ARRS

Date (mm/dd/yyyy):
Name:

1//（ Inpatient ・ Outpatient ）ARRS

Please describe your state during the past week.
For each statement below, please circle one answer that best describes you.
NeitherAgree
norDisagree

Strongly
Agree
and
Agree

Ex.）I sleep well.································································································ ×△○1) I can stop drinking alcohol by myself. ······························································ ×△○2) I am annoyed by words from others. ································································ ×△○3) It would be difficult for me to refuse if someone placed alcohol in front of me. ·········· ×△○4) I am irritated. ······························································································ ×△○5) If I drink a small amount of alcohol, I would not be able to stop drinking.·························· ×△○6) I would do almost anything in order to drink alcohol. ········································ ×△○7) I am not motivated to do anything. ·································································· ×△○8) I would be fine without alcohol. ······································································ ×△○9) I have already recovered from alcohol abuse. ····················································· ×△○10) I am confident that I would not drink alcohol again.············································· ×△○11) I feel lonely. ······························································································· ×△○12) I would not be able to control myself if I drink alcohol. ········································ ×△○13) If someone held alcohol under my nose, I would not be able to refuse it. ·················· ×△○14) I feel bored. ································································································ ×△○15) Alcohol would save me from feeling lonely. ······················································ ×△○16) I would drink alcohol if my friends offered it to me on a street.······························· ×△○17) I am anxious about my future. ········································································ ×△○18) I would drink alcohol if I am alone. ································································· ×△○19) If I drink alcohol, it would badly influence my job.·············································· ×△○20) If my friend gave me alcohol, I would drink it even in the hospital. ························· ×△○

Please circle one from (×，△，○)

Please continue on the next page.

Strongly
DisagreeandDisagreeARRS

2NeitherAgreenor
DisagreeStrongly
AgreeandAgreeEx.）I sleep well.································································································ ×△○21) I cannot control my feeling. ··········································································· ×△○22) I have significant job-related problems.····························································· ×△○23) If alcohol is placed in front of me, I would drink it. ·············································· ×△○24) I think I am an addict. ··················································································· ×△○25) I would feel restless if I drank alcohol.······························································ ×△○26) I would do anything to get money for alcohol.···················································· ×△○27) I might drink alcohol at a party or a gathering. ···················································· ×△○28) If I drink alcohol, I will feel everything is going well.··········································· ×△○29) I want alcohol even if I have to steal. ································································ ×△○30) If I drink alcohol, I will feel invigorated. ··························································· ×△○31) I will drink alcohol in near future.···································································· ×△○32) I want to drink alcohol even if it deteriorates my health.········································ ×△○

Please circle one from (×，△，○)

StronglyDisagreeandDisagree

Please check your answers. Thank you very much for your participation.