SEMI-STRUCTURED ASSESSMENT OF COCAINE DEPENDENCE

SSACD SPECIFICATIONS

version: 4/22/2002

1. INTRODUCTION TO THE SSACD The Semi-Structured Assessment of Cocaine Dependence (SSACD) addresses psychiatric disorders according to several diagnostic classification systems, including DSM-III-R, DSM-IV, ICD-10, Feighner, and RDC. Its diagnostic coverage is most extensive for substance abuse and dependence, including nicotine, alcohol and several classes of drugs. The SSACD assesses physical, psychological, and social manifestations of substance abuse or dependence and other psychiatric disorders. All diagnoses are available according to DSM-IV criteria. The SSACD capitalizes on prior research in psychiatric epidemiology and relies on items previously validated by other research interviews, including the SSAGA-II, DIS, CIDI, and CIDI-SAM. The SSACD is formatted with an index in the left margin, questions in the center, and coding space in the right margin. The labels in the left margin are coded to reflect the diagnosis, the diagnostic system, and the criterion covered by the question. The following key lists the diagnoses assessed by the SSACD, the diagnostic systems used, and the abbreviations used in the index labels: DIAGNOSES: AD = Alcohol Dependence AGP = Agoraphobia ASP = Antisocial Personality Disorder AT = Attention Deficit Hyperactivity Disorder CD = Cocaine Dependence (section E only) CD = Conduct Disorder (section M only) DD = Drug Dependence DEP = Depression MAN = Mania ND = Nicotine Dependence PAN = Panic PG = Pathological Gambling PTS = Post Traumatic Stress Disorder SP = Social Phobia DIAGNOSTIC SYSTEM: 4 = DSM-IV EXAMPLES OF LABELS: DD4A2 = Drug Dependence, DSM-IV system, criterion A, item 2.

2. GENERAL NOTES ON INTERVIEWING SSACD interviewers do not need a clinical background, but they must be skilled communicators and listeners. Interviewers need to read questions smoothly and clearly. They must also listen carefully to answers, ensuring that respondents understand the questions and that answers fit the questions appropriately (e.g., a response that doesn't fit is an age of onset of 16 for a question that reads “Before age 15, did you...?”). When an interviewer feels an answer is inconsistent with the respondent's previous answers, s/he needs to ask for clarification without expressing judgment, disbelief, or dissatisfaction. Because the SSACD covers a wide range of human experiences, interviewers must also be sensitive, tolerant, and empathetic. At the same time, they need to ask personal and sometimes embarrassing questions in a matter-of-fact way. Interviewers may, at times, be surprised by what they hear, but they should never show this. Interviewers should never lead a respondent or assume they know how a respondent will answer a question (e.g., “You are in treatment, so in the last week you haven't had a drink.” It may be that R relapsed on pass, and, in this case, the interviewer may have made it hard for R to admit this. Interviewers should never ask questions apologetically or comment on what might seem inappropriate for R, for example, “This probably doesn't apply to you, but...” or “You might find this (funny/tough to answer/awkward), but...”. Such comments may influence the respondent's answers if s/he thinks the interviewer is making judgments on what is appropriate for R. Interviewers may want to explain at the start that the interview is in the form of a structured booklet, and that each participant is asked the very same questions. This will help a respondent understand that even though some questions may not be of relevance to him/her, the interviewer still has to read them. (This can be repeated during the interview if R gets annoyed or offended by a question.) The SSACD's semi-structured design gives interviewers the freedom needed to extract the best information possible, while also maintaining a standardized pattern of interviewing. Whenever possible, questions should be read exactly as written. Skipping phrases may change the content of the question. Long questions may need to be broken into two questions for some respondents. If the respondent looks confused after the question is read, the interviewer should try re-reading the question before rephrasing. Questions should only be rephrased or followed up with additional probes when a response does not seem appropriate for the question, leading the interviewer to suspect that the respondent did not understand. If this is done, interviewers should carefully document the dialogue in the left margin for the editor's reference. Sometimes respondents volunteer information before a question is asked. When this happens, interviewers may ask the question in a confirmatory way, but they should also pay careful attention to the respondent's answer in case the information provided earlier is wrong or does not fit the question as it is worded. Interviewers should start an interview by introducing himself/herself. Interviewers should be pleasant, but professional. This includes dressing appropriately and addressing respondents with Mr., Mrs., Ms., or Dr., etc. Interviewers need to explain that the interview is for research purposes, so the respondent does not confuse it with any kind of treatment. Interviewers must keep in mind that even though many respondents find the interview therapeutic, the interviewer's job is to collect the data -- a job of utmost importance to the whole project. Interviewers should let R know that s/he may always refuse to answer any question, but that we would appreciate honesty. Interviewers should also stress confidentiality. One way to explain this is to tell R that all answers are assigned a numerical code that is entered into a computer, and that is what makes the research interview different from an interview with a doctor or therapist.

The interviewer should make sure that R is interviewable; that is, is in a condition suitable to understanding and responding to questions. The interviewer should note any evidence of substance involvement (alcohol on breath, etc.), impairment of speech, disorientation, etc. If there is reason to believe that R is under the influence of alcohol or drugs, or has any other impairment that interferes with interview comprehension, the interviewer should break off the interview in a diplomatic way and reschedule. Interviewer attitude and demeanor are very important because they can influence the data collection tremendously. If R is trying to please the interviewer, s/he may not be honest; if s/he is trying to impress the interviewer, s/he could exaggerate. The interviewer's attitude should be very professional and serious. This means not laughing, regardless of what is said; one can instead smile politely. Interviewers should not make comments, get into discussions, or share personal information with R. If R has questions or asks for advice or help, the interviewer should refer him/her to his/her doctor or therapist. Interviewers must follow the structure of the interview in a friendly, but professional and distant manner. Even touchy situations (e.g., description of a suicide attempt, crying) should be approached with a serious, professional manner. The interviewer may show compassion by handing a tissue, offering a glass of water, or a similar gesture, but s/he should not make any comments because sometimes these comments may be uninformative, misleading, or misunderstood as patronizing or condescending. Many different interviewers will administer the SSACD. The interview should be conducted in such a way that it makes no difference which interviewer is collecting the data. Ideally, an interview would be coded in the same manner by all interviewers. Because everyone's history is unique, each interview is going to be different. It is impossible to structure and specify questions for all possibilities and variations of the problems people might have. There will be situations when the interviewer is uncertain about how to code or how to interpret a response. In such cases, interviewers should record all the information in the margins and discuss it later with an editor. Interviewers should follow these safety precautions when interviewing: • Don't sit anywhere that would make it difficult to leave in a hurry, like behind a desk or where you

have to pass R to get to the door. If possible, arrange the interviewing rooms so that the interviewer's back is to the door.

• Don't let R sit behind a desk with an unlocked drawer that might contain sharp objects like scissors. • Don't sit too close to R both for safety and to ensure that R cannot see the interview questions or what

you are writing down. • When in the field, make sure your supervisor knows where and when you will be interviewing a

subject (name, address, and phone number of subject). Always call your supervisor, after the interview is completed so the project staff will know the interview has concluded and that you are on your way back.

• Emergency Procedures: If, during the interview, an emergency situation develops (e.g., overt suicidal

gesture, current or suicidal thoughts, actual requests for help, or any situation that you feel uncomfortable about letting R leave once the interview is completed), immediately contact one of the project clinicians. (Immediately means right after the interview; R should not be allowed to leave). When calling a clinician, identify yourself as a staff member of the research project, explain the situation, and ask the clinician what his/her recommendation would be.

After the interview, interviewers should only discuss relevant details of the interview with the appropriate project personnel, and outside of earshot of non-study personnel. A basic rule to follow is this: Treat the information you have heard with the same respect that you would want a researcher to treat your personal information. That means, not swapping "horror" stories at the lunch table with other interviewers for entertainment purposes. Interviewers also must never share interview information, including family history information, with other family members. Some participants may not want their family members to even know that they participated, so it is most prudent to not even share the names of who has participated. 3. INTERVIEW CONVENTIONS Questions and Instructions: The questions that are to be read aloud are printed in upper and lower case letters, and interviewer instructions are printed in upper case letters. Interviewer instructions are not read to the respondent. They can be located in the center column above or under questions, in interviewer boxes, or in parentheses next to coding options. Interviewer instructions direct the interviewer how to code and/or where to proceed. EXAMPLE:

AD42B D39 Did you ever take any medication or drug to avoid any of these problems or to make them go away? DO NOT COUNT ASPIRIN, TYLENOL, ETC. DO COUNT MEDS GIVEN IN TREATMENT. SPECIFY: _________________________________________

NO. . . .(SKIP TO D40) 1 YES. . .(SPECIFY) . . . . 5*

[In this example, the interviewer does not tell the respondent that aspirin, Tylenol and/or drugs given in treatment, do not count. If a respondent volunteers that she only used aspirin, Tylenol or drugs given in treatment, the interviewer circles the code for "NO" and skips to the next question D40.] Optional Phrases: Some questions contain optional phrases in parentheses that allow the interviewer to tailor the question based on previous information. EXAMPLE:

D25 Have you ever been arrested or detained by the police even for a few hours because of drunk behavior (other than for drunk driving)?

NO. . . .(SKIP TO D22) 1 YES. . . . . . . . . . . . . . . . 5*

[In this example, the interviewer would not read the optional phrase if the respondent had never been

rrested for drunk driving.] a

Word Substitutions: The SSACD uses upper case letters in parentheses for generic words that should be substituted with the appropriate word. EXAMPLE:

G15 Have you ever stayed high from (DRUG) for a whole day or more?

STIM SED OP PCP HAL OTH

NO 1 1 1 1 1 1 YES 5 5 5 5 5 5

[In this example, the interviewer reads the question for each drug as needed, "Have you ever stayed high from a stimulant for a whole day or more?” or "Have you ever stayed high from a sedative for a whole day

r more?”] o Another convention used for word substitution is parentheses containing slashes. In these questions, the interviewer selects the appropriate word based on the respondent's previous answers. EXAMPLE:

H24 Did this episode of feeling (depressed/ uninterested/empty/irritable) begin within 6 months of learning about the death of someone close to you?

NO. . . .(SKIP TO H25) 1 YES. . .(SPECIFY) . . . . 5

Timeline and Tally Sheet Items: Responses that require the interviewer to mark the timeline or a tally sheet are labeled in the far right margin next to the code. The character used for the tally sheet label is typically an asterisk. The timeline items are marked with "t". Timeline items are found in sections A and B only. For tally sheet items, the Tobacco, Alcohol, Cocaine, Marijuana, Drug, Depression, Antisocial Personality, and Post Traumatic Stress Disorder sections use an asterisk. The tally sheets should be coded in tandem with the diagnostic section, not completed at the end of the section. Abbreviations: The interview and the specifications manual use the following abbreviations: DK = don't know IVR = the interviewer ONS = onset, the first occurrence R = the respondent REC = recency, the last occurrence RF = refused to answer

4. READING QUESTIONS AND RECORDING ANSWERS Questions are located in the center column and answers are usually coded in the right margin. Most questions require a pre-coded answer to be circled, but some require the information to be written on a blank line. Interviewers should record additional notes and comments in the left margin or on lines provided. EXAMPLE:

D22 Did you ever drive a car after having too much to drink?

NO. . . .(SKIP TO D25) 1 YES. . . . . . . . . . . . . . . . 5

A. How many times have you driven a car after having a lot or too much to drink?

___ ___ ___ ___ TIMES

When a number is to be recorded (as in the above example), all spaces should be filled. That means that leading zeros may need to be added (e.g., if R had driven after having to much to drink 3 times, it would be coded “0003”). Generally, a separate line is available for each digit. The only exception is found in the drug section, where page space is limited. For example, in G1A, even though only one line is available for number of times a drug was used, interviewer can code up to 9999 times. Some questions begin with a stem that is repeated for the list of questions that follow. The stem generally should be repeated after every third question, but some respondents may need it repeated more often. EXAMPLE:

P2 Did you feel this way about:

NO

YES

1. going outside of the house alone?............................... 1

2. being in a crowd ......................................................... 1 3. standing in a line? ....................................................... 1 4. being on a bridge or in a tunnel? ................................ 1 5. traveling in a bus, train, or car? .................................. 1 6. being in an elevator?................................................... 1

5 5 5 5 5 5

When recording answers, interviewers should be careful to circle codes clearly and print legibly. Any changes in coding should be crossed out with a single slash, with the correct code clearly circled or printed above it. That is, interviewers should not erase answers. Interviewers are encouraged to document the reason for the change (e.g., R changed mind, IVR error). Changes made by editors will be made in colored ink. If an interviewer is uncertain about how to code a response, s/he should record information in the left margin so the editor can make an informed decision. If a respondent refuses to answer a question, document this with “RF” and code “-98”. If a respondent says s/he does not know a particular answer, the interviewer should ask "Could you give me your best guess?" If the respondent cannot guess, and simply does not know the answer, document with “DK” and code “-99”. The Antisocial Personality section has an additional probe if the respondent does not know at what age the experience first happened. If the respondent cannot guess the age, the interviewer follows up with a standard probe: "Do you think it was

before your 13th birthday or was it later than that?" In this section, there are specific codes for BEFORE 13, 13-14, 15-17, and 18 OR OLDER. Ranges of Values: Many times, when respondents are asked for a number, like the age when something took place or how many times something happened, they give a range rather than an exact number (e.g., “Oh, I was 19 or 20 when that happened” or “That happened 4 or 5 times”). The convention for recording two consecutive ages is to record the younger age for an age onset and the older age for age recency. For recording other consecutive numbers, the interviewer codes the more pathological number. For example, if R said she had 4 or 5 blackouts, code 5. If she said she was abstinent for 1 to 2 months, code 1 month. Onset and Recency Codes: Many questions ask for the first time (onset) and/or the last time (recency) that an experience happened. The age of onset is coded in the spaces next to AGE ONS and the age of recency next to AGE REC. In the case of episodic illness, such as major depression, the end of the most recent episode gets coded as recency. AGE ONS and AGE REC allow the interviewer to code the age at which something happened and REC allow the interviewer to code when it happened in relation to the time of interview. REC codes: 1 = within the last month 2 = within the last year If the experience clearly happened more than a year ago (e.g., when the 43 year old respondent was 25 years old) the interviewer doesn’t need to ask if the event happened within the last month or year. However if the time was not clearly over a year ago (e.g., when the 43 year old respondent was 42 years old), the interviewer must probe for a REC code. REC probing should start with the lowest code, such as “Was that within the last month?” If YES, code 1, but if NO, ask “Was that within the last year?”. EXAMPLE:

A. How old were you the (first/last) time this

happened?

AGE ONS ___/___ AGE REC ___/___ REC 1 2

IVR: “How old were you the first time this happened?”

R (who just turned 43 years old): “When I was 40 or 41.”

IVR: “How old were you the last time this happened?”

R: AWhen I was 42. ”

[IVR codes AGE REC=42]

IVR: “Was that within the last month? ”

R: “No.”

IVR: “Was that within the year? ”

R: “No.”

[IVR does not circle a REC code]

5. CLUSTERING - SYNDROMES The Tobacco, Alcohol, Marijuana, Cocaine, Drug, Depression, and Antisocial Personality sections ask if symptoms ever occurred around the same time, or in other words “clustered”. These co-occurring symptoms establish a syndrome of a psychiatric disorder. When asking these clustering questions, interviewers use tally sheets to list all the symptoms that occurred. DSM-IV clustering requires symptoms to occur together within a one-year period. The duration of clustering can last from one month to many years. Symptoms that have occurred sporadically throughout the respondent's life (e.g., one problem when R was 18, another when 25, another when 30) are not considered to have clustered. Similarly, we would not consider it clustering if multiple symptoms occurred as a result of an isolated incident (e.g., when R had been involved in hazing for a fraternity). For clustering to occur, symptoms do not have to occur at the same time or even on the same day. Rather, they must co-occur as part of a pattern in which R is experiencing several problems repeatedly within a given time span, within twelve months. The time frame for clustering in Depression is different from that in the substance sections. In Depression, we ask if symptoms from different groups co-occurred within the span of two weeks (see H16A). All clustering questions in the SSACD require the interviewer to record on the tally sheet which symptoms clustered by circling the symptoms. A: DEMOGRAPHICS

Book Question #/ Computeri-zed Interview #

General: This is a non-diagnostic section that elicits basic demographic information. The demographic topics are age, gender, race, marital status and parenthood, and education.

A1/DM1

Record gender as observed.

A2/DM2

Record age.

A3/DM3

Record date of birth. Make sure that the birth date is consistent with the age given in A2.

A4/DM4

Record city and state of birth.

A5/DM5

Include full siblings only. Stress “same biological father and mother.” Do not count step, foster or adopted siblings. This should match the number of siblings listed on the FHAM face sheet.

A6/DM6

Record only those siblings with the same biological father.

A7/DM7

Record only those siblings with the same biological mother.

A8/DM8

Record code from card A. In cases where R is unsure of his/her race, ask him/her to choose the group that s/he most closely identifies with. If R refuses to answer, record apparent race in the margin.

A9/DM9

“Married” refers to legal marriages only, not live-in relationships that would, in some

lif l i M i b b f h

states, qualify as common law marriages. Marriages between members of the same sex and marriages that were annulled do not count because they were not legal marriages. In the case of annulment, code legal annulment as never married and religious annulment as divorced. If R has married the same person twice, code as two separate marriages. “Separated” includes both legal and informal separations from a legal spouse B it would not include separation from a live-in partner. Even if R has been separated from his/her spouse for a number of years, count this as a separation (rather than a divorce).

A10/DM10

If R has been married more than four times, code his/her four most recent marriages in the space provided and code all other marriages in the margins. Mark all marriages on the timeline.

Box A10

If R is currently married and has only been married once, skip to question A13.

A11/DM11

If R has been divorced more than four times, code his/her four most recent divorces in the space provided and code all other divorces in the margins. If R has never been divorced, code “00”. Mark all divorces on the timeline.

A12/DM12

Record the number of times R has been widowed. If R has never been widowed, code “00”. Mark all dates on the timeline.

A13/DM13

The question refers to live-in relationships “as though you were married” and not to marriages or roommate situations. This also includes homosexual live-in relationships. Do not count people that R has married. If R has lived with someone more than four times, code the four most recent years in the space provided and the other years in the margin. Mark all dates that R has lived with someone on the timeline.

A14/DM14

This includes all of the children that R has fathered or given birth to, including any that have died. Do not count miscarriages or abortions.

A14A/ DM14A

Record the date of birth, sex, state of birth and whether the child is alive or deceased. List children from oldest to youngest.

Box A14 BOX DM14

Specify the cause of death for any deceased children. Again, do not include miscarriages or abortions.

A15/DM15

Record the number of children that R has raised in appropriate blanks (include biological, adopted, step, foster, and/or relatives’ children). Add these and enter for total raised.

A16/DM16

Record the highest grade that R has completed.

A17/DM17

Record the highest educational degree that R has received. “Other School” is to be used for technical schools, such as auto mechanic, secretarial, LPN, CNA, QMA, and other special degrees including registered nursing (R.N.) degrees awarded based on additional training following a college degree. This does not include 6-month training programs, such as cable line school.

A18/DM18

Ask for the dates of all graduations that apply to R. Associate degrees and vocational tech diplomas are coded as other. If R has multiple college and/or graduate degrees, code the most recent graduation of each. If R has both a Masters and a Ph.D. code the date the Ph.D. was awarded. Make note of the other graduation dates in the margin.

B: MEDICAL HISTORY

The beginning of this section asks questions to assess R’s lifetime history of physical illness/injury, hospitalizations, chemical dependency treatments, surgeries, doctor and emergency room visits, type of health insurance, and lifetime/current use of medications. The last question in the section asks about R’s lifetime/current use of alcohol and/or drugs.

B1/MH1

The intent of this question is to get a general rating of health, not a “day of interview” rating.

B2/MH2

The state of R’s health, coded in B1, is inserted here. If R is customarily in excellent health but has a temporary condition, such as a broken collarbone, code as “excellent” since the broken collarbone is temporary.

B3/MH3

This is a list of medical illnesses of neuro-physiological relevance. If R says “Oh, I have high blood pressure” or “I get headaches all the time,” or “I know I have heart disease because my father, uncle, grandfather and brother all had heart disease” you must again follow-up with “Did a doctor or other health professional ever tell you that you have:” The year that R was diagnosed by the doctor is to be coded for each “yes”. Illnesses must be diagnosed by a doctor or other health professional. Definitions and descriptions:

1. High blood pressure - The following findings are considered abnormal: systolic pressure persistently above 100; pulse pressure constantly greater than 50. Blood pressure varies with age, sex, muscular development, and states of worry and fatigue. Usually it is lower in women than in men, low in childhood, and higher in elderly individuals.

2. Brain injury or concussion - Blunt trauma to the cranial vault will have differing consequences and final outcomes depending on whether the injury was penetrating or non-penetrating. Non-penetrating injuries can result in fractures of bones that directly affect adjacent brain tissue. Bleeding (hemorrhage) from head injuries may occur at various sites, depending on the site of the injury, which have different prognostic implications. In an epidural hemorrhage, the blood is in a layer between the skull and a sheath-like covering of the brain (the dura). Sometimes the blood accumulates slowly with neurological symptoms proceeding to coma within hours to days. In a subdural hematoma the hemorrhage is located between the brain and the dura or sheath-like covering of the brain. The neurological consequences are obvious almost immediately. A chronic version of the acute subdural hematoma caused by a minor blow to an elderly person may result in a slow period of mental decline over weeks. Keep in mind that a Ahead injury@ is some type of trauma to the brain; it does not include scalp lacerations. Concussion - An injury to the head resulting from impact with an object or violent shaking and agitation of the brain. The effects include loss of consciousness (usually), loss of reflexes, brief cessation of breathing, slowing of the heart, and changes in blood pressure. Amnesia and confusion may last only briefly or several days.

3. Stroke - The sudden, non-convulsive focal neurologic deficit, also known as a cerebrovascular accident (CVA). A malfunction of the cerebral vessels has many causes including Atherosclerosis (hardening of the vessels). There is sudden loss of consciousness followed by paralysis caused by hemorrhage into the brain.

4. Heart problems or heart attack - Diseases that affect the heart can be congenital or intrinsic (such as an abnormal valve, malformed heart or arrhythmias, the irregular beating of the heart) or acquired (such as endocarditis; ischemic due to atherosclerosis of the vessels flowing to the heart or secondary to external problems such as heart failure due to hypertension). Occasionally, heart disease may need to be determined on a case-by-case basis but would also include such things as angina, heart murmurs, and CAD.

5. Hepatitis B or C - Inflammation of the liver, due usually to viral infection but sometimes to toxic agents. Hepatitis B is transmitted through sexual contact, sharing of needles, needlestick injuries, and from mother to fetus. Hepatitis C is in the principal form of transfusion - induced hepatitis.

6. Cirrhosis or liver disease – Alcohol’s effect on the liver initially causes fat accumulation but eventually causes a small hard fibrotic liver that is ineffective in metabolizing body products. This is called cirrhosis. Gall stones in the gall bladder near the liver can have negative effects on the liver. Also, the liver may develop cancer, be the site of a cancer originating in another part of the body, or become filled with abnormal substances due to a genetic enzymatic disorder – Gaucher’s disease

7. Asthma - A respiratory disorder characterized by recurrent episodes of difficulty breathing, wheezing, cough, and thick mucous production, usually caused by a spasm or inflammation of the bronchial airways. Attacks are precipitated by exposure to an allergen (e.g., pollen, dust, food), strenuous exercise, stress or infection. Asthma is most common in childhood (occurring more often in boys) and has a strong hereditary factor. Treatment usually involves the use of bronchodilators.

8. Diabetes - A metabolic disorder characterized by extreme thirst and the passing of very large amounts of urine; it is caused by failure of the pituitary gland to produce or secrete sufficient amounts of antidiuretic hormone (ADH). Treatment depends on the severity of the disease; mild forms may be managed with diet alone, but other cases require the use of drugs to lower blood sugar levels or injections of insulin.

9. Cancer - An abnormal malignant growth of cells that invades nearby tissues and often spreads to other sites in the body, interfering with the normal function of the affected sites. We obtain the type of cancer (breast, lung, etc). Specify the type of cancer in the space provided. Record any additional cancer diagnosis under “13. Any other illness(es).”

10. Tuberculosis - TB is a disease that is spread from person to person through the air. TB usually affects the lungs, but it can also affect other parts of the body, such as the brain, the kidneys, or the spine. TB germs are put into the air when a person with TB disease of the lungs or throat coughs or sneezes. When a person inhales air that contains TB germs, he or she may become infected. People with TB infection do not feel sick and do not have any symptoms. However, they may develop TB disease at some time in the future.

The general symptoms of TB disease include feeling sick or weak, weight loss, fever, and night sweats. The symptoms of TB of the lungs include coughing, chest pain, and coughing up blood. Other symptoms depend on the part of the body that is affected.

11. HIV / AIDS - AIDS: First identified in 1981, AIDS is a serious and often fatal condition in which the immune system breaks down and does not respond normally to infection. HIV: A test has been developed to detect the presence in a person=s blood of antibodies that specifically recognize HIV and that serve as a marker for viral infection. The virus can be isolated from most persons who test positive for the presence of these antibodies. Anyone who has antibodies to the virus must be assumed to be infected. A person infected with HIV may not show any clinical symptoms for months or even years but apparently never becomes free of the virus.

12. Sexually transmitted disease - Refers to communicable diseases transmitted by sexual intercourse or genital contact. This may include gonorrhea, syphilis, genital herpes, etc. Specify the type of STD in the space provided. Record each different STD under a separate line. If there are more than four STD diagnosed, under “13. Any other illness(es).”

13. Any additional illness(es) can be recorded here.

B4/MH4 B4A/ MH4A

Record if R has knocked out, or knocked unconscious. If yes, was it longer than 5 minutes?

B5/MH5

Count all emergency room visits that were for accidents or injuries or acute conditions such as food poisoning. Include ER visits that led directly to in-patient hospitalization.

B6/MH6 Record total number of overnight hospitalizations. Include hospitalizations for pregnancies and surgeries. Do not count hospitalizations for psychiatric or substance abuse treatment. If R was a student, and “hospitalized” in the college infirmary, this counts. If R was admitted to a hospital (not a psychiatric ward) for medical problems associated with anorexia or a suicide attempt, this should be coded here under B6, instead of B7.

B7/MH7

Record the number of times R was a patient in a psychiatric hospital or ward. If R was never an inpatient in a psychiatric hospital, code “0000”. If R was an inpatient, record the month and year when R first entered the psychiatric hospital and mark on the timeline. Under “specify”, record the specific reason why R was hospitalized and the hospital name (e.g. Malcolm Briggs – suicide attempt).

B8/MH8

Record the number of times R was an inpatient in a chemical dependency program. If R was never an inpatient in a chemical dependency program, code “0000”. If R was an inpatient, record the month and year when R first entered the program and mark on the timeline. Under “specify”, record the treatment center(s) that R went to and the specific substance R was treated for (e.g. Bridgeway – St. Charles – cocaine, and Farmington – alcohol and cocaine).

B9/MH9

Record the number of times R was an outpatient in a chemical dependency program. If R was never an outpatient in a chemical dependency program, code “0000”. If R was an outpatient, record the month and year when R first entered the program and mark on the timeline. Under “specify”, record the treatment center(s) that R went to and the specific substance R was treated for (e.g. BASIC – marijuana and cocaine, and DART – treated for

all drugs, no specific one). B10/ MH10

This question asks about visits to doctors or clinics, the emergency room, dentist, psychologists/social workers/counselors, or other professionals, that occurred within the past year. Under “Doctor or Clinic” count routine check-ups or visits to any doctors, D.O.s (Doctors of Osteopathy), eye doctors, as well as visits due to illness/injury. If R has been to a psychiatrist in the past year record it under “Doctor or Clinic”.

B11/ MH12

Record if R has health insurance, as well as the type of insurance. For the type of insurance, circle all that apply.

B12/ MH12

This question is used to screen for prescription medications R has taken for at least 2 weeks anytime in his/her life. Count only medications that were prescribed to R by a doctor. Do not count over-the-counter (OTC) medication. For every “Yes” response, the interviewer should elicit the name of the medication, and whether or not R is currently taking the medication. Medication taken to have more energy can include items such as diet pills and other caffeine-containing products, if the medication was prescribed by a doctor. This does not include any illegal drugs R was using (for example, taking cocaine for more energy). Do not count prescription drugs that R was taking if they were not prescribed to R (e.g., taking a friend’s prescription drugs). Items should be coded according to R’s understanding of what the medication was to be used for. For example, if a subject went to a general practitioner complaining of depression and was given medication to help sleep (“if you get a few nights sleep you won’t be depressed anymore”) then this would be coded under B6.A.3 (to feel less depressed), even if the medication was a sleeping pill. If a medication was taken for more than 1 reason (e.g. R took a medication to feel less nervous and less depressed), code the medication under both categories.

B13/ MH13

Stress a time that R may have wanted to talk to a doctor or health professional about any emotional problems. Code “Yes” even if R never went to talk to a doctor or health professional.

B13A-C/ MH13 A-C

R is asked if s/he ever spoke with a professional, including a medical doctor, about emotional problems. Probation officers are not considered mental health professionals and should not be coded here.

B14/ MH14

This question asks if R ever wanted to talk to a doctor or health professional about any problems s/he might have had with alcohol or drugs.

B14A-C/ MH14 A-C

R is asked if s/he ever spoke with a professional, including a medical doctor, about problems with alcohol or drugs. Probation officers are not considered mental health professionals and should not be coded here.

B15/ MH15

The purpose of this question is to determine which substances R has used in the past thirty days, over the course of their lifetime, and whether or not s/he thinks they have had a problem with the substance. If a doctor prescribed R a sedative or an opiate (such as a prescription painkiller) do not count it as “Yes” unless R took more than what was prescribed.

This question also allows the interviewer to determine if R will go through the tobacco, alcohol, marijuana, cocaine and drug sections of the interview.

C: TOBACCO

The Tobacco section assesses DSM-IV Nicotine Dependence for cigarette smokers. Nicotine Dependence and Withdrawal can develop with use of all forms of tobacco (cigarettes, chewing tobacco, snuff, pipes, and cigars) and with prescription medications (nicotine gum and patch). Several features associated with Nicotine Dependence appear to predict a greater level of difficulty in stopping nicotine use: smoking soon after waking, smoking when ill, difficulty refraining from smoking, reporting the first cigarette of the day to be the one most difficult to give up, and smoking more in the morning than in the afternoon. Indications of withdrawal include daily use of nicotine for at least several weeks, abrupt cessation of nicotine use or reduction of amount use that result in the following symptoms within twenty-four hours: dysphoric or depressed mood, insomnia, irritability, frustration, or anger, anxiety, difficulty concentrating, restlessness, decreased heart rate, and increased appetite or weight gain. The symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Symptoms must not be due to a general medical condition and are not better accounted for by another mental disorder.

C1/TB1

R is asked if s/he has ever used tobacco. Only count smoking a whole cigarette, cigar, pipeful, or pinch of chewing tobacco. A few puffs of a cigarette would not be sufficient to code “Yes”. R must have smoked 1 full cigarette.

Box C1

If R has never smoked a cigarette, cigar, pipe or used chewing tobacco or snuff, then skip to Section D (Alcohol).

C2/TB2

This question determines who will continue in the section. In order to continue, R must have smoked a minimum of 100 cigarettes.

C3/TB3

Asks if R has smoked cigarettes daily for a month or more.

C4/TB4

This question assesses R’s most typical pattern of cigarette smoking over the past year. If R has not smoked in the past year, this question is skipped.

C5/TB5

This question assesses the most typical pattern of cigarette smoking over R’s lifetime.

C6/TB6

Record the largest number of cigarettes smoked in 24 hours. (1 pack is equal to 20 cigarettes.)

C7 -C12/ TB7-TB12

These questions focus on when R was smoking the most. R should focus on the month (or longer period) when s/he was smoking or using tobacco the most. If R always used at the same level and reports that s/he had no period of “heaviest” use, then ask R to focus on the time when s/he was smoking regularly.

C7/TB7

Assesses R’s most typical pattern of smoking during the time when R was smoking the most. This period has to last for at least 1 month. We are not interested in a period of a few days when R was smoking heavily. If R has not smoked more than assessed in the previous questions (TB4 and TB5) then the answer is no.

C8/TB8

This question is non-diagnostic. We ask how many minutes after waking did R usually smoke his/her first cigarette. If R cannot give a number, code “-999” and ask A. Code the smallest duration.

C9/TB9

Emphasize what R “usually” did when they were smoking the most.

C10/TB10

This question asks which cigarette R would have hated most to give up. There are only two coding categories: “first one in the morning” and “any others”.

C11/TB11

Emphasize “places where it was forbidden”. The given examples may not fit every situation (e.g., 10-20 years ago non-smoking regulations were not as common). The interviewer may need to probe with other examples as needed, such as: church, school, work, library, hospital, etc.

C12/TB12

This question doesn’t ask specifically about smoking in bed, just whether R smoked when s/he was very sick. However, if R did endorse smoking in bed, also code that in C19.

C13 –30/ TB13-30

Emphasis should be placed on “cigarette smoking throughout R’s life.”

C13/TB13

This question asks about chain-smoking cigarettes, that is smoking one cigarette right after another.

C13B/ TB13B

Emphasize “everyday or nearly everyday”. We want to code the length of the period R chain smoked on a daily or nearly daily basis.

C14-C15/ TB14-15

R is asked if s/he ever smoked more than intended or ran out of cigarettes sooner than intended.

C16-C17/ TB16-17

These questions ask about tolerance to nicotine. Tolerance can be indicated by either needing more tobacco to get an effect, or after time finding that the same amount of tobacco has less of an effect.

C18/TB18

R is asked if s/he ever reduced important activities because of smoking.

C19/TB19

Even if R claims smoking in bed isn’t dangerous (e.g., s/he would sit up), count the behavior as “Yes”.

C20/TB20

This question asks about desire to quit or cut down on tobacco use, whether or not R actually made the effort to quit or cut down. If R says s/he always wanted to quit, code as “Yes”.

C20A/ TB20A

If R wanted to quit, record how long R wanted to stop or cut down on smoking (not how long they actually quit). If R does not know, record “-9999” and ask if it was for a month or more. R may say ‘I always wanted to quit smoking,’ IVR should probe further to see how long they were actually thinking about quitting.

C21/TB21

R is asked if s/he has ever tried to quit using tobacco. Quitting smoking during pregnancy counts. Switching from one form of tobacco to another does not count as quitting (e.g., stopped smoking cigarettes, but chewed tobacco instead). If R states that s/he has never tried to quit using tobacco, but at some point stopped using tobacco, code “No”.

C21A-B/ TB21A-B

Record how many times R tried to quit or cut down and if R was always able to quit for at least a month. Stress “always”. So if R tried to quit 3 times, but only once quit for a month, C21B would be coded “No”.

C22/TB22

This question asks about failed efforts to quit or cut down.

C23/TB23 This question asks about cravings for cigarettes. C24/TB24

This question asks if R ever experienced any kind of withdrawal symptom when s/he stopped or cut down on smoking. If R says s/he never stopped or cut down, have R focus on a time when s/he went without a cigarette (e.g. when on a plane, at a movie, etc…).

C25/TB25

Withdrawal symptoms from stopping or cutting down on tobacco use are elicited.

Box C25

Count item 7 only once (if item 7 and 7A are both yes – count this only 1 time).

C26/TB26

This question asks if R used nicotine gum or a nicotine patch to keep from having any withdraw symptoms, not to quit smoking.

C27-C29/ TB27-29

These problems should stem from the use of tobacco, not withdrawal. Withdrawal problems are coded in C25. It is reasonable to code problems that stemmed from tobacco use and continued even after R stopped using tobacco.

C27/TB27

In this question, we ask if smoking has caused R to have any serious health problems. Shortness of breath is not considered a serious health problem, so it would not be coded.

C28/TB28

In this question R is asked if s/he smoked when s/he had a condition that was made worse by smoking. Examples of illnesses that count are asthma, bronchitis, pneumonia, and gum disease. Do not count the illness if it was already coded in C27. For example, R said in C27 that high blood pressure was caused by smoking. In C28, if R says high blood pressure was also made worse by smoking, code “No”. Illnesses that are not clearly exacerbated by smoking should be reviewed by a clinician.

C29/TB29

This question asks about emotional problems that may be caused by smoking.

C30/TB30

This question asks if R feels s/he is dependent on tobacco.

C31/TB31

This question asks if smoking has caused problems with R’s family, friends, work, school, or any other aspects of his/her life.

C32/TB32

In this question, the interviewer reviews with R all items that are checked off on the tally sheet. The interviewer asks R when the first time and last time any of the experiences occurred.

C33/TB33

If more than 2 boxes are checked on the tally sheet, the interviewer must ask if the symptoms occurred in the same year. As with all clustering questions, the interviewer should circle the symptoms that cluster.

C34/TB34

This question asks about a time when R wanted to talk to a doctor or other health professional about smoking. Code “Yes” even if R never went to talk to anyone.

C35/TB35

This question asks if a medical doctor ever advised R to quit smoking.

C36/TB36

R is asked if s/he ever tried any type of treatment to help quit smoking. If R has never tried any form of treatment, s/he skips to the next section. If R has tried treatment, s/he is asked questions about which treatments that s/he has tried.

D: ALCOHOL

The alcohol section is a fully diagnostic section that assesses Alcohol Dependence for DSM-IV. Card D can be used throughout the section to clarify and define alcohol equivalents. Alcohol dependence is indicated by evidence of tolerance or symptoms of withdrawal. Some symptoms associated with withdrawal are autonomic hyperactivity, increased motor hand tremor, insomnia, nausea or vomiting, transient visual, tactile or auditory hallucinations or illusions, and psychomotor agitation. Such symptoms develop four to twelve hours after the reduction of intake following prolonged, heavy, alcohol ingestion and cause significant distress or impairment in social, occupational, or other important areas of functioning. Alcohol Intoxication is indicated by slurred speech, incoordination, nystagmus, impairment in attention or memory, stupor or coma, and an unsteady gait. Intoxication is also characterized by clinically significant maladaptive behavioral or psychological changes like mood lability, impaired judgment, and inappropriate sexual or aggressive behavior that developed during, or shortly after, alcohol ingestion. Both Withdrawal and Intoxication symptoms must not be due to general medical conditions and are not better accounted for by another mental disorder. Respondents are given the opportunity to skip out of the section in the following cases: 1) if they have never had one full drink of alcohol (D1); 2) if they have never had more than 3 drinks within a 24-hour period (Box D9A), or 3) If they have never consumed alcohol at least once a month for 6 months or more and have never been drunk (Box D9B).

D1/ AL1

R is asked if s/he has ever had a full drink of alcohol in his/her lifetime. Do not include sipping wine when taking communion or having only a small portion of one drink. If R has never has a full drink of alcohol, skip to Section E.

D2/AL2

R is asked about alcohol consumption in the past 12 months. R is asked how many weeks (out of 52) did s/he drink alcohol.

D3/AL3

Record how much R “usually” drinks per week. “Usually” does not mean the worst. If R drank only 1 week out of the past 12 months, how much R drank in that week would be recorded. The fact that R is an infrequent drinker is captured in D2, which would be coded 5. Make sure you code how much R drank per week, not per day. If R said s/he drank 1 bottle of wine a day, everyday, code 42 drinks (1 bottle wine = 6 drinks x 7 days a week = 42 drinks total per week).

D4/AL4

This question asks about the year that R drank the most. R is asked how many weeks (out of 52) did s/he drink alcohol during the year R drank the most.

D5/AL5

This question asks how much R “usually” drank per week during the weeks that R drank in the year R drank the most. This amount must be greater than or equal to the amount given in questions D2/D3.

D6/AL6

Record the largest number of drinks that R has had in a 24-hour period. If R does not know, ask if it was more than 3.

D7/AL7

“Drinking regularly” is defined as drinking at least once a month for 6 months or more. If R has never been a regular drinker, code age as “00”.

D7A/ AL7a

“Drunk” is defined as having slurred speech or being unsteady on you feet. If never, code as “00”. If r does not know, ask if it was before the age of 18.

D8/AL8

This question asks for the longest period that R has abstained from using alcohol starting from the time that R began to drink regularly (age in D7) up until now. If less than 1 day code “0000”.

D9/AL9

This question asks about a period when R drank almost every day for a week or more. “Almost every day” is defined as at least 4 out of 7 days. If R says “Yes”, then s/he is asked how old they were when it started and how long the behavior lasted.

BOX D9

This box determines who completes the rest of the section. If R has never had more than 3 drinks in his/her lifetime, skip to section E. If R has never been a regular drinker and has never been drunk, skip to section E.

D10/AL10

This question asks if R ever became drunk when s/he didn’t intend to.

D11/AL11

This question asks if R drank a lot more than intended.

D12/AL12

This question asks about drinking for more hours or days than intended.

D13/AL13

This question asks if R has gone on binges where s/he drank for 2 days or more without sobering up.

D14/AL14

This question asks if R has spent a great deal of time, getting, using, or getting over the effects of alcohol.

D15-19/ AL15-19

These questions assess if R has become tolerant to alcohol.

D16/AL16

Record how many drinks it took R to feel an effect when s/he first started drinking. R doesn’t necessarily have to be drunk, just feel any effects from drinking alcohol. R may report different numbers based on different types of alcohol (beer vs. hard liquor). Which ever type of alcohol R reports, it needs to be consistent across the tolerance questions.

D17/AL17

Record how many drinks it took R to feel an effect after s/he had been drinking for some years.

BOX D17

This check determines if R needed 50% or more alcohol in order to feel an effect.

D18/AL18

Record how many drinks it took R to get drunk when s/he first started drinking. Remember that “drunk” is defined as either having slurred speech or being unsteady on your feet.

D19/AL19

Record how many drinks it took R to get drunk after s/he had been drinking for some years.

BOX D19

This check determines if R needed 50% or more alcohol in order to get drunk.

D20/Al20

This question asks if R has given up or greatly reduced important activities because of alcohol.

D21/AL21

This question asks R is s/he has ever been drinking and ridden in a car with a driver who h h d h d i k

has had too much to drink. D22/AL22

This question asks if R has ever driven after having too much to drink.

D23/AL23

This question asks if R’s drinking and driving has ever resulted in damage to his/her car or an accident.

D24/AL24

This question asks about arrests due to drunk driving.

D25/AL25

This question asks if R has been arrested or detained by the police for drunken behavior. Do not include drunk driving incidents.

D26/AL26

This question asks if R got into any arguments while drinking.

D27/AL27

This question asks if R ever got into physical fights while drinking.

D28/AL28

This question asks if R ever hit a significant other or any family member while drinking.

D29-32/ AL29-32

These questions ask about risky behaviors R may have engaged in while drinking.

D29/AL29

This question asks about sexual activity R may have engaged in while drinking.

D30/AL30

This question asks if drinking ever made R careless about sex. R is asked if drinking either made them careless so they didn’t protect themselves against disease or protection themselves or their partner against pregnancy.

D31/AL31

This asks about other situations where R could have put him or herself in a situation where they could have caused an accident or gotten hurt. Do not count drunk driving here since it gets captured in question D22.

D32/AL32

This question asks about alcohol related injuries. This includes anything that R would consider an injury. Include being hurt in a traffic accident here.

D33/AL33

This question asks about R’s desire to cut down on drinking and how long R thought about cutting down. This should be coded “Yes” even if R didn’t actually stop or cut down, but they wanted to.

D34/ AL34

This question asks whether R has tried to stop or cut down on drinking. If R has tried to cut down, also ask for the amount of times R has attempted to cut down, and if R was always able to quit for at least 1 month. Stress “always”.

D35/ AL35

This question asks about failed attempts to stop or cut down on drinking.

D36/ AL36

This question asks if R ever had a strong craving for alcohol.

D37/ AL37

This question asks R whether s/he experienced any withdrawal symptoms when stopping or cutting down on drinking.

D38/AL38

This question asks about specific withdrawal symptoms R may have experienced when s/he stopped or cut down on drinking. If R says s/he never stopped or cut down, ask about a time when s/he went without alcohol. This question gets asked even if R says they did

not experience any withdraw symptoms in D37. D38A-D/ AL38A-D

These questions are asked if R experienced any withdraw symptoms.

D39/AL39

This question asks if R took any medications or drugs to avoid withdraw symptoms or to make them go away. Do not count over the counter medications, such as Tylenol or aspirin. Do not count any drugs that were given in treatment.

D40/AL40 This question asks about severe withdrawal symptoms such as fits, seizures, convulsions. Grand mal seizures occur in less than 3% of individuals who experience withdraw from alcohol.

D41/AL41

This question asks if R had the DT’s when they stopped or cut down on drinking. DT’s stand for Delirium Tremens and includes symptoms such as disturbances in consciousness and cognition, visual, tactile or auditory hallucinations. Fewer than 10% of people who have withdraw from alcohol will develop the symptoms listed in these two questions (AL40-41).

D42/AL42 This question asks if R has had any blackouts from drinking. Do not count passing out from drinking.

D43/AL43

This question asks if R used alcohol with medications or drugs that s/he knew were dangerous to mix with alcohol. It is important to obtain information here about what kind or drugs or medications were taken and why R thought that it was dangerous. Information should also be obtained about any adverse effects that were experienced.

D44/AL43

This question asks about health problems R may have experienced from using alcohol and if s/he continued to drink after these health problems became apparent. Repeated intake of high doses of alcohol can affect nearly every organ system. About 15% of people who drink heavily develop liver cirrhosis and pancreatitis. There is also an increased rate of cancer of the esophagus, stomach and other parts of the gastrointestinal tract. Low-grade hypertension (high blood pressure) is one of the most common general medical conditions associated with heavy drinking. Cardiomyopathy and other myopathies are less common, but occur at an increased rate among those who drink heavily.

1. Liver Disease or Yellow Jaundice - Alcohol’s effect on the liver initially causes fat accumulation but eventually causes a small hard fibrotic liver that is ineffective in metabolizing body products. This is called cirrhosis. Gall stones in the gall bladder near the liver can have negative effects on the liver. Also, the liver may develop cancer, be the site of a cancer originating in another part of the body, or become filled with abnormal substances due to a genetic enzymatic disorder - Gaucher=s disease. Yellow Jaundice is a condition produced when excess amounts of bilirubin circulating in the blood stream dissolve in the subcutaneous layer of fat just beneath the skin), causing a yellowish appearance of the skin and the whites of the eyes. With the exception of physiologic jaundice in the newborn (normal newborn jaundice), all other jaundice indicates overload or damage to the liver, or inability to move bilirubin from the liver through the biliary tract to the gut.

2. Stomach Disease – Gastritis and ulcers (stomach and duodenal) are some of the stomach diseases associated with heavy alcohol consumption. Gastritis is an inflammation of the lining of the stomach. An ulcer is a crater-like lesion on the skin or mucous membrane caused by an inflammatory, infectious, or malignant condition. Duodenal

ulcers are an erosion in the lining of the duodenum (first part of the small intestine, connecting to the stomach).

3. Pancreatitis - an inflammation of the pancreas that can be cause by heavy drinking.

4. Memory Problems – do not count blackouts here, count any memory problems even when R was not drinking.

5. Any other physical health problems – Code any other health problems caused by alcohol here, such as cancer, hypertension (high blood pressure), cardiomyopathy, or any other physical health problems caused by drinking. Alcoholic cardiomyopathy is a disorder resulting from excessive alcohol ingestion where the heart muscle is weakened and cannot pump blood efficiently. Decreased heart function affects the lungs, liver, and other body systems.

D45/AL45

This question asks if R drank alcohol despite the fact that they had a serious physical illness or condition that could be made worse by drinking. Record illness or condition. Do not count any illnesses that were already coded in D44.

D46/AL46

This question asks about emotional problems that R may experience due to drinking, if the problems interfered with R’s functioning at work, school or home, and if R continued to drink knowing that the problems were due to drinking.

D47/AL47

This question asks if R has ever thought that s/he was an excessive drinker.

D48/AL48

This question asks if R has ever felt guilty about drinking.

D49/AL49

This question asks if R has felt s/he needed or was dependent on alcohol.

D50/AL50

This question asks if alcohol caused problems for R’s with family, friends, work, school, or other situations, and if they continued to drink after these problems occurred.

D51/AL51

This question asks if R neglected children or housework due to drinking.

D52/AL52

This question asks about job related problems from drinking alcohol.

D53/AL53

This question asks if R had any problems with school because alcohol.

D54/AL54

Review all of the experiences and problems that R endorsed for alcohol. Ask R when the first time and last time any of the experiences occurred.

D55/AL55

If more than 2 boxes are checked on the tally sheet, the interviewer must ask if the symptoms occurred in the same year or within 12 months of eachother. As with all clustering questions, the interviewer should circle the symptoms that cluster.

D56/AL56

This question asks if R has ever wanted to talk to someone about a problem with alcohol even if they have not. If R has spoken to a doctor or other health professional, read all the category choices, and ask for the onset and recency.

D57/AL57

This question asks if a doctor or other health professional has ever spoken to R about his/her drinking.

D58/AL58

This question asks if R was ever advised by a doctor to cut down or quit drinking.

D59/AL59

This question asks if R has received treatment for a problem with alcohol.

D60/AL60 This question asks about the type of treatment that R received.

E: COCAINE

The Cocaine section of the SSACD is fully diagnostic for DSM-IV criteria. Cocaine, a naturally occurring substance produced by the coca plant, is consumed in several preparations (e.g., coca leaves, coca paste, cocaine hydrochloride, and cocaine alkaloids such as freebase and crack) that differ in potency due to varying levels of purity and speed of onset. The hydrochloride powder is usually “snorted” through the nostrils or dissolved in water and injected intravenously. It is sometimes mixed with heroin, yielding a drug combination known as a “speedball”. A commonly used form of cocaine in the United States is “crack”, a cocaine alkaloid that is extracted from its powdered hydrochloride salt by mixing it with sodium bicarbonate and allowing it to dry into small “rocks”. Crack differs from other forms of cocaine primarily because it is easily vaporized and inhaled and thus its effects have an extremely rapid onset. Before the advent of crack, cocaine was separated from its hydrochloride base by heating it with ether, ammonia, or some other volatile solvent. The resulting “free base” cocaine was then smoked. Cocaine has extremely potent euphoric effects, and individuals exposed to it can develop Cocaine Dependence after using the drug for very short periods of time. Because of its short half-life of about 30-50 minutes, there is a need for frequent dosing to maintain a “high”. Persons with Cocaine Dependence can spend extremely large amounts of money on the drug within a very short period of time. As a result, the person using the substance may become involved in theft, prostitution, or drug dealing or may request salary advances to obtain funds to purchase the drug. Important responsibilities such as work or child-care may be grossly neglected to obtain or use cocaine. Regardless of the route of administration, tolerance occurs with repeated use. Withdrawal symptoms, particularly hypersomnia (sleeping too much), increased appetite, and dysphoric mood, can be seen and are likely to enhance craving and the likelihood of relapse. Cocaine Intoxication usually begins with a “high” feeling and includes one or more of the following: euphoria with enhanced vigor, gregariousness, hyperactivity, restlessness, hyper-vigilance, interpersonal sensitivity, talkativeness, anxiety, tension, alertness, grandiosity, stereotyped and repetitive behavior, anger, and impaired judgment, and in the case of chronic intoxication, affective blunting with fatigue or sadness and social withdrawal. These are accompanied by two or more of the following signs and symptoms: tachycardia (rapid heartbeat – over 90 beats per minute) or bradycardia (slowness of the heartbeat – under 50 beats per minute); pupillary dilation; elevated or lowered blood pressure; perspiration or chills; nausea or vomiting; evidence of weight loss; psychomotor agitation or retardation; muscular weakness, respiratory depression, chest pain or cardiac arrhythmias (irregular heartbeat); and confusion, seizures, dyskinesias (difficulty in performing voluntary movements), dystonias (abnormal tonacity in any of the tissues resulting in impairment of voluntary movement), or coma. Intoxication is often associated with impaired social or occupational functioning. The withdrawal syndrome is characterized by the development of dysphoric mood accompanied by two or more of the following physiological changes: fatigue, vivid and unpleasant dreams, insomnia or hypersomnia, increased appetite, and psychomotor retardation or agitation. Cocaine is a short-acting drug that produces rapid and powerful effects on the central

nervous system, especially when taken intravenously or smoked. When injected or smoked, cocaine typically produces an instant feeling of well-being, confidence, and euphoria. Dramatic behavioral changes can rapidly develop, especially in association with dependence. Individuals may engage in criminal activities to obtain money for cocaine. Erratic behavior, social isolation, and sexual dysfunction are often seen in the context of long-term Cocaine Dependence. Individuals with Cocaine Dependence often have temporary depressive symptoms that meet symptomatic and duration criteria for Major Depressive Disorder. Histories consistent with repeated Panic Attacks, social phobic-like behavior, and generalized anxiety-like syndromes are not uncommon. Cocaine Use Disorders are often associated with other Substance Dependence or Abuse, especially involving alcohol, marijuana, heroin (a speedball), and benzodiazpines, which are often taken to reduce the anxiety and other unpleasant stimulant side effects of cocaine. Cocaine Dependence may be associated with Posttraumatic Stress Disorder, Antisocial Personality Disorder, Attention-Deficit/Hyperactivity Disorder, and Pathological Gambling. Hepatitis, sexually transmitted diseases including HIV, and tuberculosis may be associated with cocaine use.

E1/CO1

Asks if R has ever used cocaine. If an individual denies ever having used cocaine, then s/he will immediately skip to the next section.

E1A/ CO1A

“Number of times” really means the number of different occasions. If R took cocaine ten times in one night, count as one time. If R took a small amount of cocaine on 10 different days, count as ten times.

E2/CO2

Asks for age of onset and recency of cocaine use.

E3/CO3

This question asks if R has ever injected cocaine, the frequency, and onset and recency.

E4/CO4

Count any needle sharing - even if R claims s/he used the needle first.

E5/CO5

This question asks for all the ways that R may have taken cocaine, besides injecting it. Circle all answers that apply.

Box E6

Determines who will continue through the rest of the cocaine section. Check E1A. If cocaine was used less than 11 times, then skip to the next section. Continue if R used cocaine more than 11 times.

E7/CO7

This question asks about daily or almost daily cocaine use. Note the longest period R used cocaine “almost every day”. The standard definition of “almost every day” is at least 4 days out of 7. Code in units that gives the most accuracy. For example, code 1 year and 2 months as 14 months, instead of rounding to 1 year.

E8-9/CO8-9

Emphasis should be placed on the time when R was “using cocaine the most”. These questions ask how many days per month R used and how long that period lasted.

E10-11/ CO10-11

Record how much cocaine R used on an average day, during R’s period of heaviest use. We want how much cocaine was used on average during this time period, not the most used in one day. This question is asking for quantity not money spent. We also ask how old R was when that period started.

E12/CO12

This question asks how long R has gone without using cocaine.

E13/CO13 This question asks if R has ever stayed high on cocaine for a whole day or more, if it happened 3 or more times, and the onset and recency.

E14/CO14

Record how much money R spent on cocaine during the period of heaviest use. Include a time period over which the money was spent (e.g., $500 spent over a week). If R never spent money on cocaine, record $0. In the computerized interview, the amount spent is entered into CO14_NUM and the time period is entered into CO14_TMFRM.

E15/CO15

This question asks how for the most amount of money spent on a cocaine “run” or binge.

E16/CO16

Record “Yes” if R has stolen things or money and in order to purchase cocaine.

E17/CO17

Record “Yes” if R has ever sold drugs in order to raise money to buy cocaine.

E18/CO18

This question asks if R has ever exchanged sex for cocaine.

E19/CO19

Record “Yes” if R has ever gotten a salary advance or payday loan in order to buy cocaine.

E20/CO20

This question asks R if when s/he first started using cocaine, if s/he got higher or stayed higher longer than other people who would use the same amount of cocaine.

E21-23/ CO21-23

These questions ask if R ever used cocaine in larger amounts than intended, for more hours or days than intended, and if R has ever stayed high on cocaine for 2 days or more.

E24/CO24

Record “Yes” if R has ever spent a great deal of time getting, using or getting over the effects of cocaine. “A great deal of time” is defined as whatever R feels is a great deal of time. The follow up question asks how long the period of time lasted, and the onset and recency.

E25-26/ CO25-26

These questions ask if R has ever become tolerant to cocaine: did R ever need more cocaine to get an effect, or did the same amount of cocaine have less effect than before. If R reports that more was needed because a difference is the quality of cocaine, then the answer should be no.

E27/CO27

This question asks if R’s cocaine use ever became so regular that s/he would not change when or how much s/he used.

E28/CO28

Record “Yes” if R has given up or reduce important activities because of cocaine use. In some cases, an individual may withdraw from family activities or hobbies in order to use the substance in private or to spend more time with substance using friends.

E29/CO29

Asks about arrests or trouble with the police because of cocaine.

E30/CO30

Asks if R got into any physical fights while using cocaine.

E31/CO31

Asks about situations in which using cocaine may be hazardous (e.g., when driving a car or boat). This is similar to a question in the alcohol section, except driving is included here, and is a separate question in the alcohol section.

E32/CO32

This question asks if R was ever injured while using cocaine.

E33-35/

These questions ask if R wanted to stop or cut down, tried to stop and whether or not they

CO33-35 were successful if they tried to stop or cut down. E36/CO36

This question asks about cravings for cocaine.

E37/CO37

Asks if R has ever had a withdrawal from cocaine when s/he stopped or cut down.

E38/CO38

This question asks about specific withdrawal symptoms. This question is asked regardless of the answer to E37. If R reports at least one withdrawal symptom, several follow up questions are asked.

E39/CO39

If R experienced any withdrawal symptoms, R is asked if s/he used alcohol or any other drug to keep from having any withdrawal problems, or to make R feel better when coming down from the effects of cocaine.

E40/CO40

This question asks R if s/he had any specific health problems associated with cocaine use. If Part F asks R if s/he had any other health problems not already mentioned in A-E. If any health problems occurred, ask R for the onset and recency, and if R continued to use cocaine knowing it caused health problems.

E41/CO41

Asks if R ever overdosed, if R got medical treatment for the overdose, if R overdosed three or more times, and the onset and recency.

E42/CO42

Asks about emotional problems that may have been caused by cocaine use, if those problems interfered with R’s functioning at work, school, or home, and did R continue to use cocaine knowing it caused problems.

E43/CO43

Asks R if s/he ever felt like s/he needed or were dependent on cocaine.

E44/CO44

Asks if cocaine ever caused R problems with family, friends, work, school or other situations, and if R continued to use knowing it caused problems.

E45-47 /CO45-47

These questions ask R if cocaine has ever kept R from taking care of household chores or children, problems at work, or problems at school.

E48/CO48

Review all of the experiences and problems that R endorsed for cocaine. Ask R when the first time and last time any of the experiences occurred. Make sure that the age ranges fit with the age ranges that R has given throughout the section.

E49/CO49

If more than 2 boxes are checked on the tally sheet, the interviewer must ask if the symptoms occurred in the same year. As with all clustering questions, the interviewer should circle the symptoms that cluster.

E50/CO50

This question asks if R has ever wanted to talk to someone about a problem with cocaine even if they have not. If R has spoken to a doctor or other health professional, read all the category choices, and ask for the onset and recency.

E51/CO51

This question asks if a doctor or other health professional has ever spoken to R about his/her cocaine use.

E52/CO52

This question asks if R was ever advised by a doctor to cut down or quit using cocaine.

E53/CO53

This question asks if R has received treatment for a problem with cocaine.

E54/CO54 This question asks about the type of treatment that R received.

F: MARIJUANA

The Marijuana section of the SSACD is fully diagnostic for the DSM-IV criteria system. Marijuana has been separated from the general Drug section because use of marijuana is relatively common (according to DSM-III-R Cannabis is the most widely used illicit psychoactive substance in the United States) and because there are thought to be fewer negative withdrawal, physical, and emotional effects from marijuana, when compared with other drugs such as cocaine, stimulants, and sedatives. Marijuana is usually smoked, but it can be ingested orally as well. It is often used in combination with other substances such as alcohol and cocaine. Symptoms associated with marijuana use include tachycardia, increased appetite, paranoid ideation, panic attack, listlessness and dysphoric effects following cessation of use. Maladaptive behavioral effects include impaired judgment and interference with social or occupational functioning. With cannabis abuse, use is episodic and the person exhibits symptoms of maladaptive behavior, such as driving while under its influence.

F1/MJ1

This section parallels in form and content the Alcohol, Cocaine and Drug sections since all come under the umbrella term of psychoactive substance use. The threshold for entry into this section, use of marijuana 21 times or more, differs from that of the “Drug” section. This threshold was selected because occasional recreation use is not uncommon in many sub-samples of the population. If an individual denies ever having used marijuana then s/he will immediately skip to the next section.

F2/MJ2

Everyone who has used marijuana will be asked for age of onset and recency. If R has used marijuana less than 21 times, skip to section G.

F3/MJ3

Asks if R ever used marijuana at least once a week for one month or more. Stress “a month or more”.

F4/MJ4

This question asks about daily or almost daily use of marijuana. Stress “longest” and “almost every day”.

F5-F8/ MJ5-8

These questions ask about R’s period of heaviest marijuana use. R is asked how many days out of the month did R use marijuana, how long the period lasted, the amount used on an average day and the age of onset. For the amount used, record this however R gives it to you (i.e., joints, ounces, etc…). Quantity used, not money spent, is a more appropriate answer.

F9/MJ9

Record the longest period that R has gone without using marijuana.

F10/MJ10 This question asks if R has ever stayed high on marijuana for a whole day or more. F11/MJ11

This question asks R if when s/he first started using marijuana, if s/he got higher or stayed higher longer than other people who would use the same amount of marijuana.

F12-F13/ MJ12-13

These questions ask if R ever used marijuana in larger amounts or over longer periods than intended.

F14/MJ14

R is asked if s/he ever spent a great deal of time using, getting, or getting over the effects of marijuana. If “Yes”, ask R how long the period lasted.

F15-F16/ MJ 15 16

These questions ask R if s/he has ever become tolerant to marijuana.

MJ 15-16

F17/MJ17

Asks if marijuana use ever became so regular that R would not change use not matter where they were or what they were doing.

F18/MJ18

Record “Yes” if R has given up or reduced important activities because of his/her marijuana use.

F19/MJ19

This question asks about legal trouble that resulted from marijuana use.

F20-F21/ MJ20-21

These questions ask if R ever put themselves in situations where they could have gotten hurt, or if they were ever injured when they were using marijuana.

F22-F24/ MJ22-24

These questions ask if R ever wanted to stop or cut down on marijuana, tried to stop and whether or not they were successful.

F25/MJ25

Asks about cravings for marijuana and if they used marijuana to satisfy cravings.

F26/MJ26

Asks if R thought they ever had withdrawal symptoms when they stopped or cut down on their marijuana use.

F27/MJ27

Lists withdrawal symptoms associated with marijuana.

F28/MJ28

If R had any withdrawal symptoms, ask if marijuana was ever used to keep from having these problems or to make them go away.

F29/MJ29

Asks if marijuana has ever caused any serious health problems such as a chronic cough.

F30/MJ30

Asks about emotional problems that may have been caused by marijuana use. These emotional problems are distinct from feelings of being ‘high’. So if R says they were paranoid or had trouble concentrating but only when high, then the answer is no.

F31/MJ31

Asks if R ever felt like they needed or were dependent on marijuana.

F32/MJ32

Asks if marijuana ever caused problems with family, friends, work, school or other situations.

F33-F35/ MJ33-35

These questions ask if marijuana has ever caused R problems with taking care of children or household chores, caused R to miss work, lose a raise or promotion or get fired, or cause R to miss school, do poorly on tests or homework or be suspended or expelled.

F36/MJ36

Review all of the experiences and problems that R endorsed for marijuana. Ask R when the first time and last time any of the experiences occurred. Make sure that the age ranges fit with the age ranges that R has given throughout the section.

F37/MJ37

If more than 2 boxes are checked on the tally sheet, the interviewer must ask if the symptoms occurred in the same year. As with all clustering questions, the interviewer should circle the symptoms that cluster.

F38/MJ38

This question asks if R has ever wanted to talk to someone about a problem with marijuana even if they have not. If R has spoken to a doctor or other health professional, read all the category choices, and ask for the onset and recency.

F39/MJ39

This question asks if a doctor or other health professional has ever spoken to R about hi /h ij

his/her marijuana use. F40/MJ40

This question asks if R was ever advised by a doctor to cut down or quit using marijuana.

F41/MJ41

This question asks if R has received treatment for a problem with marijuana.

F42/MJ42

This question asks about the type of treatment that R received.

G: DRUGS

This is a fully diagnostic section that assesses Drug Dependence, using the DSM-IV diagnostic systems. The Drug section is similar in form and content to the Tobacco, Alcohol, Cocaine, and Marijuana sections.

The section allows for coding a total of six classes of drugs: stimulants, sedatives, opiates, PCP, hallucinogens and the class of drugs used most from those remaining (i.e. solvents/inhalants, combination drugs, or drugs that don=t fit in any other category).

Sedatives

Sedatives have a significant level of physiological dependence, marked by both tolerance and withdrawal. Withdrawal syndromes differs depending on the specific substance. Symptoms associated with sedative use include: slurred speech, incoordination, unsteady gait, nystagmus, impairment in attention or memory, and stupor or coma. Maladaptive behavioral effects include inappropriate sexual or aggressive behavior, mood lability, impaired judgment, impaired social or occupational functioning which develops during, or shortly after, sedative, hypnotic, or anxiolytic use. Individuals may use intoxicating doses of sedatives or benzodiazepines to Acome down@ from cocaine or amphetamines or use high doses of benzodiazepines in combination with methadone to Aboost@ its effects. The individual may miss work or school or neglect home duties as a result of intoxication.

Opiates

The essential feature of Opioid Intoxication is the presence of clinically significant maladaptive behavioral or psychological changes that develop during, or shortly after, opioid use. Intoxication is accompanied by pupillary constriction and one or more of the following signs: drowsiness or even coma, slurred speech, and impairment in attention or memory. Maladaptive behavioral effects include initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, impaired judgement, or impaired social or occupational functioning. Withdrawal symptoms for opiates may include diarrhea, insomnia, nausea or vomiting.

Amphetamines

The patterns of use and course of Amphetamine Dependence are similar to Cocaine Dependence because both substances are potent central nervous system stimulants with similar psychoactive and sympathomimetic effects. Aggressive or violent behavior is associated with Amphetamine Dependence, especially when high doses are smoked, ingested, or administered intravenously. Symptoms associated with amphetamine use include tachycardia, pupillary dilation, elevated or lowered blood pressure, perspiration or chills, nausea or vomiting, evidence of weight loss, psychomotor agitation or retardation, muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias, and confusion, seizures, dyskinesias, dystonias, or coma. Amphetamine users may experience are fatigue, increased appetite, vivid, unpleasant dreams, insomnia or hypersomnia, and psychomotor retardation or agitation after cessation of use.

Hallucinogens

This group of substances include LSD, DMT, and psilocybin (mushrooms). Tolerance develops with repeated use, but a withdrawal has not yet been well documented. Signs

of use include pupillary dilation, sweating, tremors, and incoordination. Intoxication from the drug begins with stimulant effects as well as feelings of euphoria. Visual illusions or enhanced sensory experience may give way to hallucinations. Maladaptive behavioral or psychological changes such as marked anxiety or depression, ideas of reference, fear of losing one=s mind, paranoid ideation, impaired judgment, or impaired social or occupational functioning develop shortly after use.

Phencyclidine (PCP)

Phencyclidine Intoxication can be used intravenously, snorted, smoked or orally. Its essential feature is the presence of clinically significant maladaptive behavioral changes such as belligerence, assaultiveness, impulsiveness, unpredictability, psychomotor agitation, impaired judgment, or impaired social or occupational functioning. Signs of use include vertical or horizontal nystagmus, hypertension or tachycardia, numbness or diminished responsiveness to pain, ataxia, dysarthria, muscle rigidity, seizures or coma, hyperacusis. Peak effects occur about 2 hours after hours after oral doses. In milder intoxications, the effects resolve after 8-20 hours, whereas signs and symptoms of severe intoxications may persist for several days. Phencyclidine-Induced Psychotic Disorder may persist for weeks.

Solvents and Inhalants Inhalants are used by inhaling the aliphatic and aromatic hydrocarbons found in substances such as gasoline, glue and paint thinners. This may be done by applying the substance to a rag and breathing it through the mouth and nose huffing or placing the substance in a bag and breathing it in bagging. There are no unique criteria for Inhalant Dependence or Inhalant Abuse. Tolerance has been reported among individuals with heavy use. It has not been established that a clinically meaningful withdrawal syndrome occurs in humans. Inhalant intoxication is marked by a clinically significant maladaptive behavioral or psychological changes such as confusion, belligerence, assaultiveness, apathy, impaired judgment, impaired social or occupational functioning.

Other Drugs

Anabolic steroids sometimes produce an initial sense of enhanced well-being which is replaced after repeated use by lack of energy, irritability, and other forms of dysphoria. Ecstasy is a human-made drug that acts as both a stimulant and a hallucinogen. It is taken orally as a capsule or tablet. Short-term effects include feelings of mental stimulation, emotional warmth, enhanced sensory perception, and increased physical energy. Adverse health effects can include nausea, chills, sweating, teeth clenching, muscle cramping, and blurred vision. Nitrite Inhalants produce an intoxication that is characterized by a feeling of fullness in the head, mild euphoria, a change in perception of time, relaxation of smooth muscles, and a possible increase in sexual feelings. These substances carry dangers of potential impairment of immune functioning, irritation of the respiratory system, a decrease in the oxygen-carrying capacity of the blood. Nitrous Oxide causes rapid onset of an intoxication that is characterized by light-headedness and a floating sensation that clears in a matter of minutes after administration is stopped.

Betel Nut is chewed in many cultures to produce a mild euphoria and floating sensation. Kava is derived from the South Pacific pepper plant, produces sedation, in coordination,

eight loss, mild forms of hepatitis, and lung abnormalities. w

IVR: Was there ever a period of a month or more when a great deal of your time was spent using stimulants, getting stimulants, or getting over its effects?

R: Yes.

IVR: Did this happen with sedatives?

R: No.

IVR: Did this happen with opiates?

R: Yes.

(Some respondents may need the stem question repeated more often.)

“Exceptions to this general pattern include questions (list questions), and questions that have follow-up “IF YES, ASK:” subquestions. These exceptions should be coded by column, i.e. the questions and subquestions are completed for one drug class before continuing on to the next column.

Generally, questions in the Drug section are asked in rows B meaning that if more than one drug class is being coded, the interviewer asks the question for each coded drug class before moving on to the next question. So, for example:

G1/DR1

Start by handing R the Drug Card. Ask R if they have used any drugs listed in the card, besides marijuana and cocaine, or if they ever used any prescription medication that was not prescribed or more than prescribed. Also, ask R if there are any other drugs not on the list that they have used. A drug called “water” or “wet” is not on the list, but should be included under PCP. You should already have an idea of which drugs R has used based on R’s answers in B15. You must ask about each category of drugs individually. “Have you ever used any stimulants, like amphetamines – black beauties, or hearts, or methamphetamines – like crank, ice or speed?” or “Have you ever used any sedatives, like barbiturates, benzodiazopines – roofies, valium or zanax, or methaqualones?” “Or have you tried anything else that was not on this card?”

If R has used any drug (other than as prescribed), the interviewer proceeds to G1 and asks for the number of times R used drugs within each drug class. The questions hroughout the section are also asked about each classt of drug, not each specific drug.

G1/DR1

Do not count any over the counter (OTC) medications. Also, prescribed refers to

medications prescribed for R. If R took someone else=s prescription when it was not prescribed for R, it counts here. However, do not count: (1) using a prescription drug as needed after the period for which it was prescribed, or (2) taking someone else=s prescription meds if R has the identical prescription and R is taking the medication as prescribed.

G1A/DR1A

Number of times really means the number of different occasions. If R took ten pills in one night, count as one time. If R took one pill on 10 different days, count as ten times. Record the total number of times R used drugs in a particular class. For example, if R used Valium ten time and Librium ten times, then s/he has used sedatives twenty times. Code T=s and Blues as Opiates. Code Ecstasy as Other. Code Crank as stimulants (amphetamines). For prescription drugs, count the number of times they were used when they were not prescribed or when used more than prescribed. Even though there is only a single line to record the number of times, interviewers can code numbers containing up to 4 digits, or, in other words, a maximum of 9999 times.

G2/DR2

If the drug was used at least once, then the age of first use and last use will be asked. If the drug was only used one time then the age should be the same for onset and recency.

G3/DR3

This question asks if R has ever injected drugs, the frequency, and onset and recency.

G4/DR4

Count any needle sharing B even if R claims s/he used the needle first.

G5/DR5

This questions refers to all the ways a drug was taken. Pills or eaten would be considered oral while in the eye or suppository are coded as other. More then one route of adminstration can be circled.

G6/DR6

“Favorite” is left up to R to decide. It is not necessarily the drug used the most, but the one R enjoyed the most. Marijuana can be included here, but not alcohol. If R claims to have no favorite drug, record “NONE” and the editor will code 000.

G7/DR7

If R states s/he has used two or more drugs together, then record in the margin all the drugs used at the same time. The editor can only code three drugs per occasion (1a, 1b, and 1c used together; and then if only two together 2a and 2b together). “Together” is generally defined as using at the same time or within two hours of each other. This may include prescription drugs and illicit drugs, but alcohol and marijuana do not count.

BOX G8

This box directs the interviewer to continue asking about the class of drugs used 11 or more times, and also to choose which class (if any) of the remaining substances will be coded in Column “OTH”. If any COMB or OTHER drug used 11 or more times, interviewer should choose the one used the most and code in Col. “OTH”.

The specific name or type of drug that will be coded in this sixth column should be recorded in Box G7. If R reports using equal amounts of drugs in more than one of these Aother@ classes, the interviewer should ask about the class of drugs that caused the most problems.

G8/DR8

Asks if R ever used the drug at least once a week for one month or more. Stress “a month or more”.

G9A/DR9A

Note the longest period R used (DRUG) “almost every day”. The standard definition of “almost every day” is at least 4 days out of 7. Code in units that gives the most accuracy,

for example, 1 year 2 months = 14 months. G10/DR10

This question asks how many days per month did they use the particular drug. If they only used the drug once then the answer should be 1, if they used 5 times but in 2 days, then the answer should be 2.

G11/DR11

This question is linked to the previous (DR10), and refers to how long they used at the rate from the above question.

G12/DR12

This question refers to the heaviest period of use, how much was used on an average day. Note this is not the largest amount used in a day but rather an average amount. In the computerized interview, number goes into the first field, followed by the unit in the second field, and the code is entered in the third field. So if participant used 2 pills, 2 would be entered in the first field, followed by pills is the second field and last the code.

G13/DR13

This questions refers to the age at which the heaviest time period began, same time period as elicited in DR 10 and 11. In the computerized interview, this question is asked before DR12.

G14/DR14

Record the longest period that R has gone without using (DRUG).

G15/DR15

“A whole day” is defined as most waking hours in a twenty-four hour period.

G16/DR16

This question asks R if when s/he first started using (DRUG), if s/he got higher or stayed higher longer than other people who would use the same amount of (DRUG).

G17-G18/ DR17-DR18

These questions ask if R ever used (DRUG) in larger amounts or over longer periods than intended.

G19/DR19

R is asked if s/he ever spent a great deal of time using, getting, or getting over the effects of (DRUG). If “Yes”, ask R how long the period lasted.

G20-21/ DR20-21

Asks if R ever built a tolerance to (DRUG).

G22/DR22

Asks if (DRUG) use ever became so regular that R would not change use not matter where they were or what they were doing.

G23/DR23

Record “Yes” if R has given up or reduced important activities because of his/her (DRUG) use.

G24/DR24

This question asks about legal trouble that resulted from (DRUG) use.

G25/DR25

This question pertains to physical fights while using (DRUG).

G26-27/ DR26-27

These questions ask if R ever put themselves in situations where they could have gotten hurt, or if they were ever injured when they were using marijuana.

G28-G30/ DR28-DR30

These questions ask if R ever wanted to stop or cut down on (DRUG), tried to stop and whether or not they were successful. Count persistent or unsuccessful efforts to stop or cut down during pregnancy.

G31/DR31

Asks about cravings for (DRUG) and if they used the (DRUG) to satisfy cravings.

G32/DR32

Asks if R thought they ever had withdrawal symptoms when they stopped or cut down

h i ( G)

on their (DRUG) use. G33/DR33

Asks the particular symptoms from not using a particular (DRUG). Only the symptoms that pertain to the particular drug are elicited. There are no known withdrawal symptoms for PCP and hallucinogens, thus not asked. For the other category, because the drug could be a number of different drugs, all symptoms are asked. For symptoms experienced, the age of onset and recency and the extent to which these affected daily lives is asked.

G34/DR34

If withdrawal symptoms are experienced, then this question asks if they used the (DRUG) to relieve those symptoms.

G35/DR35

Asks if R every used alcohol or any other drug to feel better after coming down from the (DRUG).

G36-G39/ DR36-39

These question refer to nay health problems such as overdose, infection from the (DRUG). If in question DR36, R reports an infection or hepatitis, then the answer should be no for DR 36 and coded yes in that particular question.

G40/DR40

Asks about emotional problems that may have been caused by (DRUG) use. These emotional problems are distinct from feelings of being ‘high’. So if R says they were paranoid or had trouble concentrating but only when high, then the answer is no.

G41/DR41

Asks if R ever felt they needed or were dependent on (DRUG).

G42/DR42

Asks if (DRUG) ever caused problems with family, friends, work, school or other situations.

G43-45/ DR43-DR45

These questions ask if (DRUG) has ever caused R problems with taking care of children or household chores, caused R to miss work, lose a raise or promotion or get fired, or cause R to miss school, do poorly on tests or homework or be suspended or expelled.

G46/DR46

Review all of the experiences and problems that R endorsed for (DRUG). Ask R when the first time and last time any of the experiences occurred. Make sure that the age ranges fit with the age ranges that R has given throughout the section.

G47/DR47

If more than 2 boxes are checked on the tally sheet, the interviewer must ask if the symptoms occurred in the same year. As with all clustering questions, the interviewer should circle the symptoms that cluster.

G48/DR48

This question asks if R has ever wanted to talk to someone about a problem with drugs even if they have not. If R has spoken to a doctor or other health professional, read all the category choices, and ask for the onset and recency. This is only drugs covered in the drug section, does not include cocaine or marijuana.

G49-50/ DR49-50

This question asks if a doctor or other health professional has ever spoken to R about his/her drug use or if R was ever advised by a doctor to cut down or quit using drugs. Again, do not include cocaine or marijuana

G51-52/ DR51-52

Asks if R has ever been treated for their use of drugs, such as AA meetings or treatment programs.

H: DEPRESSION

The essential feature of a Major Depressive Episode is a period of at least 2 weeks during which there is either depressed mood or the loss of interest or pleasure of nearly all activities. The individual must also experience at least four additional symptoms drawn from a list that includes changes in appetite or weight, sleep, and psychomotor activity; decreased energy; feelings of worthlessness or guilt; difficulty thinking, concentrating, or making decisions; or recurrent thoughts of death or suicidal ideation, plans, or attempts. The episode must be accompanied by clinically significant distress or impairment in social, occupational, or other important areas of functioning. The episode must also be distinguished from a Mood Disorder Due to a General Medical Condition, the symptoms are not due to the direct physiological effects of a substance, and are not better accounted for by bereavement.

H1/DP1

This question asks about depressed mood. This is one of the major features of a major depressive episode. In children and adolescents the mood may be irritable rather than sad. Stress “two weeks or more”.

H2/DP2

This question asks about loss of interest or pleasure in activities. Stress “two weeks or more”.

H3-H26/ DP3-26

For questions H3-H26 we are interested in R’s most severe episode of depression.

H3/DP3

This question asks R to think about the most severe period of feeling depressed. Record when the episode started, how old R was, and the duration of the episode. The duration should be at least 2 weeks.

H4/DP4

These questions ask whether R had a depressed or irritable mood, or a loss of interest in activities during the most severe episode.

H5/DP5

Loss of interest or pleasure is nearly always present to some degree. A person may become less interested in hobbies, or not feel enjoyment in activities that were once pleasurable. Some individuals experience a significant reduction from previous levels of sexual interest or desire.

H6/DP6

During an episode of depression many people experience a change in appetite. Record whether it is an increase or decrease and specific weights. If R gained and lost weight during this episode, record the more significant change. If R was pregnant during this episode, record only the amount of weight that was gained that was above what is expected for a pregnancy.

H7/DP7

Many people experience a sleep disturbance during an episode of depression. The most common sleep disturbance is insomnia. Individuals typically have middle insomnia where they wake up in the middle of the night and have trouble going back to sleep. Terminal insomnia is where people wake up too early and cannot fall back asleep. Difficulty falling asleep, initial insomnia, can also occur. A less common type of sleep disturbance is hypersomnia, or sleeping too much. In hypersomnia, a person can sleep for prolonged periods at night or during the day.

H8/DP8

Psychomotor change includes agitations such as inability to sit still, pacing and hand wringing. The agitations must be severe enough to be noticed by other people.

H9/DP9

Psychomotor retardation includes slowed speech, thinking and body movements. These symptoms must be observable by others.

H10/DP10

Decreased energy tiredness, and fatigue is common. Individuals may report that even small tasks require substantial effort.

H11/DP11

These feelings may include guilty preoccupations or ruminations over minor past failings.

H12/DP12

These feelings may include unrealistic evaluations of one’s worth.

H13/DP13

Often, an individuals ability to think or concentrate is impaired. They may appear easily distracted or complain of memory difficulties.

H14/DP14

Decision making can also become impaired during an episode of depression.

H15/DP15

These thoughts range from a belief that others would be better off if R were dead, to transient but recurrent thoughts of committing suicide, to actual specific plans of how to commit suicide.

H16/DP16

This question verifies that R felt depressed (or word of their choice) and had some of these other problems for at least 2 weeks.

H17/DP17

Oftentimes an episode of depression requires treatment by a professional. This question asks if R received such treatment.

H18/DP18

Record medicines R took for depression or ones they were already taking. If they took these medicines for two weeks or longer, then the drug should be listed in B12/MH12.

H19/DP19

This question assesses problems R may have had with friends, family, work, school, or other situations due to this episode of depression.

H20-H26/ DP20-26

These questions assess whether the episode of depression being discussed was “clean” that is, it was not influenced by changes in medications, alcohol or drug use, or the death of a loved one (among several other precipitating factors).

H21/DP21

This question asks in the 6 weeks before the episode began (the episode noted in H3/DP3) and if so how much alcohol did R use.

H22/DP22

This question asks if R used drugs in the 6 weeks before the episode of depression began. For each drug noted, ask how many times they used Drug listed should also match B15/MH15 and those noted in previous drug sections.

H23/DP23

This question asks if the episode occurred around the time of a change in prescription medicine.

H24/DP24

This question asks if the episode occurred around the time of a death of a close friend or relative. Confirm that the date given is within 6 months of time given in DP3.

H25/DP25

This question refers to serious physical illness that occurred around the time of the episode.

H26/DP26

If R is female, ask if the episode occurred around the time of childbirth, miscarriage, or abortion.

H27/DP27 This question probes R to find out if s/he ever had an episode that “came out of the blue” as well as asking questions about the particular episode like the ones asked before about the most severe episode, only in an abbreviated manner.

H28/DP28

This question asks for the longest episode of depression that R has had, not necessarily the most severe.

H29/DP29

This question asks R to estimate the number of depressive episodes s/he has had. Stress that this is including the ones already discussed in the interview.

H30/DP30

This question asks if depression in general has caused problems with family, friends, work, school, or other situations.

H31/DP31

This question asks if R had wanted to speak to a professional about their depressive symptoms whether or not they actually did so.

H32/DP32

This item finds if R actually received treatment for the depression.

H33/DP33

This question asks about any type of medications R may have been prescribed for depression. This was previously asked for the most severe episode R experienced. Examples of such are Celexa, Prozac, Zoloft, and Effexor.

H34/DP34

This question asks specifically if R had experienced such severe depression that they had to be hospitalized. This counts for dual diagnosis and involuntary hospitalizations.

I: MANIA

A manic episode is defined by a distinct period during which there is an abnormally and persistently elevated, expansive, or irritable mood. This period of abnormal mood must last at least 1 week. The mood disturbance must be accompanied by at least three additional symptoms from a list that includes inflated self-esteem or grandiosity, decreased need for sleep, pressure of speech, flight of ideas, distractibility, increased involvement in goal-directed activities or psychomotor agitation, and excessive involvement in pleasurable activities with high potential for painful consequences. The disturbance must be sufficiently severe to cause marked impairment in social or occupational functioning or to require hospitalization, or it is characterized by the presence of psychotic features. The episode should not meet criteria for a Mixed Episode nor should they be due to the direct physiological effects of a substance or a general

edical condition. m

I1A/ MN1A

Emphasize that this feeling (hyper, elated, euphoric) is clearly different from R’s normal self. Also emphasize that it lasted for 4 days or longer. Do not count recovery to normal mood from depression. If R is unsure IVR might ask if circumstances led up to this feeling such as getting a great new job. This would not count as “Yes”.

I1B/MN1B

This captures if R has experienced an unusually irritable mood. Again, emphasize that this is clearly different from R’s normal self and that it must have lasted for 4 days or longer. If R says “Yes” make sure that s/he shouted at people or started fights or arguments. A common response is when women are hormonal (menstrual cycle or menopause) which would count because it is not different from their ‘normal self’.

I2/MN2

This question asks for more information about the most severe manic episode R has experienced.

I3-I10/ MN3-10

These questions ask if R experienced other problems including elevated mood and irritability for the time specified in I2.

I4/MN4

This question refers to being fidgety or active.

I5/MN5

This question refers to being more talkative or pressure to keep talking.

I6/MN6

This question asks whether R’s thoughts raced, or it was difficult for people to understand what they were saying.

I7/MN7

This question refers to an exagerated feeling of special powers, plans, talents or abilities such as supernatural powers. If R expresses talents or abilities that are realistic or rational, then should not count.

I8/MN8

This question refers to needing less sleep during a manic episode. If R says yes and then A and B match, then the answer should be no.

I9/MN9

This question asks if R’s attention jumped from one thing to another. Stress ‘much more then usual’.

I10/MN10 BOX I10

This questions asks if they ever did anything that could of gotten them in trouble. If they say yes, ask specifically what they did. In the paper based interview: If R has 0-2 of these problems the rest of the mania section is bypassed. The interviewer should resume at the psychosis section (J).

I11/MN11 Stress that at least three of these problems occurred nearly every day (including feeling elated or irritable).

I12/MN12

This question asks for the duration of these feelings and problems associated with mania.

I13/MN13

Stress that the number of episodes includes the ones already discussed.

I14/MN14

This question asks if R’s manic behavior caused problems for him/her with family, friends, work, school, or any other situations.

I15/MN15

This question asks if R ever wanted to speak to a professional about these feelings or behaviors and if they did it.

I16/MN16

This question asks if R was treated for any of these episodes.

I17/MN17

If R was prescribed medications, list the types. Examples of such are Depakote and Lithium.

I18/MN18

This question asks if R was hospitalized for his/her experiences during a manic episode.

J: Psychosis

This section is a non-diagnostic survey of the subject’s experiences of delusions and hallucinations. Delusions are fixed false beliefs, such as the idea that one=s personal thoughts are being broadcast by a national television. Delusions are based on incorrect inference about external reality and are firmly sustained in spite of what almost everyone else believes and in spite of what constitutes incontrovertible and obvious proof to the contrary. Hallucinations are false sensory experiences: seeing, hearing, smelling, tasting or feeling something that is not present. Hallucinations are sensory perceptions without the external stimulation of the relevant sensory organ. Examples are: feeling bugs crawling all over one=s skin when they are not; seeing Martians and vampires seated at a dining table; hearing voices when no one else is in the area. The hallucinations and delusion covered in the Psychosis Section could result from a high fever, drug or alcohol use or depression. Further, some religious or culturally supported beliefs may be hard to distinguish from non-bizarre delusions (for instance, the conviction of some highly religious people that they talk with, and receive instructions from God). For this reason, interviewers are asked to record multiple detailed examples of every psychotic symptom.

J1/PS1

Check for auditory hallucinations. These hallucinations must occur when the respondent is fully awake, and can be heard either inside or outside his/her head. Stress “completely awake.” Code what was heard. Follow-up question stresses only while using substances.

J2/PS2

Checks for visual hallucinations experienced by the respondent while completely wake. The interviewer should be certain to distinguish hallucinations from illusions, which are misperceptions of real external stimuli. Illusions should not be coded. Follow-up question stresses only while using substances.

J3/PS3

This item assesses persecutory delusions, i.e., that the individual (or his/her group) is being attacked, harassed, cheated, persecuted or conspired against. These beliefs are paranoid in nature, and R must feel that people want to hurt, persecute, or plot against him/her for no apparent or sensible reason. Code what R thought. Follow-up question stresses only while using substances.

BOX J3

Only in paper-based interview: The interviewer should check if J1-J3 are answered “No”. If they are the interviewer bypasses the rest of the psychosis section and moves on to the suicide section (K).

J4/PS4

This question asks when any of the experiences in J1-J3 occurred. Assesses whether delusions (non-bizarre or bizarre) or hallucinations ever lasted for 6 months or longer. (If delusions were present “on and off for 6 months or more” use the “more times than not” rule and check with a clinician).

J5/PS5

This question asks if these psychotic experiences caused problems for R with family, friends, work, school, or other situations.

J6/PS6

This question asks if R wanted at any time to talk to a professional about the experiences in J1-J3.

J7/PS7

This question asks if R was ever treated for psychosis.

J8/PS8

This question asks if R was ever prescribed medicines for these experiences. Examples of

h d i d l

such are Zyprexa and Risperdal. K: SUICIDE This section asks questions about thoughts of killing oneself and if those thoughts were

ever acted upon. In addition to suicide, self-mutilation is also addressed. K1/SU1 This question asks if R has ever had thoughts about killing him/her self, and if so how

long did those thoughts last and did they ever have a specific plan as to how to kill him/her self. This question should match DP15A.

K2/SU2 This question asks if R ever tried to kill him/her self. If R said yes to trying to kill him/her self in DP15B, then this answer must be yes.

K3/SU3 If R did try to kill him/her self then this question should be asked, pertaining to how they tried. If R says overdose, ask whether the pills were prescription or over the counter.

K4/SU4 This question asks if they received medical attention afterwards. K5/SU5 This question asks if they were admitted to the hospital afterwards. K6/SU6 This question asks if they tried to kill him/her self while experiencing any of the

following problems, depressed, using substances or hallucinating. K7/SU7 This question asks about self-mutilation, if R ever tried to hurt themselves on purpose by

cutting or burning.

L: ATTENTION DEFICIT DISORDER

ADHD is a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and more severe than is typically observed in individuals at a comparable level of development. Some hyperactive-impulsive or inattentive symptoms that cause impairment must have been present before age 7 years. Some impairment from the symptoms must be present in at least two settings (e.g., at home and at school or work). Some symptoms associated with inattention are: forgetfulness in daily activities, failure to give close attention to details or makes careless mistakes in school work , work, or other activities. Some symptoms associated with hyperactivity are: fidgeting, talking excessively, and often running about or climbing excessively in situations where it is inappropriate. Impulsivity includes: blurting out answers before questions have been completed and difficulty waiting for his/her turn.

L1

Stress that these attention difficulties must have occurred for at least 6 months to be answered “Yes”.

L2

This question asks for onset and recency of these problems with attention. Even though the question is asking about the age range of 6-10 R can report that the problems lasted longer or that s/he is currently experiencing them.

L3

This question asks if these difficulties were extreme enough to get R into trouble with family, friend, school, or other situations.

L4

This question asks if R or his/her parents spoke to a doctor about R=s inattention.

L5

This question asks for the names of medications R took for these difficulties (if any). Examples of such are Dexadrine, Cylert, and Ritalin.

L6

Stress that these hyperactive symptoms must have been present for at least 6 months to be answered “Yes”.

L7

This question asks for onset and recency of these problems with hyperactivity. Even though the question is asking about the age range of 6-10 R can report that the problems lasted longer or that s/he is currently experiencing them.

L8

This question asks if these difficulties were extreme enough to get R into trouble with family, friend, school, or other situations.

L9

This question asks if R or his/her parents spoke to a doctor about R=s hyperactivity.

L10

This question asks for the names of medications R took for these difficulties (if any). Examples of such are Dexadrine, Cylert, and Ritalin.

M: ANTISOC AL PERSONALITY I

The Antisocial Personality section of the SSACD is fully diagnostic for XXXX. Antisocial Personality Disorder is characterized by a long-lasting pattern of impulsive and irresponsible behavior, a craving for excitement and new experiences, and a consistent disregard for the rights of other people. Subjects with Antisocial Personality Disorder engage in a variety of destructive behaviors including lying, “conning” or manipulation others, and threatening others or abusing them verbally or physically. Other pathological behaviors include flagrant promiscuity or marital infidelity, irresponsible financial decisions or default of responsibilities, unstable work habits (quitting without notice, frequent absenteeism, etc.). People with ASP may appear either charming, and persuasive, or violent and threatening to others B whatever they have found works to get them what they want. Persons with Antisocial Personality Disorder often use illegal substances and alcohol, in part due to their cravings for new experiences. There is a tendency towards poly-substance use. It is the experimentation and novelty that appeals to a person with this disorder, not necessarily the Ahigh@ that is achieved. ASP frequently coexists with substance use disorders, and the typical person with ASP is often a regular substance user/abuser. Not only is substance abuse/dependence a very common Acomplication@ of ASP, substance abuse by itself may also result in irresponsible or violent acts. Since Substance Use Disorders and Antisocial Personality Disorder frequently coexist, it may be difficult to determine the cause(s) of a given behavior. To further distinguish Antisocial Personality symptoms from symptoms that are directly related to substance use, the interviewer must first determine whether a specific symptom occurred only while under the influence of drugs and/or alcohol, or at other times as well. The interviewer must ask R specifically if the behavior occurred only while under the influence to a particular substance, not just in relation to drug use or to efforts to obtain the drug. The age of onset of behaviors which occurred while R was under the influence of drugs/alcohol (labeled ONS A/D) and at other times as well (labeled AGE ONS) is coded if the behavior occurred at time when R was under the influence of drugs/alcohol and at times when R was not under the influence of drugs/alcohol. If the behavior never occurred while R was under the influence of drugs/alcohol, the ONS A/D would be left blank.

M1-M28 Stress that these questions are asking about behavior before R=s 15th birthday. M1-M8

These questions fall under the serious violations of rules criteria for conduct disorder.

M1,M6, M7

Only mark the tally sheet for these questions if the age of onset is before 13.

M9-M12

These questions fall under the aggression to people and animals criteria for Conduct Disorder.

M13-M20

These questions fall under the deceitfulness or theft criteria for Conduct Disorder.

M21-M22

These questions fall under the destruction of property criteria for Conduct Disorder.

M23

This question fall under the aggression to people and animals criteria for Conduct Disorder.

M24-M25 These questions ask if R had any trouble with the law before age 15. Again, stress that this is before the age of 15.

M26

These disturbances in behavior should cause clinically significant impairment in social, academic, or occupational functioning if conduct disorder is present. The onset of Conduct Disorder may occur as early as preschool years, but the first significant symptoms usually emerge during the period from middle childhood through middle adolescence.

M27

If R answers “Yes” circle the symptoms on tally sheet (Part A) for this section.

M28

Age of onset and recency should be before 15 years of age the age of recency may be later.

M29- M84

Emphasize that these questions are pertaining to behavior since R=s 15th birthday.

M29-M34

These questions go into more detail about R=s irritable or aggressive behavior.

M35-M41

These find if R has been consistently irresponsible and/or his/her impulsivity or failure to plan ahead.

M42-M44

These questions assess R deceitfulness.

M45-M53

These questions ask about R’s failure to conform to social norms with respect to lawful behaviors.

M54-M59

These questions ask about R’s ability to sustain consistent work behavior.

M60-M65

These questions address if R exhibits reckless disregard for the safety of others and how these behaviors may have endangered R=s children (if any).

M66-M70

These questions ask about R’s impulsivity with regard to relationships.

M71-M75

These questions ask about R’s reckless disregard for self or others with regard to different kinds of behaviors.

M76

M77

M78

M79

The age of onset should be after R=s 15th birthday.

M80

These questions asks about asterisked items (ones in which others were harmed) on Part B of the tally sheet for section M.

M81

Ask R for one example of something that s/he regrets doing and why (record what R says verbatim) from the items without asterisks (no one was harmed directly). Code why R regrets behavior. If unsure, ask R to clarify.

M82-M83

These questions assess if R=s antisocial behavior was related to alcohol or drug use.

M84

This question asks if R has sought professional help for his/her antisocial behaviors.

K: SUICIDAL BEHAVIOR

Suicidal behavior is a non-diagnostic section that assesses suicidal ideation and attempts. Only if R stated explicitly in the Depression section that s/he attempted suicide should the interviewer include the word “further” when reading the introductory sentence. There may be some respondents who think about, seriously consider, or attempt suicide but do not go through the Depression section (X) because they do not meet duration criteria. Still, others may ponder or attempt suicide when not depressed. Thus, NI, N2, and N12 (check these????) are asked of all respondents. Although the total number of suicide attempts is obtained, the interviewer is instructed to ask questions N3-N9 for the most serious attempt only. R must determine for him/herself which attempt was the most serious.

K1A-C

Check for onset, persistence, and severity of suicidal thoughts.

K2

Include situations where R had a specific plan and actually took some action, even is s/he did not follow through (i.e., putting a gun to their head, but not pulling the trigger or driving to a bridge and standing as if ready to jump, but not jumping). Count as “Yes” if R said at the time s/he did want to die, but looking back on it after some therapy, thinks it may have been a cry for help.

K3

If multiple suicide attempts were made, record the method of the most serious attempt, determine by asking R which attempt, s/he considers to be the most serious. This could be the attempt that R was certain would be lethal, or it could be the attempt that caused the most serious medical consequences.

K4

Medical treatment does not include psychiatric care in this question.

K5

Hospital admission after the attempt must be for treatment of physical trauma caused by a suicide attempt. Admission to a “close watch” unit to prevent R from doing harm to him/herself does not count.

K6

This question asks about what R was feeling or using as far as substances when s/he tried to kill his/herself.

K7

Do not include suicide attempts here B only attempts to hurt oneself.

N: Pathological Gambling Pathological Gamblers exhibit a persistent and maladaptive gambling behavior that

disrupts personal, family, or vocational pursuits. The individual may be preoccupied with gambling among other tendencies such as seeking action, needing increased amounts of money to achieve desired excitement, and lying to family members to conceal the extent of their involvement with gambling. Distortions in thinking may be present in individuals with Pathological Gambling. These individuals are often highly competitive, energetic, restless, and easily bored. Increased rates of mental disorders and substance abuse problems have been reported in individuals with Pathological Gambling.

N1

This question assess if R should be asked the follow up questions for pathological gambling.

N2

N3

N4

N5

N6

N7

N8

N9

N10

N11

N12

N13

BOX N13

This box asks for the number of previous questions R has answered “Yes”. Question N1 may count for 2.

N14

This question asks if gambling has caused problems in several areas of R’s life.

N15

This question asks for the onset and recency of these problems.

N16

This question asks if R wanted to talk to a doctor or health professional about their gambling, and if so, whom did they speak with.

N17

This asks if R has ever attended Gambler’s Anonymous.

O: SOCIAL PHOBIA The Social Phobia section is fully diagnostic for DSM-IV criteria. Social Phobia is a

persistent fear of one or more situations in which the subject must interact with others socially (e.g., a party) or perform (e.g., a concert). The subject fears that in these situations s/he will act in a way that is embarrassing and will consequently be judged as anxious, weak, crazy, or stupid. The person with social phobia typically will avoid the feared situation or, less commonly, force himself or herself to endure the situation with intense anxiety. During some phases of the disturbance, exposure to the specific phobic stimulus (or stimuli) almost invariably provokes an immediate anxiety response (e.g., palpitations, trembling, blushing, shaking, or difficulty breathing, etc.). Many people feel uncomfortable in some social situations, especially (for example), public speaking. Adults (not necessarily children) with social phobia recognize that their fear goes beyond this and is excessive or unreasonable. The avoidant behavior either a) interferes with such domains as normal routine, occupational functioning, and relationships with others; or b) is accompanied by marked distress about having the fear. Social phobias involving fear of public speaking are the most common. Phobias about speaking to strangers or meeting new people are less prevalent, while those related to writing, eating in public, and using public lavatories are the least frequent.

O1

Stress that these fears are “strong” and that they are “stronger than the fears most people have.”

O1A

Record an example for each fear that R reports having.

O2

Stress “right away”. If R answers “No” to this question bypass the rest of section O and go to P1.

O3

This is what R thinks, not what others have told him or her.

O4

This question asks what areas of R’s life were affected by these fears.

O5

This question asks for the duration that these fears interfered with R=s functioning.

O6

These ages should match the time reported in O5.

O7

Emphasize the word “very”.

O8

Code the duration of 7.

O9

O10

Record the names of medications. One common social phobia medication is Paxil.

O11

This R self-medicated these problems.

P: AGORAPHOBIA

Agoraphobia is a fully diagnostic section incorporating DSM-IV and DSM-III-R criteria. Agoraphobia is defined in DSM-IV as A...anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having a panic attack... or panic-like symptoms. Typical situations are clustered and include being outside the house alone; being in a crowd or standing in a line; being on a bridge; and traveling in a bus, train or automobile. The initial phase of agoraphobia often consists of recurrent panic attacks, and the anticipatory fear of having another attack often causes incapacitation in at least one of the following ways: a) the agoraphobic refuses to enter situations in which such attacks were previously experienced (e.g., travel is restricted); b) the situations are endured with considerable distress/fear of another panic attack; or c) the agoraphobic will only enter these situations when accompanied by a companion. The agoraphobic may stay in the house and avoid open spaces and public places. Staying in familiar surroundings provides a sense of security in case an attack occurs. Although the severity of the disturbance waxes and wanes, the avoidance of a wide range of frequently encountered situations may grossly interfere with social functioning and job related activities. Agoraphobics, dominated by their fears and avoidance behaviors, increasingly restrict their range of activities. The agoraphobic person may become housebound or may refuse to leave his/her home if unaccompanied.

P1

If R has never had an experience like this go to question Q1.

P2

Record exactly what R says. If more than one situation record all.

P3, P4

These situations may be endured with marked distress.

P5

This question checks for physical symptoms of agoraphobia.

P6

Some people are able to endure these situations if someone accompanies him/her.

P7

This question asks for the onset and recency of these feelings.

P8

Stress the word “very”.

P9

These fears can limit and individual=s functioning in several of these areas.

P10

Record these medications if any have been taken.

P11

This question asks if R has self-medicated because of these fears.

Q: PANIC

The essential features of panic disorder are recurrent and unpredictable panic (anxiety) attacks, followed by at least one month of a) concern about having another attack; b) worry about the implications or consequences of the attack (e.g., fear of a heart attack); or c) a significant change in behavior associated with the attack (e.g., quitting a job). Episodes, marked by a clear onset and termination, can last from minutes to hours. Panic attacks typically begin with sudden intense apprehension, fear and terror, and are often accompanied by feelings of impending doom. People who experience panic attacks frequently develop fears of certain situations associated with the attacks (e.g., panic disorder and agoraphobia). At least two unexpected panic attacks are necessary for DSM-IV diagnosis, although most subjects have many more (DSM-III-R requires four attacks within a 4-week period). People with panic disorder may have predictable attacks as well as unexpected ones. In some cases these additional attacks may be part of co-morbid anxiety disorders such as social phobia. The severity and frequency of attacks vary considerably. The most common symptoms are shortness of breath, palpitations, chest pain or discomfort, choking or smothering sensations, and the fear of “going crazy” or doing something uncontrollable during the attack. Both DSM-III-R and DSM-IV require the presence of at least 4 out of 13 physiological symptoms. These attacks must not be precipitated by exposure to a specific phobic stimulus and cannot be attributable to the direct physiological effects of a substance (e.g., caffeine or amphetamine intoxication) or a general medical condition (e.g. hyperthyroidism).

Q1

This question asks if R has experienced panic attacks.

Q2

This question assesses the frequency of these attacks.

Q3

This question asks how R was effected by these attacks.

Q4

People often feel this way after having a panic attack.

Q5

This asks if R=s panic attacks inhibited their functioning.

Q6

Some individuals are so frightened by these attacks that they need someone to accompany them when they will be faced with a situation that has induced these attacks previously.

Q7

This question asks if R had any of these somatic or cognitive symptoms. If 4 or more are coded, proceed with the rest of section Q. If less than 4 are, resume with question R1.

Q8

If there has only been 1 episode, skip to R1. Stress that 4or more of the previous symptoms have to present to be counted as an episode.

Q9

This question measures the duration of the attack. A typical attack usually lasts 10 minutes or less.

Q10

This question asks about specific characteristics of the attacks.

Q11

This asks if the attacks being discussed occurred during situations from section O (Social Phobia).

Q12

This asks if the attacks occurred during situations from section P (Agoraphobia).

Q13

Record exactly what R says.

Q14

This question asks if R has experienced “ucued” panic attacks.

Q15

This question asks for the onset and recency of these attacks.

Q16

This question assess how the attacks effected R.

Q17

This question finds if R=s functioning in these areas has been interfered with.

Q18

Record the medications if any.

Q19

This question assess if R used alcohol or drugs to self-medicate.

R: PTSD

PTSD is characterized by the by the development of a variety of specified symptoms in response to exposure to a psychologically distressing event which is generally outside the range of normal human experience. The event is one that would be noticeably distressing to almost anyone and must be accompanied by intense fear, terror, and helplessness. Events which produce PTSD range in nature to include a serious threat to one=s life, death of ones’s child, military combat, natural catastrophes like hurricanes and earthquakes, seeing serious harm or death inflicted on another person, or a serious threat to one=s self or a close friend or relative. These events are contrasted with “normal” human events such as chronic illness, business loss, simple bereavement, or marital conflict. PTSD is manifested in characteristic symptoms listed among criteria for diagnosis include re-experiencing the traumatic event; avoidance of or numbered response to stimuli associated with the event; and increased arousal in general or regarding situations reminiscent of the event. Symptoms of PTSD begin immediately or shortly after the event occurred. While the full syndrome may not appear for months or years, avoidance symptoms will likely occur very early on. Symptoms of depression and anxiety are common and may occur severely enough to substantiate a clinical diagnosis for anxiety or depression. Other potential signs of PTSD include impulsivity (as in a sudden change in lifestyle), organic mental disorder (muteness, difficulty concentrating, emotional lability, etc.), and guilt. According to the

SM IV-TR, substance abuse is a common complication. D

R1 This question asks if R has been in military combat (not just military service). R2

This question asks about R’s combat experiences.

R3

Emphasize that these experiences are not related to military combat.

R4

This question addresses some of the symptoms of PTSD and asks R if they experienced these as the result of one of the experiences in R3.

R5

Check R2 and R3 and record event number.

R6

If R did not feel intense fear, helplessness or horror after this experience, resume asking question number S1.

R7

If R cannot remember month or year, try using the timeline items to jog his/her memory. Code 9's for any dates that R cannot remember.

R8-R12

These questions ask about ways in which R may have persistently experienced the traumatic event.

R9

R10

R11

R12

These symptoms must have been present for 1month or longer to be clinically significant.

R13-R20

These questions ask about ways in which R may have persistently avoided stimuli

i d i h h d hi /h bi f l i

associated with the trauma and his/her numbing of general responsiveness. R14

R15

R16

R17

R18

R19

R20

R21

These symptoms must have been present for 1month or longer to be clinically significant.

R22-R26

These questions ask if R had any symptoms of increased arousal after the traumatic event.

R23

R24

R25

R26

R27

These symptoms must have been present for 1month or longer to be clinically significant.

R28

This question reviews all of the symptoms that R experienced on the PTSD tally sheet and asks for the time period in which these things occurred.

R29

This question asks if R sought help from a professional for these experiences.

R30

This question asks if these problems or experiences interfered with R=s family, friends, work, school, or other situations.

R31

One example of such medication is Remeron.

R32

This question asks if R self-medicated because of these problems or experiences.

S: Home Environment - CHILD

S1

Emphasize that this is for the major part of the time when R was growing up.

S2-S7

These questions ask about R’s mother or mother figure. If one is not present omit these questions.

S8-S13

These questions ask about R’s father or father figure. If one is not present omit these questions.

S14

If R reports something general like “Christian” probe for the specific denomination.

S15

Stress that this is R’s current religious preference.

S16, S17

Emphasize “a lot” and read each individual option.

S18-S23 These questions asks about R=s relationships with his/her mother and father (mother and father figure) as well as their modes of discipline

S24-S26

These questions about R’s involvement with DFS or the foster care system as a child.

S27-S29

These questions ask about R’s parents’ relationship. Ask these unless R lived in a single parent family.

S30

This question asks R to estimate the amount of tension in R=s home before s/he was 16

S31, S32

These questions ask about early sexual experiences R may have encountered.

S33

Emphasize that this is since the age of 16.

S34

S35-S40

These questions ask about the places R lived in when s/he was growing up.

S41-S43

These questions ask about the neighborhood R currently lives in.

S45-S49

Stress that these questions are about the schools R attended through the 8th grade.

S50-S56

These questions ask about the high schools R attended.

T: Income T1

Full-time work status is 37.5 hours per week or longer.

T2

This question asks about work for pay only. If R has been hospitalized and his/her employer is holding the job until R can return or R is receiving worker=s compensation for an injury, count this as employed. Also include situations like sabbaticals and paid leaves-of-absences (such as maternity leave) after which time R would be expected to return to work. If R is a teacher and works only 9 months out of the year (generally with the summer months off), code this as 12 months of employment.

T3

R is given card A2 and asked to list the code of the income category that best fits his/her current situation. Current household gross income is the combined pre-tax income of R and spouse (or spouse equivalent), and would include other members of the household that would be contributing money for maintenance and payment of general expenses. Do not combine income of roommates who are not significant others. If R has a live-in relationship and shares bills and responsibilities with his/her live-in partner, then the two incomes should be combined. Also included are payments of child support, alimony, social security, disability, welfare, and food stamps. Students with part-time jobs should include this income with parent=s income. Married couples that live with parents, who pay rent but do not combine incomes with the parents, should not include the parent=s income. People such as farmers who have large outlays of money for equipment and supplies should use their taxable income as reported to the IRS. The sale of property does not count as income. Student loans do not count as income. Prorate income if it changes during the year. For example, if R has been retired for less than a full year and reports 02 for current retirement income and 07 before retirement, the interviewer should prorate R=s income as if R had been retired for a full year B thus code 02 as his/her current income.

T4

Ask each part of the question individually and code “Yes” or “No”.

T5

T6

Ask each part of the question individually and code “Yes” or “No”.