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Center for Substance Abuse Treatment. Enhancing Motivation for Change in Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1999. (Treatment Improvement Protocol (TIP) Series, No. 35.)

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Enhancing Motivation for Change in Substance Abuse Treatment.

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Appendix B—Screening and Assessment Instruments

This appendix includes

Ordering information for these instruments, along with other resources, appears in Appendix C.

Alcohol and Drug Consequences Questionnaire (ADCQ)

There can be good and bad consequences to any change. These consequences may not be the same for everyone. In thinking about your decision to change your alcohol or drug use, we would like to know what consequences are important to you. This is not a test: There are no right or wrong answers. We simply want to know what you think.

My primary problem drug is (write in name of primary drug, e.g. alcohol, cocaine) ____________________________________________________

All questions below refer to my primary drug use.

When I consider stopping or cutting down my primary drug use, the following reasons are important to me.

"IF I STOP OR CUT DOWN ...."

Alcohol and Drug Consequences Questionnaire (ADCQ)

Alcohol and Drug Consequences Questionnaire (ADCQ)

Alcohol and Drug Consequences Questionnaire (ADCQ).

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Alcohol and Drug Consequences Questionnaire (ADCQ).

Alcohol (and Illegal Drugs) Decisional Balance Scale

Alcohol (and Illegal Drugs) Decisional Balance Scale

Alcohol (and Illegal Drugs) Decisional Balance Scale.

Table

Alcohol (and Illegal Drugs) Decisional Balance Scale.

Alcohol Effects Questionnaire

Alcohol Effects Questionnaire

Alcohol Effects Questionnaire.

Table

Alcohol Effects Questionnaire.

Alcohol Expectancy Questionnaire--III (Adult)

Alcohol Expectancy Questionnaire--III (Adult)

Alcohol Expectancy Questionnaire--III (Adult).

Table

Alcohol Expectancy Questionnaire--III (Adult).

Alcohol Use Disorders Identification Test (AUDIT)

Alcohol Use Disorders Identification Test (AUDIT)

Alcohol Use Disorders Identification Test (AUDIT).

Table

Alcohol Use Disorders Identification Test (AUDIT).

Your score on the AUDIT is ____.

A score of eight points or less is considered nonalcoholic, while nine points and above indicates alcoholism.

Your score of ____ does not indicate a problem with alcoholism.

Brief Situational Confidence Questionnaire (BSCQ)

Brief Situational Confidence Questionnaire (BSCQ)

Brief Situational Confidence Questionnaire (BSCQ).

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Brief Situational Confidence Questionnaire (BSCQ).

Personal Feedback Report

Personal Feedback Report

Personal Feedback Report.

Table

Personal Feedback Report.

Understanding Your Personal Feedback Report

The Personal Feedback Report summarizes results from your pretreatment evaluation. Your therapist has explained these to you. This information is to help you understand the written report you have received and to remember what your therapist told you.

Your report consists of two sheets. The first sheet provides information from your pretreatment interviews. Attached to this is a second sheet summarizing your answers to a questionnaire, the Alcohol Use Inventory. The following information is presented section by section to help you understand what your results mean.

1. Your drinking

The first line in this section shows the number of drinks that you reported having in a typical drinking week. Because different alcohol beverages vary in their strength, we have converted your regular drinking pattern into standard "one drink" units. In this system, one drink is equal to

10 ounces of beer (5 percent alcohol) or
4 ounces of table wine(12 percent alcohol) or
2.5 ounces of fortified wine (sherry, port, etc.)(20 percent alcohol) or
1.25 ounces of 80 proof liquor (40 percent alcohol) or
1 ounce of 100 proof liquor (50 percent alcohol)

All of these drinks contain the same amount of the same kind of alcohol: one-half ounce of pure ethyl alcohol.

ONE STANDARD DRINK IS:
Beer 10 ozWine 4 oz80 proof liquor 1 oz100 proof liquor 1 oz

This first piece of information, then, tells you how many of these standard drinks you have been consuming per week of drinking, according to what you reported in your interview. (If you have not been drinking for a period of time recently, this refers to your pattern of drinking before you stopped.)

To give you an idea of how this compares with the drinking of American adults in general, the second number in section 1 is a percentile figure. This tells you what percentage of U.S. men (if you are a man) or women (if you are a woman) drink less than you reported drinking in a typical week of drinking. If this number were 60, for example, it would mean that your drinking is higher than 60 percent of Americans of your sex (or that 40 percent drink as much as you reported, or more).

How much is too much? It depends on many factors. Current research indicates that people who average three or more standard drinks per day have much higher risk of health and social problems. For some people, however, even 1-2 drinks per day would be too many. Pregnant women, for example, are best advised to abstain from alcohol altogether, because even small amounts of regular drinking have been found to increase risk for the unborn child. Certain health problems (such as liver disease) make even moderate drinking unsafe. Some people find that they are unable to drink moderately, and having even one or two drinks leads to intoxication.

Your total number of drinks per week tells only part of the story. It is not healthy, for example, to have 12 drinks per week by saving them all up for Saturdays. Neither is it safe to have even a few drinks and then drive. This raises the important question of level of intoxication.

2. Level of intoxication

A second way of looking at your past drinking is to ask what level of intoxication you have been reaching. It is possible to estimate the amount of alcohol that would be circulating in your bloodstream, based on the pattern of drinking you reported. Blood alcohol concentration (BAC) is an important indication of the extent to which alcohol would be affecting your body and behavior. It is used by police and the courts, for example, to determine whether a driver is too impaired to operate a motor vehicle.

To understand better what BAC means, consider the list of common effects of different levels of intoxication.

Common Effects of Different Levels of Intoxication

20-60 mg %

The two figures shown in section 2 are computer-calculated estimates of your highest (peak) BAC level during a typical week of drinking and during one of your heaviest days of drinking.

It is important to realize that there is no known "safe" level of intoxication when driving or engaging in other potentially hazardous activities (such as swimming, boating, hunting, and operating tools or machinery). Blood alcohol levels as low as 40-60 mg % can decrease crucial abilities. Adding to the danger, drinkers typically do not realize that they are impaired. The only safe BAC when driving is zero. If you must drive after drinking, plan to allow enough time for all of the alcohol to be eliminated from your body before driving. The tables below can be helpful in determining how long it takes to eliminate alcohol completely:

Approximate hours from first drink to zero alcohol concentration levels for MEN

2

Approximate hours from first drink to zero alcohol concentration levels for WOMEN

3

3. Risk factors

It is clear that some people have a much higher risk of alcohol and other drug problems. This section provides you with some information about your own level of risk, based on your personal characteristics. "High risk" does not mean that one will definitely have serious problems with alcohol or other drugs. Neither does "low risk" mean that one will be free of such problems. High-risk people, however, have greater chances of developing serious problems.

Tolerance

Your peak BAC levels, given in section 2, are one reasonably good reflection of your level of tolerance for alcohol. If you are reaching BAC levels beyond the normal social drinking range (especially if you are not feeling some of the normal effects of lower BACs), it means that you have a higher tolerance for alcohol. This is partly hereditary and partly the result of changes in the body that occur with heavier drinking. Some people are proud of this tolerance--the ability "to hold your liquor"--and think it means they are not being harmed by alcohol. Actually, the opposite is true. Tolerance for alcohol may be a serious risk factor for alcohol problems. The person with a high tolerance for alcohol reaches high BAC levels, which can damage the brain and other organs of the body but has no built-in warning that it is happening. Tolerance is not a protection against being harmed by drinking; to the contrary, it makes damage more likely because of the false confidence that it encourages. It is a bit like a person who has no sense of pain. Pain is an important warning signal. People who feel no pain can seriously injure themselves without realizing it. It is the same with people who have a high tolerance for alcohol.

Many people believe that tolerance ("holding your liquor") means that a person gets rid of alcohol at a faster rate than others. Although people do differ in how quickly their bodies can clear alcohol, tolerance has more to do with actually being at a high blood alcohol level and not feeling it.

Other drug use

A person who uses other drugs besides alcohol runs several additional risks. Decreased use of one drug may simply result in the increased use of another. The effects of different drugs can multiply when they are taken together, with dangerous results. A tolerance to one drug can increase tolerance to another, and it is common for multiple drug users to become addicted to several drugs. The use of other drugs, then, increases your risk for serious problems. Based on the lifetime drug use that you reported during your interview, your risk in this regard was judged to be low, medium, or high.

Family risk

People who have a family history of alcohol or other drug problems among their blood relatives clearly are at higher risk themselves. The exact reason for this higher risk is unknown, but it appears that the risk is inherited to an important extent. People may inherit a higher tolerance for alcohol or a body that is particularly sensitive to alcohol in certain ways. In any event, a family history of alcohol problems increases personal risk.

Personality pattern

Although there is no single personality style associated with alcohol and drug problems, certain patterns are linked to higher risk. One questionnaire you completed--the MacAndrew Scale--measures this particular kind of risk. People who score higher on this scale as teenagers, for example, have been found to have higher risk for developing serious problems with alcohol in adulthood.

Age at onset

Recent research indicates that the younger a person is when drinking problems start, the greater the person's risk for developing serious consequences and dependence. Although serious problems can occur at any time of life, a younger beginning does represent a significant risk factor.

4. Negative consequences

From your pretreatment interview, two scores were calculated to reflect the current overall severity of your negative consequences from drinking.

AUDIT

The AUDIT is a scale devised by the World Health Organization to evaluate a person's problematic involvement with alcohol. Higher scores reflect recent problems related to drinking.

DRINC

Another way to look at risks and effects of drinking is to add up alcohol's negative effects throughout one's lifetime. Your score on this scale reflects the extent to which your drinking has had negative effects over the course of your life thus far. The higher your score, the more harm has resulted from your drinking.

5. Blood tests

Your pretreatment evaluation also included a blood sample. These particular blood tests were chosen because they have been shown in previous research to be negatively affected by heavy drinking. You should realize that normal results on these tests do not guarantee that you are in good health (for example, that your liver is functioning completely normally). An abnormal score on one or more of these tests, however, probably reflects unhealthy changes in your body resulting from excessive use of alcohol and/or other drugs.

Research indicates that modestly abnormal scores on the blood tests reported here will often show improvement and a return to normal range when harmful drinking and other drug use patterns are changed. The longer one continues drinking, however, the more difficult it is to reverse the physical damage.

These tests are directly related to how the liver is working. Your liver is extremely important to your health. It is involved in producing energy, and it filters and neutralizes impurities and poisons in your bloodstream. Alcohol damages the liver, and after a long period of heavy drinking, parts of the liver begin to die. This is the process of cirrhosis, but physical changes in the liver can be caused by drinking long before cirrhosis appears. As the liver becomes damaged, it begins to leak enzymes into the blood and is less efficient in doing its work. This can be reflected in abnormally elevated values on the tests reported in this section.

Elevated values on any of these tests should be taken seriously. They do not happen by chance and are very likely related to physical changes in the body caused by excessive drinking. Consult a physician who is knowledgeable about the effects of alcohol on the body.

6. Neuropsychological tests

Some of the earliest damaging effects of drinking may be seen in certain types of abilities that are affected by alcohol. Certain patterns of brain impairment have been shown to be especially related to heavy drinking. The brain is very vulnerable to alcohol, and over a long span of time, a substantial amount of damage can occur in a heavy drinker. (Brain impairment from the use of certain other drugs has also been shown.)

Such damage occurs gradually. In later stages, it can be seen in x-rays of the brain, which show actual shrinkage and other changes in shape and density. Long before this occurs, however, harmful changes in brain functioning can be measured by psychological tests, several of which you completed. Research indicates that such negative effects can often be reversed, sometimes completely, if the individual stops or reduces drinking.

The four tests included in section 6 have been found to be related to heavy drinking. For comparison purposes, we include one test (SV) that is not usually affected by drinking to give you an idea of where your scores might normally be expected to fall. People who are heavy drinkers tend to score more poorly (higher) on the four alcohol-sensitive tests (TMTA, TMTB, SYDM, and SHVA) than on SV.

A high score on any one scale is not necessarily reason for concern. There are many reasons why a single score might be elevated. A pattern of elevated scores, however, resembles the kinds of problems that emerge among excessive drinkers. Studies of individuals currently in treatment for alcohol problems consistently show impairment on these measures.

Alcohol's effects on the brain have sometimes been described as "premature aging." The abnormal changes in the brain of a heavy drinker do resemble normal changes that occur with advanced age. For this reason, your scores reflected above take into account your present age. Scores of 4 or 5 represent below-average performance relative to others in your age group.

Summary

Your Personal Feedback Report summarizes a large amount of information that you provided during your pretreatment interviews. Sometimes this information can seem surprising or even discouraging. The best use of feedback like this is to consider it as you decide what, if anything, you will do about your drinking. Many of the kinds of problems covered in your Personal Feedback Report do improve when heavy drinking is stopped. What you do with this information is up to you. Your report is designed to give you a clear picture of where you are at present so that you can make good decisions about where you want to go from here.

Readiness To Change Questionnaire (Treatment Version) (RCQ-TV)

Readiness To Change Questionnaire (Treatment Version) (RCQ-TV).

Table

Readiness To Change Questionnaire (Treatment Version) (RCQ-TV).

Situational Confidence Questionnaire (SCQ-39)

Situational Confidence Questionnaire (SCQ-39).

Table

Situational Confidence Questionnaire (SCQ-39).

Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES 8A)

Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES 8A)

Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES 8A).

Table

Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES 8A).

Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES 8D)

Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES 8A)

Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES 8A).

Table

Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES 8A).

SOCRATES Scoring Form (19-Item Version 8)

Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES 8A)

Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES 8A).

Table

Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES 8A).

SOCRATES Profile Sheet (19-Item Version 8A)

INSTRUCTIONS: From the SOCRATES Scoring Form (19-Item Version) transfer the total scale scores into the empty boxes at the bottom of the Profile Sheet. Then for each scale, CIRCLE the same value above it to determine the decile range.

Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES 8A)

Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES 8A).

Table

Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES 8A).

These interpretive ranges are based on a sample of 1,726 adult men and women presenting for treatment of alcohol problems through Project MATCH. Note that individual scores are therefore being ranked as low, medium, or high relative to people already presenting for alcohol treatment.

Guidelines for Interpretation of SOCRATES-8 Scores

Using the SOCRATES Profile Sheet, circle the client's raw score within each of the three scale columns. This provides information as to whether the client's scores are low, average, or high relative to people already seeking treatment for alcohol problems. The following are provided as general guidelines for interpretation of scores, but it is wise in an individual case also to examine individual item responses for additional information.

RECOGNITION

HIGH scorers directly acknowledge that they are having problems related to their drinking, tending to express a desire for change and to perceive that harm will continue if they do not change.

LOW scorers deny that alcohol is causing them serious problems, reject diagnostic labels such as "problem drinker" and "alcoholic," and do not express a desire for change.

AMBIVALENCE

HIGH scorers say that they sometimes wonder if they are in control of their drinking, are drinking too much, are hurting other people, and/or are alcoholic. Thus a high score reflects ambivalence or uncertainty. A high score here reflects some openness to reflection, as might be particularly expected in the contemplation stage of change.

LOW scorers say that they do not wonder whether they drink too much, are in control, are hurting others, or are alcoholic. Note that a person may score low on ambivalence either because he "knows" his drinking is causing problems (high Recognition), or because he "knows" that he does not have drinking problems (low Recognition). Thus a low Ambivalence score should be interpreted in relation to the Recognition score.

TAKING STEPS

HIGH scorers report that they are already doing things to make a positive change in their drinking and may have experienced some success in this regard. Change is under way, and they may want help to persist or to prevent backsliding. A high score on this scale has been found to be predictive of successful change.

LOW scorers report that they are not currently doing things to change their drinking and have not made such changes recently.

University of Rhode Island Change Assessment Scale (URICA)

University of Rhode Island Change Assessment Scale (URICA).

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University of Rhode Island Change Assessment Scale (URICA).

What I Want From Treatment

William R. Miller and Janice M. Brown

Instructions

People have different ideas about what they want, need, and expect from treatment.

This questionnaire is designed to help you explain what you would like to have happen in your treatment. Many possibilities are listed. For each one, please indicate how much you would like for this to be part of your treatment.

You can do this by circling one number (0, 1, 2, or 3) for each item. This is what the numbers mean:

Instructions

0NOmeans that you definitely do NOT want or need this from treatment.
1?means that you are UNSURE. MAYBE you want this from treatment.
2YESmeans that you DO want or need this from treatment.
3YES!means that you DEFINITELY want or need this from treatment.

FOR EXAMPLE:

Consider item #1, which says, "I want to receive detoxification." If you definitely do NOT want or need to receive detoxification, you would circle 0. If you are UNSURE whether you want or need detoxification, you would circle 1. If you DO want detoxification, you would circle 2. If you DEFINITELY know that detoxification is an important goal for your treatment, you would circle 3.

If you have any questions about how to use this questionnaire, ask for assistance before you begin.

What I Want From Treatment

What I Want From Treatment.

Table

What I Want From Treatment.

Is there anything else you would like from treatment? If so, please write on the back of this sheet.

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