ARRS

1記載日

年月

氏 名日
（入院・外来）

ARRS

しゅうかん

じょうたい

ここ一週 間 のあなたの状 態 についてお聞きします。
ぶんしょう

かこ

下に出てくる文 章 について、自分にあてはまるところを○で囲んでください。

あてはまる

ややあてはまる

どちらともいえない

あまりあてはまらない

あてはまらない

×，△，○のうち，どれかひとつを○でかこんでください

例）よく眠れる································································································ ×△○1) 自分の力だけで酒をやめられると思う ···························································· ×△○△○3) 目の前で酒をすすめられたら断われない ························································· ×△○4) いらいらしている ······················································································· ×△○5) もし少しだけでも酒を飲んだら、飲み続けてしまうだろう ································· ×△○6) 酒を飲むためならほとんど何でもするだろう ··················································· ×△○7) 何に対してもやる気がない ··········································································· ×△○8) ずっと酒を飲まないでやっていくことができそうだ ·········································· ×△○△○△○11) 孤独でさみしいと感じている ········································································ ×△○12) もし、酒を飲んだら、すぐにまともな行動がとれなくなってしまうと思う ············ ×△○△○△○△○△○17) 将 来にたいして不安を感じている································································· ×△○18) ひとりになったら飲んでしまう ····································································· ×△○△○△○ことば2) まわりの人の言葉がわずらわしいと思う ························································· ×
こと

すこだいじょうぶ9) もう大丈夫だと思う ···················································································· ×
じしん10) もう酒を飲まないという自信がある ······························································· ×
こどくさそ13) 目の前で酒を誘われたら、NO とはいえない ···················································· ×
たいくつ14)退屈だなと感じている ················································································· ×すく15) もし酒を飲めば、どうしようもないさびしさから救われるように感じるだろう ······ ×
まちさそ16) 街で友達に誘われれば飲んでしまうと思う ······················································ ×
しょうらい

ふあんしごとえいきょう19) もし酒を飲んだら、仕事に影 響が出ると思う·················································· ×
びょういん

さそ20) 病 院の中でも友達に誘われれば飲んでしまう·················································· ×

次のページにも質問がありますARRS2○21) 自分の気持ちがコントロールできないと感じている ·········································· ×△○△○△○24) 自分は依存症だと思う ················································································· ×△○25) 酒を飲んだら、落ち着かなさを感じると思う ··················································· ×△○26) 酒を買うお金をかせぐためならなんでもしようと思う ······································· ×△○27) 飲み会などでもりあがったときには飲んでしまうかもしれない ··························· ×△○28) 酒を飲むと、なんでもものごとがうまくいくように感じる ································· ×△○29) 盗んででも酒がほしいと思うことがある ························································· ×△○30) 酒を飲むと元気になれる気がする ·································································· ×△○31) 近い 将 来、酒を飲む気がする······································································· ×△○32) 体をこわしてでも酒が飲みたいと思う ···························································· ×

△○

しごと

しゅうしょくもんだい22) 仕事や 就 職 について、大きな問題をかかえている ·········································· ×
じっさい23) 目の前に実際に酒があれば飲んでしまう ························································· ×
いぞんしょう

ぬす

ちか

しょうらい

記入もれはありませんか？ ご回答いただき、まことにありがとうございました。

あてはまる

ややあてはまる△

あてはまらない

どちらともいえない

あまりあてはまらない例）よく眠れる································································································ ×

×，△，○のうち，どれかひとつを○でかこんでください