| 1. Drinking alcohol would ease my pain. | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 |
| 2. If I were to experience pain, drinking would help me reduce it. | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 |
| 3. If I hurt myself, I would feel less pain if I could drink alcohol. | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 |
| 4. When I feel pain, drinking alcohol can really help. | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 |
| 5. I feel like drinking alcohol would help me cope with pain. | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 |