or more drinks
___ 19 to 24 drinks
___ 16 to 18 drinks
___ 12 to 15 drinks
___ 9 to 11 drinks
___ 7 to 8 drinks
___ 5 to 6 drinks
___ 3 to 4 drinks
___ 2 drinks
___ 1 drink

Question 3 - (asks about frequency of binge drinking in past 12 months)

During the last 12 months, how often did you have 5 or more (males) or 4 or more (females) drinks containing any kind of alcohol in within a two-hour period? [That would be the equivalent of at least 5 (4) 12-ounce cans or bottles of beer, 5 (4) five ounce glasses of wine, 5 (4) drinks each containing one shot of liquor or spirits - to be provided by interviewer if asked.] Choose only one.

___ Every day
___ 5 to 6 days a week
___ 3 to 4 days a week
___ two days a week
___ one day a week
___ 2 to 3 days a month
___ one day a month
___ 3 to 11 days in the past year
___ 1 or 2 days in the past year

Four Question Set

Question 1 - (asks about frequency of past 12 month drinking)

During the last 12 months, how often did you usually have any kind of drink containing alcohol? By a drink we mean half an ounce of absolute alcohol (e.g. a 12 ounce can or glass of beer or cooler, a 5 ounce glass of wine, or a drink containing 1 shot of liquor). Choose only one.
___ Every day
___ 5 to 6 times a week
___ 3 to 4 times a week
___ twice a week
___ once a week
___ 2 to 3 times a month
___ once a month
___ 3 to 11 times in the past year
___ 1 or 2 times in the past year
(IF RESPONDENT GIVES ANY OF THE ABOVE RESPONSES, GO TO QUESTION 2)
___ I did not drink any alcohol in the past year, but I did drink in the past
(GO TO QUESTION 1A)
___ I never drank any alcohol in my life
(GO TO QUESTION 1B)

1A - During your lifetime, what is the maximum number of drinks containing alcohol that you drank within a 24-hour period? (asked here only of those who did not drink any alcohol during the past 12 months)
___ 36 drinks or more
___ 24 to 35 drinks
___ 18 to 23 drinks
___ 12 to 17 drinks
___ 8 to 11 drinks
___ 5 to 7 drinks
___ 4 drinks
___ 3 drinks
___ 2 drinks
___ 1 drink
(DONE WITH ALCOHOL QUESTIONS)

1B - So you have never had a drink containing alcohol in your entire life. (asked only of those who say they never drank alcohol in their lives)
___ Yes, I never drank.
(DONE WITH ALCOHOL QUESTIONS)
___ No, I did drink
(GO BACK TO QUESTION 1 AND REPEAT)

Question 2 - (asks about number of drinks on typical drinking day in past 12 months)

During the last 12 months, how many alcoholic drinks did you have on a typical day when you drank alcohol?

___ 25 or more drinks
___ 19 to 24 drinks
___ 16 to 18 drinks
___ 12 to 15 drinks
___ 9 to 11 drinks
___ 7 to 8 drinks
___ 5 to 6 drinks
___ 3 to 4 drinks
___ 2 drinks
___ 1 drink

Question 3 - (NEW QUESTION FOR 4 ITEM SET - NOTE ORDER CHANGE - NEW QUESTION IS #3) (asks about maximum drinks in a 24 hour period in past 12 months)

During the last 12 months, what is the largest number of drinks containing alcohol that you drank within a 24-hour period?

___ 36 drinks or more
___ 24 to 35 drinks
___ 18 to 23 drinks
___ 12 to 17 drinks
___ 8 to 11 drinks
___ 5 to 7 drinks
___ 4 drinks
___ 3 drinks
___ 2 drinks
___ 1 drink

Question 4 - (asks about frequency of binge drinking in past 12 months)

During the last 12 months, how often did you have 5 or more (males) or 4 or more (females) drinks containing any kind of alcohol in within a two-hour period? [That would be the equivalent of at least 5 (4) 12-ounce cans or bottles of beer, 5 (4) five ounce glasses of wine, 5 (4) drinks each containing one shot of liquor or spirits - to be provided by interviewer if asked.] Choose only one.

___ Every day
___ 5 to 6 days a week
___ 3 to 4 days a week
___ two days a week
___ one day a week
___ 2 to 3 days a month
___ one day a month
___ 3 to 11 days in the past year
___ 1 or 2 days in the past year

Five Question Set

Question 1 - (asks about frequency of past 12 month drinking)

During the last 12 months, how often did you usually have any kind of drink containing alcohol? By a drink we mean half an ounce of absolute alcohol (e.g. a 12 ounce can or glass of beer or cooler, a 5 ounce glass of wine, or a drink containing 1 shot of liquor). Choose only one.
___ Every day
___ 5 to 6 times a week
___ 3 to 4 times a week
___ twice a week
___ once a week
___ 2 to 3 times a month
___ once a month
___ 3 to 11 times in the past year
___ 1 or 2 times in the past year
(IF RESPONDENT GIVES ANY OF THE ABOVE RESPONSES, GO TO QUESTION 2)
___ I did not drink any alcohol in the past year, but I did drink in the past
(GO TO QUESTION 1A)
___ I never drank any alcohol in my life
(GO TO QUESTION 1B)

1A - During your lifetime, what is the maximum number of drinks containing alcohol that you drank within a 24-hour period? (asked here only of those who did not drink any alcohol during the past 12 months)
___ 36 drinks or more
___ 24 to 35 drinks
___ 18 to 23 drinks
___ 12 to 17 drinks
___ 8 to 11 drinks
___ 5 to 7 drinks
___ 4 drinks
___ 3 drinks
___ 2 drinks
___ 1 drink
(DONE WITH ALCOHOL QUESTIONS)

1B - So you have never had a drink containing alcohol in your entire life. (asked only of those who say they never drank alcohol in their lives)
___ Yes, I never drank.
(DONE WITH ALCOHOL QUESTIONS)
___ No, I did drink
(GO BACK TO QUESTION 1 AND REPEAT)

Question 2 - (asks about number of drinks on typical drinking day in past 12 months)

During the last 12 months, how many alcoholic drinks did you have on a typical day when you drank alcohol?

___ 25 or more drinks
___ 19 to 24 drinks
___ 16 to 18 drinks
___ 12 to 15 drinks
___ 9 to 11 drinks
___ 7 to 8 drinks
___ 5 to 6 drinks
___ 3 to 4 drinks
___ 2 drinks
___ 1 drink

Question 3 - (asks about maximum drinks in a 24 hour period in past 12 months)

During the last 12 months, what is the largest number of drinks containing alcohol that you drank within a 24-hour period?

___ 36 drinks or more
___ 24 to 35 drinks
___ 18 to 23 drinks
___ 12 to 17 drinks
___ 8 to 11 drinks
___ 5 to 7 drinks
___ 4 drinks
___ 3 drinks
___ 2 drinks
___ 1 drink

Question 4 - (asks about frequency of binge drinking in past 12 months)

During the last 12 months, how often did you have 5 or more (males) or 4 or more (females) drinks containing any kind of alcohol in within a two-hour period? [That would be the equivalent of at least 5 (4) 12-ounce cans or bottles of beer, 5 (4) five ounce glasses of wine, 5 (4) drinks each containing one shot of liquor or spirits - to be provided by interviewer if asked.] Choose only one.

___ Every day
___ 5 to 6 days a week
___ 3 to 4 days a week
___ two days a week
___ one day a week
___ 2 to 3 days a month
___ one day a month
___ 3 to 11 days in the past year
___ 1 or 2 days in the past year

Question 5 - (asks about maximum drinks in 24 hours in lifetime)

During your lifetime, what is the largest number of drinks containing alcohol that you drank within a 24-hour period?

___ 36 drinks or more
___ 24 to 35 drinks
___ 18 to 23 drinks
___ 12 to 17 drinks
___ 8 to 11 drinks
___ 5 to 7 drinks
___ 4 drinks
___ 3 drinks
___ 2 drinks
___ 1 drink

Six Question Set

Question 1 - (asks about frequency of past 12 month drinking)

During the last 12 months, how often did you usually have any kind of drink containing alcohol? By a drink we mean half an ounce of absolute alcohol (e.g. a 12 ounce can or glass of beer or cooler, a 5 ounce glass of wine, or a drink containing 1 shot of liquor). Choose only one.
___ Every day
___ 5 to 6 times a week
___ 3 to 4 times a week
___ twice a week
___ once a week
___ 2 to 3 times a month
___ once a month
___ 3 to 11 times in the past year
___ 1 or 2 times in the past year
(IF RESPONDENT GIVES ANY OF THE ABOVE RESPONSES, GO TO QUESTION 2)
___ I did not drink any alcohol in the past year, but I did drink in the past
(GO TO QUESTION 1A)
___ I never drank any alcohol in my life
(GO TO QUESTION 1B)

1A - During your lifetime, what is the maximum number of drinks containing alcohol that you drank within a 24-hour period? (asked here only of those who did not drink any alcohol during the past 12 months)
___ 36 drinks or more
___ 24 to 35 drinks
___ 18 to 23 drinks
___ 12 to 17 drinks
___ 8 to 11 drinks
___ 5 to 7 drinks
___ 4 drinks
___ 3 drinks
___ 2 drinks
___ 1 drink
(DONE WITH ALCOHOL QUESTIONS)

1B - So you have never had a drink containing alcohol in your entire life. (asked only of those who say they never drank alcohol in their lives)
___ Yes, I never drank.
(DONE WITH ALCOHOL QUESTIONS)
___ No, I did drink
(GO BACK TO QUESTION 1 AND REPEAT)

Question 2 - (asks about number of drinks on typical drinking day in past 12 months)

During the last 12 months, how many alcoholic drinks did you have on a typical day when you drank alcohol?

___ 25 or more drinks
___ 19 to 24 drinks
___ 16 to 18 drinks
___ 12 to 15 drinks
___ 9 to 11 drinks
___ 7 to 8 drinks
___ 5 to 6 drinks
___ 3 to 4 drinks
___ 2 drinks
___ 1 drink

Question 3 - (asks about maximum drinks in a 24 hour period in past 12 months)

During the last 12 months, what is the largest number of drinks containing alcohol that you drank within a 24-hour period?

___ 36 drinks or more
___ 24 to 35 drinks
___ 18 to 23 drinks
___ 12 to 17 drinks
___ 8 to 11 drinks
___ 5 to 7 drinks
___ 4 drinks
___ 3 drinks
___ 2 drinks
___ 1 drink

Question 4 - (NEW QUESTION FOR 6 ITEM SET - NOTE ORDER CHANGE - NEW QUESTION IS #4) (asks about frequency of maximum drinks in last 12 months)

During the last 12 months, how often did you drink this largest number of drinks? Choose only one.

___ Every day
___ 5 to 6 times a week
___ 3 to 4 times a week
___ twice a week
___ once a week
___ 2 to 3 times a month
___ once a month
___ 3 to 11 times in the past year
___ 1 or 2 times in the past year

Question 5 - (asks about frequency of binge drinking in past 12 months)

During the last 12 months, how often did you have 5 or more (males) or 4 or more (females) drinks containing any kind of alcohol in within a two-hour period? [That would be the equivalent of at least 5 (4) 12-ounce cans or bottles of beer, 5 (4) five ounce glasses of wine, 5 (4) drinks each containing one shot of liquor or spirits - to be provided by interviewer if asked.] Choose only one.

___ Every day
___ 5 to 6 days a week
___ 3 to 4 days a week
___ two days a week
___ one day a week
___ 2 to 3 days a month
___ one day a month
___ 3 to 11 days in the past year
___ 1 or 2 days in the past year

Question 6- (asks about maximum drinks in 24 hours in lifetime)

During your lifetime, what is the largest number of drinks containing alcohol that you drank within a 24-hour period?

___ 36 drinks or more
___ 24 to 35 drinks
___ 18 to 23 drinks
___ 12 to 17 drinks
___ 8 to 11 drinks
___ 5 to 7 drinks
___ 4 drinks
___ 3 drinks
___ 2 drinks
___ 1 drink

There are many other important areas of inquiry related to alcohol consumption which are not addressed by the recommended questions. Researchers who want more detailed information about alcohol issues may want to consider asking additional questions in one or more of the following areas: more detailed and/or beverage specific consumption, alcohol problems including abuse and dependence, drinking contexts, drinking expectancies and reasons for drinking, concurrent use of other substances, and screening for alcohol problems as a goal of questions.

Another important consideration is other health-related variables which should be collected in conjunction with alcohol consumption information whenever possible. These are height, weight, smoking information and possibly a measure of health status.