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Protocol - Addiction Severity Index

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Description:

An interviewer-administered assessment that focuses on a respondent’s medical status, employment and support, drug use, alcohol use, legal status, family/social status, and psychiatric status to determine a respondent’s level of stability and understand life events that contribute to alcohol and drug dependency.

Specific Instructions:

The following questions may gather sensitive information relating to the use of substances or illegal conduct. If the information is released, it might be damaging to an individual’s employability, lead to social stigmatization, or result in other consequences.

For information on obtaining a Certificate of Confidentiality, which helps researchers protect the privacy of human research participants, please go to the National Human Genome Research Institute’s Institutional Review Board website (http://www.genome.gov/10005108).

Protocol:

INSTRUCTIONS

1. Leave No Blanks-Where appropriate, code items:

X = question not answered

N = question not applicable

Use only one character per item.

2. Questions that are italicized are to be asked at follow-up. Items with an asterisk are cumulative and should be rephrased at follow-up (see Manual).

3. Space is provided after sections for additional comments.

SEVERITY RATINGS

The severity ratings are interviewer estimates of the patient’s need for additional treatment in each area. The scales range from 0 (no treatment necessary) to 9 (treatment needed to intervene in life-threatening situation). Each rating is based upon the patient’s history of problems, symptoms, present condition, and subjective assessment of his treatment needs in a given area. For a detailed description of severity ratings’ derivation procedures and conventions, see manual. Note: These severity ratings are optional.

SUMMARY OF PATIENT’S RATING SCALE

0-Not at all

1-Slightly

2-Moderately

3-Considerably

4-Extremely

1. RELIGIOUS PREFERENCE

1[ ]Protestant

2[ ]Catholic

3[ ]Jewish

4[ ]Islamic

5[ ]Other

6[ ]None

2. Have you been in a controlled environment in the past 30 days?

1[ ]No - Go to Q4

2[ ]Jail

3[ ]Alcohol or Drug Treatment

4[ ]Medical Treatment

5[ ]Psychiatric Treatment

6[ ]Other ___________________________

3. How many days? |__|__|

Medical Status

4. *How many times in your life have you been hospitalized for medical problems? (Include o.d.’s, d.t.’s, exclude detox.)

5. How long ago was your last hospitalization for a physical problem

|__|__| |__|__|

YRS MOS

6. Do you have any chronic medical problems which continue to interfere with your life?

0[ ]No

1[ ]Yes _____________ Specify

7. Are you taking any prescribed medication on a regular basis for a physical problem?

0[ ]No

1[ ]Yes

8. Do you receive a pension for a physical disability? (Exclude psychiatric disability.)

0[ ]No

1[ ]Yes _____________ Specify

9. How many days have you experienced medical problems in the past 30?

|__|__|

FOR QUESTIONS 10 and 11 PLEASE ASK PATIENT TO USE THE PATIENT RATING SCALE

10. How troubled or bothered have you been by these medical problems in the past 30 days? |__|

11. How important to you now is treatment for these medical problems? |__|

INTERVIEWER SEVERITY RATING

How would you rate the patient’s need for medical treatment?

CONFIDENCE RATINGS

Is the above information significantly distorted by:

13. Patient’s misrepresentation?

0[ ]No

1[ ]Yes

14. Patient’s inability to understand?

0[ ]No

1[ ]Yes

EMPLOYMENT/SUPPORT STATUS

15. Do you have a profession, trade, or skill?

0[ ]No

1[ ]Yes _____________ Specify

16. Do you have a valid driver’s license?

0[ ]No

1[ ]Yes

17. Do you have an automobile available for use? (Answer No if no valid driver’s license.)

0[ ]No

1[ ]Yes

How long was your longest full-time job?

|__|__| |__|__|

YRS MOS

19. *Usual (or last) occupation.

_________________ (Specify in detail)

20. Does someone contribute to your support in any way?

0[ ]No

1[ ]Yes

21. (ONLY IF ITEM 20 IS YES) Does this constitute the majority of your support?

0[ ]No

1[ ]Yes

22. Usual employment pattern, past 3 years.

1[ ]full time (40 hrs/wk)

2[ ]part time (reg. hrs)

3[ ]part time (irreg, daywork)

4[ ]student

5[ ]service

6[ ]retired/disability

7[ ]unemployed

8[ ]in controlled environment

23. How many days were you paid for working in the past 30? (include "under the table" work"

24. How much money did you receive from the following sources in the past 30 days?

Employment (net income) |__|__|__|__|

Unemployment compensation |__|__|__|__|

DPA |__|__|__|__|

Pension, benefits or Social Security |__|__|__|__|

Mate, family or friends (Money for personal expenses.) |__|__|__|__|

Illegal |__|__|__|__|

25. How many people depend on you for the majority of their food, shelter, etc.? [ ]

26. How many days have you experienced employment problems in the past 30? [ ]

FOR QUESTIONS 27 & 28 PLEASE ASK PATIENT TO USE THE PATIENT’S RATING SCALE

27. How troubled or bothered have you been by these employment problems in the past 30 days?

28. How important to you now is counseling for these employment problems?

INTERVIEWER SEVERITY RATING

29. How would you rate the patient’s need for employment counseling?

CONFIDENCE RATINGS

Is the above information significantly distorted by:

30. Patient’s misrepresentation?

0[ ]No

1[ ]Yes

31. Patient’s inability to understand?

0[ ]No

1[ ]Yes

DRUG/ALCOHOL USE

PAST 30 Days

LIFETIME

Yrs.

USE

Rt of adm.

32. Alcohol - Any use at all

|__|__|

|__|__|

|__|

33. Alcohol - To intoxication

|__|__|

|__|__|

|__|

34. Heroin

|__|__|

|__|__|

|__|

35. Methadone

|__|__|

|__|__|

|__|

36. Other opiates/analgesics

|__|__|

|__|__|

|__|

37. Barbiturates

|__|__|

|__|__|

|__|

38. Other sed/hyp/tranq.

|__|__|

|__|__|

|__|

39. Cocaine

|__|__|

|__|__|

|__|

40. Amphetamines

|__|__|

|__|__|

|__|

41. Cannabis

|__|__|

|__|__|

|__|

42. Hallucinogens

|__|__|

|__|__|

|__|

43. Inhalants

|__|__|

|__|__|

|__|

44. More than one substance per day (Include alcohol)/ |__|__| |__|__|

Note: See manual for representative examples for each drug class

*Route of Administration: 1 = Oral, 2 = Nasal, 3 = Smoking, 4 = Non IV injection, 5 = IV injection

45. Which substance is the major problem? Please code as above or 00-No problem; 15-Alcohol & Drug (Dual addiction); 16-Polydrug; when not clear, ask patient.

|__|__|

46. How long was your last period of voluntary abstinence from this major substance? (00-never abstinent)

|__|__|

47. How many months ago did this abstinence end?

How many times have you:

48. *Had alcohol d.t.’s |__|__|

49. *Overdosed on drugs |__|__|

How many times in your life have you been treated for:

50. *Alcohol Abuse: |__|__|

51. *Drug Abuse: |__|__|

How many of these were detox only?

52. *Alcohol |__|__|

53. *Drug |__|__|

How much would you say you spent during the past 30 days on:

54. Alcohol |__|__||__|__|

55. Drug |__|__||__|__||

56. How many days have you been treated in an outpatient setting for alcohol or drugs in the past 30 days (Include NA, AA). |__|__|

How many days in the past 30 have you experienced:

57. Alcohol Problems |__|__|

58. Drug Problems |__|__|

FOR QUESTIONS 59 & 60 PLEASE ASK PATIENT TO USE THE PATIENT’S RATING SCALE

How troubled or bothered have you been in the past 30 days by these:

59. Alcohol Problems |__|

60. Drug Problems |__|

How important to you now is treatment for these:

61. Alcohol Problems |__|

62. Drug Problems |__|

INTERVIEWER SEVERITY RATING

How would you rate the patient’s need for treatment for:

63. Alcohol Abuse |__|

64. Drug Abuse |__|

CONFIDENCE RATINGS

Is the above information significantly distorted by:

65. Patient’s misrepresentation?

0[ ]No

1[ ]Yes

66. Patient’s inability to understand?

0[ ]No

1[ ]Yes

LEGAL STATUS

67. Was this admission prompted or suggested by the criminal justice system (judge, probation/parole officer, etc.)

0[ ]No

1[ ]Yes

68. Are you on probation or parole?

0[ ]No

1[ ]Yes

How many times in your life have you been arrested and charged with the following:

69. *Shoplifting/vandalism |__|__|

70. *Parole/probation violations |__|__|

71. *Drug charges |__|__|

72. *Forgery |__|__|

73. *Weapons offense |__|__|

74. *Burglary, larceny, B&E |__|__|

75. *Robbery |__|__|

76. *Assault |__|__|

77. *Arson |__|__|

78. *Rape |__|__|

79. *Homicide, manslaughter |__|__|

80. *Prostitution |__|__|

81. *Contempt of court |__|__|

82. *Other |__|__|

83. *How many of these charges resulted in convictions? |__|__|

How many times in your life have you been charged with the following:

84. *Disorderly conduct, vagrancy, public intoxication |__|__|

85. *Driving while intoxicated |__|__|

86. *Major driving violations (reckless driving, speeding, no license, etc.) |__|__|

87. *How many months were you incarcerated in your life?

|__|__|

MOS.

88. How long was your last incarceration?

|__|__|

MOS.

89. What was it for? (Use code 3-16, 18-20. If multiple charges, code most severe)

|__|__|

90. Are you presently awaiting charges, trial or sentence?

0[ ]No

1[ ]Yes

91. What for (if multiple charges, use most severe). |__|__|

92. How many days in the past 30 were you detained or incarcerated? |__|__|

93. How many days in the past 30 have you engaged in illegal activities for profit? |__|__|

FOR QUESTION 94 & 95 PLEASE ASK PATIENT TO USE THE PATIENT’S RATING SCALE

94. How serious do you feel your present legal problems are? (Exclude civil problems)

|__|

95. How important to you now is counseling or referral for these legal problems? |__|

INTERVIEWER SEVERITY RATING

96. How would you rate the patient’s need for legal services or counseling? |__|

CONFIDENCE RATINGS

Is the above information significantly distorted by:

97. Patient’s misrepresentation?

0[ ]No

1[ ]Yes

98. Patient’s inability to understand?

0[ ]No

1[ ]Yes

FAMILY/SOCIAL RELATIONSHIPS

99. Marital Status |__|

1-Married

2-Remarried

3-Widowed

4-Separated

5-Divorced

6-Never Married

100. How long have you been in this marital status? (If never married, since age 18).

|__|__| |__|__|

YRS MOS

101. Are you satisfied with this situation?

0[ ]No

1[ ]Indifferent

2[ ]Yes

102. *Usual living arrangements (past 3 yr.) |__|

1-With sexual partner and children

2-With sexual partner alone

3-With children alone

4-With parents

5-With family

6-With friends

7-Alone

8-Controlled environment

9-No stable arrangements

103. How long have you lived in these arrangements. (If with parents or family, since age 18).

|__|__| |__|__|

YRS MOS

104. Are you satisfied with these living arrangements?

0[ ]No

1[ ]Indifferent

2[ ]Yes

Do you live with anyone who: 0 = No, 1 = Yes

105. Has a current alcohol problem? [ ]

  • Uses non-prescribed drugs? [ ]

    107. With whom do you spend most of your free time: [ ]

    1-Family

    2-Friends

    3-Alone

    108. Are you satisfied with spending your free time this way?

    0[ ]No

    1[ ]Indifferent

    2[ ]Yes

    109. How many close friends do you have? |__|

    Direction for 110-124: Place "0" in relative category where the answer is clearly no for all relatives in the category; "1" where the answer is clearly yes for any relative within the category; "X" where the answer is uncertain or "I don’t know" and "N" where there never was a relative from that category.

    Would you say you have had close, long lasting, personal relationships with any of the following people in your life:

    110. Mother [ ]

  • Father [ ]
  • Brothers/Sisters [ ]
  • Sexual Partner/Spouse [ ]
  • Children [ ]
  • Friends [ ]

    Have you had significant periods in which you have experienced serious problems getting along with:

    0 = No

    1 = Yes

    PAST 30 DAYS

    IN YOUR LIFE

    116. Mother

    [ ]

    [ ]

    117. Father

    [ ]

    [ ]

    118. Brothers/Sisters

    [ ]

    [ ]

    119. Sexual partner/spouse

    [ ]

    [ ]

    120. Children

    [ ]

    [ ]

    121. Other significant family __________

    [ ]

    [ ]

    122. Close friends

    [ ]

    [ ]

    123. Neighbors

    [ ]

    [ ]

    124. Co-Workers

    [ ]

    [ ]

    Did any of these people (Questions 116-124) abuse you:

    0 = No, 1 = Yes

    PAST 30 DAYS

    IN YOUR LIFE

    125. Emotionally (make you feel bad through harsh words)?

    [ ]

    [ ]

    126. Physically (cause you physical harm)?

    [ ]

    [ ]

    127. Sexually (force sexual advances or sexual acts)?

    [ ]

    [ ]

    How many days in the past 30 have you had serious conflicts:

    128. With your family? |__|__|

    129. With other people? (excluding family) |__|__|

    FOR QUESTIONS 130-133 PLEASE ASK PATIENT TO USE THE PATIENT’S RATING SCALE

    How troubled or bothered have you been in the past 30 days by these:

    130. Family problems |__|

    131. Social problems |__|

    How important to you now is treatment or counseling for these:

    132. Family problems |__|

    133. Social problems |__|

    INTERVIEWER SEVERITY RATING

    134. How would you rate the patient’s need for family and/or social counseling?

    |__|

    CONFIDENCE RATINGS

    Is the above information significantly distorted by:

    135. Patient’s misrepresentation?

    0[ ]No

    1[ ]Yes

    136. Patient’s inability to understand?

    0[ ]No

    1[ ]Yes

    PSYCHIATRIC STATUS

    How many times have you been treated for any psychological or emotional problems?

    137. *In a hospital |__|__|

    138. *As an Opt, or Priv, patient |__|__|

    139. Do you receive a pension for a psychiatric disability? 0 = No, 1 = Yes [ ]

    Have you had a significant period (that was not a direct result of drug/alcohol use), in which you have: 0 = No, 1 = Yes

    PAST 30 DAYS

    IN YOUR LIFE

    140. Experienced serious depression

    [ ]

    [ ]

    141. Experienced serious anxiety or tension

    [ ]

    [ ]

    142. Experienced hallucinations

    [ ]

    [ ]

    143. Experienced trouble understanding, concentrating, or remembering

    [ ]

    [ ]

    144. Experienced trouble controlling violent behavior

    [ ]

    [ ]

    145. Experienced serious thoughts of suicide

    [ ]

    [ ]

    146. Attempted suicide

    [ ]

    [ ]

    147. Been prescribed medication for any psychological emotional problem

    [ ]

    [ ]

    148. How many days in the past 30 have you experienced these psychological or emotional problems? |__|__|

    FOR QUESTIONS 149 & 150 PLEASE ASK PATIENT TO USE THE PATIENTS RATING SCALE

    149. How much have you been troubled or bothered by these psychological or emotional problems in the past 30 days? |__|

    150. How important to you now is treatment for these psychological problems? |__|

    THE FOLLOWING ITEMS ARE TO BE COMPLETED BY THE INTERVIEWER

    At the time of the interview, is patient: 0 = No, 1 = Yes

    151. Obviously depressed/withdrawn [ ]

    152. Obviously hostile [ ]

    153. Obviously anxious/nervous [ ]

    154. Having trouble with reality testing thought disorders, paranoid thinking [ ]

    155. Having trouble comprehending, concentrating, remembering [ ]

    156. Having suicidal thoughts [ ]

    INTERVIEWER SEVERITY RATING

    157. How would you rate the patient’s need for psychiatric/psychological treatment? |__|

    CONFIDENCE RATINGS

    Is the above information significantly distorted by:

    158. Patient’s misrepresentation?

    0[ ]No

    1[ ]Yes

    159. Patient’s inability to understand?

    0[ ]No

    1[ ]Yes

  • Protocol Name from Source:

    Addiction Severity Index (ASI)

    Availability:

    Publicly available

    Personnel and Training Required

    The interviewer must be trained and found competent to conduct personal interviews with individuals from the general population. The questions are sensitive in nature, and the interviewer should be trained to react appropriately to emotional responses. If a distressed respondent protocol is adopted, the interviewer should be trained to administer those procedures.

    Equipment Needs

    None

    Requirements
    Requirement CategoryRequired
    Major equipment No
    Specialized training No
    Specialized requirements for biospecimen collection No
    Average time of greater than 15 minutes in an unaffected individual No
    Mode of Administration

    Interviewer-administered questionnaire

    Life Stage:

    Adult

    Participants:

    Adults aged 18 years or older

    Selection Rationale

    The Addiction Severity Index (ASI) is the most commonly used addiction assessment tool by state agencies and treatment providers. It is simple to use and cost effective.

    Language

    English

    Standards
    StandardNameIDSource
    Common Data Elements (CDE) Substance Abuse Addiction Severity Index Assessment Scale 5577980 CDE Browser
    Derived Variables

    None

    Process and Review

    The Expert Review Panel #3 (ERP 3) reviewed the measures in Alcohol, Tobacco and Other Substances, and Substance Abuse and Addiction domains.

    Guidance from ERP 3 includes:

    • Added a new measure

    Back-compatible: NA

    Source

    Treatment Research Institute. 1998. Addiction Severity Index (5th Ed.). Philadelphia: Author.

    General References

    None

    Protocol ID:

    510801

    Variables:
    Export Variables
    Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
    PX510801_AddictionSeverity_Abstinence_End PX510801004700 How many months ago did this abstinence end? N/A
    PX510801_AddictionSeverity_Admission_Criminal_Justice PX510801006700 Was this admission prompted or suggested by more
    the criminal justice system (judge, probation/parole officer, etc.) show less
    N/A
    PX510801_AddictionSeverity_AlcoholAbuse_Interviewer_Rating PX510801006300 How would you rate the patient's need for more
    treatment for: Alcohol Abuse show less
    N/A
    PX510801_AddictionSeverity_Alcohol_AnyUse_Administration PX510801003203 Alcohol - Any use at all - Route of administration N/A
    PX510801_AddictionSeverity_Alcohol_AnyUse_Lifetime PX510801003202 Alcohol - Any use at all - Lifetime - Years N/A
    PX510801_AddictionSeverity_Alcohol_AnyUse_PastMonth PX510801003201 Alcohol - Any use at all - Past 30 days N/A
    PX510801_AddictionSeverity_Alcohol_Delerious_Tremors PX510801004800 How many times have you *Had alcohol d.t.'s N/A
    PX510801_AddictionSeverity_Alcohol_Problems_Past_Month PX510801005700 How many days in the past 30 have you more
    experience alcohol problems? show less
    N/A
    PX510801_AddictionSeverity_Alcohol_ToIntoxication_Administration PX510801003303 Alcohol - To intoxication - Route of more
    administration show less
    N/A
    PX510801_AddictionSeverity_Alcohol_ToIntoxication_Lifetime PX510801003302 Alcohol - To intoxication - Lifetime - Years N/A
    PX510801_AddictionSeverity_Alcohol_ToIntoxication_PastMonth PX510801003301 Alcohol - To intoxication - Past 30 days N/A
    PX510801_AddictionSeverity_Alcohol_Treatment PX510801005000 How many times in your life have you been more
    treated for alcohol abuse? show less
    N/A
    PX510801_AddictionSeverity_Amphetmaines_Administration PX510801004003 Amphetamines - Route of administration N/A
    PX510801_AddictionSeverity_Amphetmaines_Lifetime PX510801004002 Amphetamines - Lifetime - Years N/A
    PX510801_AddictionSeverity_Amphetmaines_PastMonth PX510801004001 Amphetamines - Past 30 days N/A
    PX510801_AddictionSeverity_Anxiety_Lifetime PX510801014102 Have you had a significant period (that was more
    not a direct result of drug/alcohol use), in which you have: Experienced serious anxiety or tension - in your lifetime? show less
    N/A
    PX510801_AddictionSeverity_Anxiety_Past_Month PX510801014101 Have you had a significant period (that was more
    not a direct result of drug/alcohol use), in which you have: Experienced serious anxiety or tension - in the past 30 days? show less
    N/A
    PX510801_AddictionSeverity_Arrested_Arson PX510801007700 How many times in your life have you been more
    arrested and charged with the following: *Arson show less
    N/A
    PX510801_AddictionSeverity_Arrested_Assault PX510801007600 How many times in your life have you been more
    arrested and charged with the following: *Assault show less
    N/A
    PX510801_AddictionSeverity_Arrested_Burglary PX510801007400 How many times in your life have you been more
    arrested and charged with the following: *Burglary, larceny, B&E show less
    N/A
    PX510801_AddictionSeverity_Arrested_Contempt_Court PX510801008100 How many times in your life have you been more
    arrested and charged with the following: *Contempt of court show less
    N/A
    PX510801_AddictionSeverity_Arrested_Convictions PX510801008300 *How many of these charges resulted in more
    convictions? show less
    N/A
    PX510801_AddictionSeverity_Arrested_Drug_Charges PX510801007100 How many times in your life have you been more
    arrested and charged with the following: *Drug charges show less
    N/A
    PX510801_AddictionSeverity_Arrested_Forgery PX510801007200 How many times in your life have you been more
    arrested and charged with the following: *Forgery show less
    N/A
    PX510801_AddictionSeverity_Arrested_Homicide PX510801007900 How many times in your life have you been more
    arrested and charged with the following: *Homicide, manslaughter show less
    N/A
    PX510801_AddictionSeverity_Arrested_Other PX510801008200 How many times in your life have you been more
    arrested and charged with the following: *Other show less
    N/A
    PX510801_AddictionSeverity_Arrested_Parole_Violations PX510801007000 How many times in your life have you been more
    arrested and charged with the following: *Parole/probation violations show less
    N/A
    PX510801_AddictionSeverity_Arrested_Prostitution PX510801008000 How many times in your life have you been more
    arrested and charged with the following: *Prostitution show less
    N/A
    PX510801_AddictionSeverity_Arrested_Rape PX510801007800 How many times in your life have you been more
    arrested and charged with the following: *Rape show less
    N/A
    PX510801_AddictionSeverity_Arrested_Robbery PX510801007500 How many times in your life have you been more
    arrested and charged with the following: *Robbery show less
    N/A
    PX510801_AddictionSeverity_Arrested_Shoplifting PX510801006900 How many times in your life have you been more
    arrested and charged with the following: *Shoplifting/vandalism show less
    N/A
    PX510801_AddictionSeverity_Arrested_Weapons_Offense PX510801007300 How many times in your life have you been more
    arrested and charged with the following: *Weapons offense show less
    N/A
    PX510801_AddictionSeverity_Attempt_Suicide_Lifetime PX510801014602 Have you had a significant period (that was more
    not a direct result of drug/alcohol use), in which you have: Attempted suicide - in your lifetime? show less
    N/A
    PX510801_AddictionSeverity_Attempt_Suicide_Past_Month PX510801014601 Have you had a significant period (that was more
    not a direct result of drug/alcohol use), in which you have: Attempted suicide - in the past 30 days? show less
    N/A
    PX510801_AddictionSeverity_Automobile PX510801001700 Do you have an automobile available for use? more
    (Answer No if no valid driver's license.) show less
    N/A
    PX510801_AddictionSeverity_Barbituates_Administration PX510801003703 Barbiturates - Route of administration N/A
    PX510801_AddictionSeverity_Barbituates_Lifetime PX510801003702 Barbiturates - Lifetime - Years N/A
    PX510801_AddictionSeverity_Barbituates_PastMonth PX510801003701 Barbiturates - Past 30 days N/A
    PX510801_AddictionSeverity_Cannabis_Administration PX510801004103 Cannabis - Route of administration N/A
    PX510801_AddictionSeverity_Cannabis_Lifetime PX510801004102 Cannabis - Lifetime - Years N/A
    PX510801_AddictionSeverity_Cannabis_PastMonth PX510801004101 Cannabis - Past 30 days N/A
    PX510801_AddictionSeverity_Charged_Disorderly_Conduct PX510801008400 How many times in your life have you been more
    charged with the following: *Disorderly conduct, vagrancy, public intoxication show less
    N/A
    PX510801_AddictionSeverity_Charged_Driving_Violations PX510801008600 How many times in your life have you been more
    charged with the following: *Major driving violations (reckless driving, speeding, no license, etc.) show less
    N/A
    PX510801_AddictionSeverity_Charged_DUI PX510801008500 How many times in your life have you been more
    charged with the following: *Driving while intoxicated show less
    N/A
    PX510801_AddictionSeverity_Chronic_MedicalProblems PX510801000601 Do you have any chronic medical problems more
    which continue to interfere with your life? show less
    N/A
    PX510801_AddictionSeverity_Chronic_MedicalProblems_Specify PX510801000602 Do you have any chronic medical problems more
    which continue to interfere with your life? Specify show less
    N/A
    PX510801_AddictionSeverity_Close_Friends PX510801010900 How many close friends do you have? N/A
    PX510801_AddictionSeverity_Close_Relationship_Children PX510801011400 Would you say you have had close, long more
    lasting, personal relationships with any of the following people in your life: Children show less
    N/A
    PX510801_AddictionSeverity_Close_Relationship_Father PX510801011100 Would you say you have had close, long more
    lasting, personal relationships with any of the following people in your life: Father show less
    N/A
    PX510801_AddictionSeverity_Close_Relationship_Friends PX510801011500 Would you say you have had close, long more
    lasting, personal relationships with any of the following people in your life: Friends show less
    N/A
    PX510801_AddictionSeverity_Close_Relationship_Mother PX510801011000 Would you say you have had close, long more
    lasting, personal relationships with any of the following people in your life: Mother show less
    N/A
    PX510801_AddictionSeverity_Close_Relationship_Partner PX510801011300 Would you say you have had close, long more
    lasting, personal relationships with any of the following people in your life: Sexual Partner/Spouse show less
    N/A
    PX510801_AddictionSeverity_Close_Relationship_Siblings PX510801011200 Would you say you have had close, long more
    lasting, personal relationships with any of the following people in your life: Brothers/Sisters show less
    N/A
    PX510801_AddictionSeverity_Cocaine_Administration PX510801003903 Cocaine - Route of administration N/A
    PX510801_AddictionSeverity_Cocaine_Lifetime PX510801003902 Cocaine - Lifetime - Years N/A
    PX510801_AddictionSeverity_Cocaine_PastMonth PX510801003901 Cocaine - Past 30 days N/A
    PX510801_AddictionSeverity_Controlled_Environment PX510801000201 Have you been in a controlled environment in more
    the past 30 days? show less
    N/A
    PX510801_AddictionSeverity_Controlled_Environment_Days PX510801000300 How many days? N/A
    PX510801_AddictionSeverity_Controlled_Environment_Other PX510801000202 Have you been in a controlled environment in more
    the past 30 days? Other show less
    N/A
    PX510801_AddictionSeverity_Counseling_Employment_Problems PX510801002800 How important to you now is counseling for more
    these employment problems? show less
    N/A
    PX510801_AddictionSeverity_Counseling_Family_Problems PX510801013200 How important to you now is treatment or more
    counseling for these: Family problems show less
    N/A
    PX510801_AddictionSeverity_Counseling_Legal_Problems PX510801009500 How important to you now is counseling or more
    referral for these legal problems? show less
    N/A
    PX510801_AddictionSeverity_Counseling_Social_Problems PX510801013300 How important to you now is treatment or more
    counseling for these: Social problems show less
    N/A
    PX510801_AddictionSeverity_Criminal_Activity_Past_Month PX510801009300 How many days in the past 30 have you more
    engaged in illegal activities for profit? show less
    N/A
    PX510801_AddictionSeverity_Dependents PX510801002500 How many people depend on you for the more
    majority of their food, shelter, etc.? show less
    N/A
    PX510801_AddictionSeverity_Depression_Lifetime PX510801014002 Have you had a significant period (that was more
    not a direct result of drug/alcohol use), in which you have: Experienced serious depression - in your lifetime? show less
    N/A
    PX510801_AddictionSeverity_Depression_Past_Month PX510801014001 Have you had a significant period (that was more
    not a direct result of drug/alcohol use), in which you have: Experienced serious depression - in the past 30 days? show less
    N/A
    PX510801_AddictionSeverity_Detox_Alcohol PX510801005200 How many of these were detox only? Alcohol N/A
    PX510801_AddictionSeverity_Detox_Drug PX510801005300 How many of these were detox only? Drug N/A
    PX510801_AddictionSeverity_Drivers_License PX510801001600 Do you have a valid driver's license? N/A
    PX510801_AddictionSeverity_DrugAbuse_Interviewer_Rating PX510801006400 How would you rate the patient's need for more
    treatment for: Drug Abuse show less
    N/A
    PX510801_AddictionSeverity_Drug_Overdoses PX510801004900 How many times have you Overdosed on drugs N/A
    PX510801_AddictionSeverity_Drug_Problems_Past_Month PX510801005800 How many days in the past 30 have you more
    experience drug problems show less
    N/A
    PX510801_AddictionSeverity_Drug_Treatment PX510801005100 How many times in your life have you been more
    treated for drug abuse? show less
    N/A
    PX510801_AddictionSeverity_Emotional_Abuse_Lifetime PX510801012502 Did any of these people (Questions 116-124) more
    abuse you: Emotionally (make you feel bad through harsh words)? - In your life? show less
    N/A
    PX510801_AddictionSeverity_Emotional_Abuse_Past_Month PX510801012501 Did any of these people (Questions 116-124) more
    abuse you: Emotionally (make you feel bad through harsh words)? - In the past 30 days? show less
    N/A
    PX510801_AddictionSeverity_EmploymentProblems_Interviewer_Rating PX510801002900 How would you rate the patient's need for more
    employment counseling? show less
    N/A
    PX510801_AddictionSeverity_EmploymentProblems_Past_Month PX510801002600 How many days have you experienced more
    employment problems in the past 30? show less
    N/A
    PX510801_AddictionSeverity_Employment_Pattern PX510801002200 Usual employment pattern, past 3 years. N/A
    PX510801_AddictionSeverity_Family_Counseling_Interviewer_Rating PX510801013400 How would you rate the patient's need for more
    family and/or social counseling? show less
    N/A
    PX510801_AddictionSeverity_Free_Time PX510801010700 With whom do you spend most of your free time: N/A
    PX510801_AddictionSeverity_Free_Time_Satisfied PX510801010800 Are you satisfied with spending your free more
    time this way? show less
    N/A
    PX510801_AddictionSeverity_FullTime_Employment_Months PX510801001802 How long was your longest full-time job? Months N/A
    PX510801_AddictionSeverity_FullTime_Employment_Years PX510801001801 How long was your longest full-time job? Years N/A
    PX510801_AddictionSeverity_Hallucinations_Lifetime PX510801014202 Have you had a significant period (that was more
    not a direct result of drug/alcohol use), in which you have: Experienced hallucinations - in your lifetime? show less
    N/A
    PX510801_AddictionSeverity_Hallucinations_Past_Month PX510801014201 Have you had a significant period (that was more
    not a direct result of drug/alcohol use), in which you have: Experienced hallucinations - in the past 30 days? show less
    N/A
    PX510801_AddictionSeverity_Hallucinogens_Administration PX510801004203 Hallucinogens - Route of administration N/A
    PX510801_AddictionSeverity_Hallucinogens_Lifetime PX510801004202 Hallucinogens - Lifetime - Years N/A
    PX510801_AddictionSeverity_Hallucinogens_PastMonth PX510801004201 Hallucinogens - Past 30 days N/A
    PX510801_AddictionSeverity_Heroin_Administration PX510801003403 Heroin - Route of administration N/A
    PX510801_AddictionSeverity_Heroin_Lifetime PX510801003402 Heroin - Lifetime - Years N/A
    PX510801_AddictionSeverity_Heroin_PastMonth PX510801003401 Heroin - Past 30 days N/A
    PX510801_AddictionSeverity_Hospitalization_Medical_Problems PX510801000400 *How many times in your life have you been more
    hospitalized for medical problems? (Include o.d.'s, d.t.'s, exclude detox.) show less
    N/A
    PX510801_AddictionSeverity_Incarcerated PX510801008700 *How many months were you incarcerated in more
    your life? show less
    N/A
    PX510801_AddictionSeverity_Incarcerated_Last PX510801008800 How long was your last incarceration? N/A
    PX510801_AddictionSeverity_Incarcerated_Last_Charge PX510801008900 What was it for? (Use code 3-16, 18-20. If more
    multiple charges, code most severe) show less
    N/A
    PX510801_AddictionSeverity_Incarcerated_Past_Month PX510801009200 How many days in the past 30 were you more
    detained or incarcerated? show less
    N/A
    PX510801_AddictionSeverity_Inhalants_Administration PX510801004303 Inhalants - Route of administration N/A
    PX510801_AddictionSeverity_Inhalants_Lifetime PX510801004302 Inhalants - Lifetime - Years N/A
    PX510801_AddictionSeverity_Inhalants_PastMonth PX510801004301 Inhalants - Past 30 days N/A
    PX510801_AddictionSeverity_Last_Occupation PX510801001900 *Usual (or last) occupation. N/A
    PX510801_AddictionSeverity_Legal_Interviewer_Rating PX510801009600 ÔøΩHow would you r more
    te the patient's need for legal services or counseling? show less
    N/A
    PX510801_AddictionSeverity_Living_Arrangements PX510801010200 Usual living arrangements (past 3 more
    yr.)ÔøΩ show less
    N/A
    PX510801_AddictionSeverity_Living_Arrangements_Alcohol_Problems PX510801010500 Do you live with anyone who: Has a current more
    alcohol problem? show less
    N/A
    PX510801_AddictionSeverity_Living_Arrangements_Length PX510801010300 How long have you lived in these more
    arrangements.ÔøΩ(If with parents or family, since age 18). show less
    N/A
    PX510801_AddictionSeverity_Living_Arrangements_Nonprescribed_Drugs PX510801010600 Do you live with anyone who: Uses more
    non-prescribed drugs? show less
    N/A
    PX510801_AddictionSeverity_Living_Arrangements_Satisfied PX510801010400 Are you satisfied with these living arrangements? N/A
    PX510801_AddictionSeverity_Longest_Abstinence PX510801004601 How long was your last period of voluntary more
    abstinence from this major substance? (00-never abstinent) show less
    N/A
    PX510801_AddictionSeverity_Longest_Abstinence_Coded PX510801004602 How long was your last period of voluntary more
    abstinence from this major substance? (00-never abstinent) show less
    N/A
    PX510801_AddictionSeverity_Martial_Status PX510801009900 Marital Status N/A
    PX510801_AddictionSeverity_Martial_Status_Length PX510801010000 How long have you been in this marital more
    status?ÔøΩ(If never married, since age 18). show less
    N/A
    PX510801_AddictionSeverity_Martial_Status_Satisified PX510801010100 Are you satisfied with this situation? N/A
    PX510801_AddictionSeverity_Medical_Hospitalization_Months PX510801000502 How long ago was your last hospitalization more
    for a physical problem - Months show less
    N/A
    PX510801_AddictionSeverity_Medical_Hospitalization_Years PX510801000501 How long ago was your last hospitalization more
    for a physical problem - Years show less
    N/A
    PX510801_AddictionSeverity_Medical_Problems_Interviewers_Rating PX510801001200 How would you rate the patient's need for more
    medical treatment? show less
    N/A
    PX510801_AddictionSeverity_Medical_Problems_PastMonth PX510801000900 How many days have you experienced medical more
    problems in the past 30? show less
    N/A
    PX510801_AddictionSeverity_Medical_Problems_PastMonth_Rating PX510801001000 How troubled or bothered have you been by more
    these medical problems in the past 30 days? show less
    N/A
    PX510801_AddictionSeverity_Medical_Problems_Treatment_Rating PX510801001100 How important to you now is treatment for more
    these medical problems? show less
    N/A
    PX510801_AddictionSeverity_Methadone_Administration PX510801003503 Methadone - Route of administration N/A
    PX510801_AddictionSeverity_Methadone_Lifetime PX510801003502 Methadone - Lifetime - Years N/A
    PX510801_AddictionSeverity_Methadone_PastMonth PX510801003501 Methadone - Past 30 days N/A
    PX510801_AddictionSeverity_Money_DPA PX510801002403 How much money did you receive from the more
    following sources in the past 30 days? DPA show less
    N/A
    PX510801_AddictionSeverity_Money_Employment PX510801002401 How much money did you receive from the more
    following sources in the past 30 days? Employment (net income) show less
    N/A
    PX510801_AddictionSeverity_Money_Friends_Family PX510801002405 How much money did you receive from the more
    following sources in the past 30 days? Mate, family or friends (Money for personal expenses.) show less
    N/A
    PX510801_AddictionSeverity_Money_Illegal PX510801002406 How much money did you receive from the more
    following sources in the past 30 days? Illegal show less
    N/A
    PX510801_AddictionSeverity_Money_Pension PX510801002404 How much money did you receive from the more
    following sources in the past 30 days? Pension, benefits or Social Security show less
    N/A
    PX510801_AddictionSeverity_Money_Unemployment PX510801002402 How much money did you receive from the more
    following sources in the past 30 days? Unemployment compensation show less
    N/A
    PX510801_AddictionSeverity_MoreThan_OneSubstance_Administration PX510801004403 More than one substance per day (Include more
    alcohol) - Route of administration show less
    N/A
    PX510801_AddictionSeverity_MoreThan_OneSubstance_Lifetime PX510801004402 More than one substance per day (Include more
    alcohol) - Lifetime show less
    N/A
    PX510801_AddictionSeverity_MoreThan_OneSubstance_PastMonth PX510801004401 More than one substance per day (Include more
    alcohol) - Past month show less
    N/A
    PX510801_AddictionSeverity_Opiates_Administration PX510801003603 Other opiates/analgesics - Route of administration N/A
    PX510801_AddictionSeverity_Opiates_Lifetime PX510801003602 Other opiates/analgesics - Lifetime - Years N/A
    PX510801_AddictionSeverity_Opiates_PastMonth PX510801003601 Other opiates/analgesics - Past 30 days N/A
    PX510801_AddictionSeverity_Outpatient_Past_Month PX510801005600 How many days have you been treated in an more
    outpatient setting for alcohol or drugs in the past 30 days (Include NA, AA). show less
    N/A
    PX510801_AddictionSeverity_Outside_Support PX510801002000 Does someone contribute to your support in more
    any way? show less
    N/A
    PX510801_AddictionSeverity_Outside_Support_Majority PX510801002100 (ONLY IF ITEM 20 IS YES) Does this more
    constitute the majority of your support? show less
    N/A
    PX510801_AddictionSeverity_PaidDays_Past_Month PX510801002300 How many days were you paid for working in more
    the past 30? (include "under the table" work" show less
    N/A
    PX510801_AddictionSeverity_Patient_Anxious PX510801015300 At the time of the interview, is patient: more
    Obviously anxious/nervous show less
    N/A
    PX510801_AddictionSeverity_Patient_Comprehension PX510801015500 At the time of the interview, is patient: more
    Having trouble comprehending, concentrating, remembering show less
    N/A
    PX510801_AddictionSeverity_Patient_Depressed PX510801015100 At the time of the interview, is patient: more
    Obviously depressed/withdrawn show less
    N/A
    PX510801_AddictionSeverity_Patient_Hostile PX510801015200 At the time of the interview, is patient: more
    Obviously hostile show less
    N/A
    PX510801_AddictionSeverity_Patient_Misrepresentation PX510801001300 Is the above information significantly more
    distorted by: Patient's misrepresentation? show less
    N/A
    PX510801_AddictionSeverity_Patient_Misrepresentation_Employment PX510801003000 Is the above information significantly more
    distorted by: Patient's misrepresentation? show less
    N/A
    PX510801_AddictionSeverity_Patient_Misrepresentation_FamilyProblems PX510801013500 Is the above information significantly more
    distorted by: Patient's misrepresentation? show less
    N/A
    PX510801_AddictionSeverity_Patient_Misrepresentation_LegalProblems PX510801009700 Is the above information significantly more
    distorted by: Patient's misrepresentation? show less
    N/A
    PX510801_AddictionSeverity_Patient_Misrepresentation_PsychologicalProblems PX510801015800 Is the above information significantly more
    distorted by: Patient's misrepresentation? show less
    N/A
    PX510801_AddictionSeverity_Patient_Misrepresentation_SubstanceAbuse PX510801006500 Is the above information significantly more
    distorted by: Patient's misrepresentation? show less
    N/A
    PX510801_AddictionSeverity_Patient_Misunderstanding PX510801001400 Is the above information significantly more
    distorted by: Patient's inability to understand? show less
    N/A
    PX510801_AddictionSeverity_Patient_Misunderstanding_Employment PX510801003100 Is the above information significantly more
    distorted by: Patient's inability to understand? show less
    N/A
    PX510801_AddictionSeverity_Patient_Misunderstanding_FamilyProblems PX510801013600 Is the above information significantly more
    distorted by: Patient's inability to understand? show less
    N/A
    PX510801_AddictionSeverity_Patient_Misunderstanding_LegalProblems PX510801009800 Is the above information significantly more
    distorted by: Patient's inability to understand? show less
    N/A
    PX510801_AddictionSeverity_Patient_Misunderstanding_PsychologicalProblems PX510801015900 Is the above information significantly more
    distorted by: Patient's inability to understand? show less
    N/A
    PX510801_AddictionSeverity_Patient_Misunderstanding_SubstanceAbuse PX510801006600 Is the above information significantly more
    distorted by: Patient's inability to understand? show less
    N/A
    PX510801_AddictionSeverity_Patient_Reality PX510801015400 At the time of the interview, is patient: more
    Having trouble with reality testing thought disorders, paranoid thinking show less
    N/A
    PX510801_AddictionSeverity_Patient_Suicidal PX510801015600 At the time of the interview, is patient: more
    Having suicidal thoughts show less
    N/A
    PX510801_AddictionSeverity_Pending_Charges PX510801009000 Are you presently awaiting charges, trial or more
    sentence? show less
    N/A
    PX510801_AddictionSeverity_Pending_Charges_Details PX510801009100 What for (if multiple charges, use most severe). N/A
    PX510801_AddictionSeverity_Pension_Disability PX510801000801 Do you receive a pension for a physical more
    disability? (Exclude psychiatric disability.) show less
    N/A
    PX510801_AddictionSeverity_Pension_Disability_Specify PX510801000802 Do you receive a pension for a physical more
    disability? (Exclude psychiatric disability.) Specify show less
    N/A
    PX510801_AddictionSeverity_Physical_Abuse_Lifetime PX510801012602 Did any of these people (Questions 116-124) more
    abuse you: Physically (cause you physical harm)? - In your life? show less
    N/A
    PX510801_AddictionSeverity_Physical_Abuse_Past_Month PX510801012601 Did any of these people (Questions 116-124) more
    abuse you: Physically (cause you physical harm)? - In the past 30 days? show less
    N/A
    PX510801_AddictionSeverity_Prescribed_Medication PX510801000700 Are you taking any prescribed medication on more
    a regular basis for a physical problem? show less
    N/A
    PX510801_AddictionSeverity_Prescribed_Medication_Lifetime PX510801014702 Have you had a significant period (that was more
    not a direct result of drug/alcohol use), in which you have: Been prescribed medication for any psychological emotional problem - in your lifetime? show less
    N/A
    PX510801_AddictionSeverity_Prescribed_Medication_Past_Month PX510801014701 Have you had a significant period (that was more
    not a direct result of drug/alcohol use), in which you have: Been prescribed medication for any psychological emotional problem - in the past 30 days? show less
    N/A
    PX510801_AddictionSeverity_Probation_Parole PX510801006800 Are you on probation or parole? N/A
    PX510801_AddictionSeverity_Profession PX510801001501 Do you have a profession, trade, or skill? N/A
    PX510801_AddictionSeverity_Profession_Specify PX510801001502 Do you have a profession, trade, or skill? Specify N/A
    PX510801_AddictionSeverity_Psychological_Interviewer_Rating PX510801015700 How would you rate the patient's need for more
    psychiatric/psychological treatment? show less
    N/A
    PX510801_AddictionSeverity_Psychological_Problems_Hospital PX510801013700 How many times have you been treated for any more
    psychological or emotional problems? *In a hospital show less
    N/A
    PX510801_AddictionSeverity_Psychological_Problems_Past_Month PX510801014800 How many days in the past 30 have you more
    experienced these psychological or emotional problems? show less
    N/A
    PX510801_AddictionSeverity_Psychological_Problems_Patient PX510801013800 How many times have you been treated for any more
    psychological or emotional problems? *As an Opt, or Priv, patient show less
    N/A
    PX510801_AddictionSeverity_Psychological_Problems_Pension PX510801013900 Do you receive a pension for a psychiatric more
    disability? show less
    N/A
    PX510801_AddictionSeverity_Religion PX510801000100 ÔøΩRELIGIOUS PREFERENCE N/A
    PX510801_AddictionSeverity_Sedatives_Administration PX510801003803 Other sed/hyp/tranq. - Route of administration N/A
    PX510801_AddictionSeverity_Sedatives_Lifetime PX510801003802 Other sed/hyp/tranq. - Lifetime - Years N/A
    PX510801_AddictionSeverity_Sedatives_PastMonth PX510801003801 Other sed/hyp/tranq. - Past 30 days N/A
    PX510801_AddictionSeverity_Seriousness_Legal_Problems PX510801009400 How serious do you feel your present legal more
    problems are? (Exclude civil problems) show less
    N/A
    PX510801_AddictionSeverity_SeriousProblems_Children_Lifetime PX510801012002 Have you had significant periods in which more
    you have experienced serious problems getting along with: Children - in your life? show less
    N/A
    PX510801_AddictionSeverity_SeriousProblems_Children_Past_Month PX510801012001 Have you had significant periods in which more
    you have experienced serious problems getting along with: Children - in past 30 days? show less
    N/A
    PX510801_AddictionSeverity_SeriousProblems_CloseFriends_Lifetime PX510801012202 Have you had significant periods in which more
    you have experienced serious problems getting along with: Close friends - in your life? show less
    N/A
    PX510801_AddictionSeverity_SeriousProblems_CloseFriends_Past_Month PX510801012201 Have you had significant periods in which more
    you have experienced serious problems getting along with: Close friends - in past 30 days? show less
    N/A
    PX510801_AddictionSeverity_SeriousProblems_Coworkers_Lifetime PX510801012402 Have you had significant periods in which more
    you have experienced serious problems getting along with: Co-Workers - in your life? show less
    N/A
    PX510801_AddictionSeverity_SeriousProblems_Coworkers_Past_Month PX510801012401 Have you had significant periods in which more
    you have experienced serious problems getting along with: Co-Workers - in past 30 days? show less
    N/A
    PX510801_AddictionSeverity_SeriousProblems_Father_Lifetime PX510801011702 Have you had significant periods in which more
    you have experienced serious problems getting along with: Father - in your life? show less
    N/A
    PX510801_AddictionSeverity_SeriousProblems_Father_Past_Month PX510801011701 Have you had significant periods in which more
    you have experienced serious problems getting along with: Father - in past 30 days? show less
    N/A
    PX510801_AddictionSeverity_SeriousProblems_Mother_Lifetime PX510801011602 Have you had significant periods in which more
    you have experienced serious problems getting along with: Mother - in your life? show less
    N/A
    PX510801_AddictionSeverity_SeriousProblems_Mother_Past_Month PX510801011601 Have you had significant periods in which more
    you have experienced serious problems getting along with: Mother - in past 30 days? show less
    N/A
    PX510801_AddictionSeverity_SeriousProblems_Neighbors_Lifetime PX510801012302 Have you had significant periods in which more
    you have experienced serious problems getting along with: Neighbors - in your life? show less
    N/A
    PX510801_AddictionSeverity_SeriousProblems_Neighbors_Past_Month PX510801012301 Have you had significant periods in which more
    you have experienced serious problems getting along with: Neighbors - in past 30 days? show less
    N/A
    PX510801_AddictionSeverity_SeriousProblems_OtherFamily_Lifetime PX510801012102 Have you had significant periods in which more
    you have experienced serious problems getting along with: Other significant family __________ - in your life? show less
    N/A
    PX510801_AddictionSeverity_SeriousProblems_OtherFamily_Past_Month PX510801012101 Have you had significant periods in which more
    you have experienced serious problems getting along with: Other significant family __________ - in past 30 days? show less
    N/A
    PX510801_AddictionSeverity_SeriousProblems_Partner_Lifetime PX510801011902 Have you had significant periods in which more
    you have experienced serious problems getting along with: Sexual partner/spouse - in your life? show less
    N/A
    PX510801_AddictionSeverity_SeriousProblems_Partner_Past_Month PX510801011901 Have you had significant periods in which more
    you have experienced serious problems getting along with: Sexual partner/spouse - in past 30 days? show less
    N/A
    PX510801_AddictionSeverity_SeriousProblems_Siblings_Lifetime PX510801011802 Have you had significant periods in which more
    you have experienced serious problems getting along with: Brothers/Sisters - in your life? show less
    N/A
    PX510801_AddictionSeverity_SeriousProblems_Siblings_Past_Month PX510801011801 Have you had significant periods in which more
    you have experienced serious problems getting along with: Brothers/Sisters - in past 30 days? show less
    N/A
    PX510801_AddictionSeverity_Serious_Conflicts_Family PX510801012800 How many days in the past 30 have you had more
    serious conflicts: With your family? show less
    N/A
    PX510801_AddictionSeverity_Serious_Conflicts_Others PX510801012900 How many days in the past 30 have you had more
    serious conflicts: With other people? (excluding family) show less
    N/A
    PX510801_AddictionSeverity_Sexual_Abuse_Lifetime PX510801012702 Did any of these people (Questions 116-124) more
    abuse you: Sexually (force sexual advances or sexual acts)? - In your life? show less
    N/A
    PX510801_AddictionSeverity_Sexual_Abuse_Past_Month PX510801012701 Did any of these people (Questions 116-124) more
    abuse you: Sexually (force sexual advances or sexual acts)? - In the past 30 days? show less
    N/A
    PX510801_AddictionSeverity_Spent_On_Alcohol PX510801005400 How much would you say you spent during the more
    past 30 days on: Alcohol show less
    N/A
    PX510801_AddictionSeverity_Spent_On_Drugs PX510801005500 How much would you say you spent during the more
    past 30 days on: Drugs show less
    N/A
    PX510801_AddictionSeverity_Substance_Major_Problem PX510801004500 Which substance is the major problem? Please more
    code as above or 00-No problem; 15-Alcohol & Drug (Dual addiction); 16-Polydrug; when not clear, ask patient. show less
    N/A
    PX510801_AddictionSeverity_Suicidal_Thoughts_Lifetime PX510801014502 Have you had a significant period (that was more
    not a direct result of drug/alcohol use), in which you have: Experienced serious thoughts of suicide - in your lifetime? show less
    N/A
    PX510801_AddictionSeverity_Suicidal_Thoughts_Past_Month PX510801014501 Have you had a significant period (that was more
    not a direct result of drug/alcohol use), in which you have: Experienced serious thoughts of suicide - in the past 30 days? show less
    N/A
    PX510801_AddictionSeverity_Treatment_Alcohol_Problems PX510801006100 How important to you now is treatment for more
    these: Alcohol Problems show less
    N/A
    PX510801_AddictionSeverity_Treatment_Drug_Problems PX510801006200 How important to you now is treatment for more
    these: Drug Problems show less
    N/A
    PX510801_AddictionSeverity_Treatment_Psychological_Problems PX510801015000 How important to you now is treatment for more
    these psychological problems? show less
    N/A
    PX510801_AddictionSeverity_Troubled_Alcohol_Problems PX510801005900 How troubled or bothered have you been in more
    the past 30 days by these: Alcohol Problems show less
    N/A
    PX510801_AddictionSeverity_Troubled_Drug_Problems PX510801006000 How troubled or bothered have you been in more
    the past 30 days by these: Drug Problems show less
    N/A
    PX510801_AddictionSeverity_Troubled_Employment_Problems PX510801002700 How troubled or bothered have you been by more
    these employment problems in the past 30 days? show less
    N/A
    PX510801_AddictionSeverity_Troubled_Family_Problems PX510801013000 How troubled or bothered have you been in more
    the past 30 days by these: Family problems show less
    N/A
    PX510801_AddictionSeverity_Troubled_Psychological_Problems PX510801014900 How much have you been troubled or bothered more
    by these psychological or emotional problems in the past 30 days? show less
    N/A
    PX510801_AddictionSeverity_Troubled_Social_Problems PX510801013100 How troubled or bothered have you been in more
    the past 30 days by these: Social problems show less
    N/A
    PX510801_AddictionSeverity_TroubleUnderstanding_Lifetime PX510801014302 Have you had a significant period (that was more
    not a direct result of drug/alcohol use), in which you have: Experienced trouble understanding, concentrating, or remembering - in your lifetime? show less
    N/A
    PX510801_AddictionSeverity_TroubleUnderstanding_Past_Month PX510801014301 Have you had a significant period (that was more
    not a direct result of drug/alcohol use), in which you have: Experienced trouble understanding, concentrating, or remembering - in the past 30 days? show less
    N/A
    PX510801_AddictionSeverity_Violent_Behavior_Lifetime PX510801014402 Have you had a significant period (that was more
    not a direct result of drug/alcohol use), in which you have: Experienced trouble controlling violent behavior - in your lifetime? show less
    N/A
    PX510801_AddictionSeverity_Violent_Behavior_Past_Month PX510801014401 Have you had a significant period (that was more
    not a direct result of drug/alcohol use), in which you have: Experienced trouble controlling violent behavior - in the past 30 days? show less
    N/A
    Substance Abuse and Addiction
    Measure Name:

    Addiction Severity Index

    Release Date:

    November 21, 2016

    Definition

    Interview-based questions related to areas within a respondent’s life that may contribute to their substance abuse problems.

    Purpose

    Using the Addiction Severity Index, this measure helps to determine a respondent’s level of stability and is also useful for understanding life events that contribute to alcohol and drug dependency.

    Keywords

    Addiction Severity Index, ASI, substance abuse and addiction, SAA, alcohol use, drug use