Addiction Severity Index (ASI)

Addiction Severity Index

Treatnet Version

Manual and
Question by Question
“Q by Q” Guide
Adapted from the 1990 Version of the ASI Manual developed at
The University of Pennsylvania/Veterans Administration Center for Studies of Addiction

D. Carise

Treatment Research Institute

600 Public Ledger Building, 150 S. Independence Mall West
Philadelphia, PA 19106-3475
[email protected] (215) 399-0980

Sources of Support for this work include the National Institute of Drug Abuse, Veterans
Administration, United Nations Office on Drugs and Crime and Treatment Research
Institute
 THE TREATNETASI MANUAL
and
Question by Question Guide (Q by Q)
Purpose:
The purpose of this manual is to provide information regarding the development and use of
the ASI, its adaptation for the Treatnet Project, a 20-country UNODC international
consortium, and a question by question manual for its users.

History and Development of the ASI 3

This is too long but could you add a few questions?
There’s an ASI “Lite?”
Can’t the patient just fill this out?
Coding Issues 6
Patient Severity Ratings
Confidence Ratings
Difficult Situations
Research Issues 11
Follow-ups
Outcomes
Composite Scores
The ASI Clinical Interview 13
Introducing the ASI to your client
Transitioning between sections of the ASI
General Instructions 16
The ASI Question by Question Guide 18
General Information Section 19
Medical Section 28
Employment Support Section 38
Drug & Alcohol Sections 54
Legal Section 75
Family/Social Section 87
Psychiatric Section 101
Closing the ASI 111
APPENDICES
ASI Introduction 114
Instructions for using “N” on the ASI 115
ISCO Abbreviated Categories 116
List of Commonly Used Substances 117
Coding of the “Final 3” 118

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Description of the ASI
The Addiction Severity Index is a relatively brief, semi-structured interview designed to provide
important information about aspects of a patient's life which may contribute to his/her substance abuse
syndrome. It is the first step in the development of a patient profile for subsequent use by clinical AND
research staffs. The semi-structured instrument can be conducted by a trained clinician, researcher, or
technician. It was developed by A. Thomas McLellan, Ph.D. and colleagues at the University of
Pennsylvania in 1980. The ASI covers seven (7) important areas of a patient's life: medical,
employment / support, drug and alcohol use, legal, family / social, and psychiatric. The instrument is
designed to obtain lifetime information about problem behaviors as well as focusing specifically on the
30 days prior to assessment. The ASI has strong scientific reliability and validity, as confirmed in
studies published in leading journals. It is a widely used addiction assessment tool throughout the
United States and in other countries. In 1990, the University of Pennsylvania released the Fifth Edition
ASI instrument. This is the version currently in use.

It is frequently used by both clinical and research staff within treatment facilities, thus, it is particularly
important that the patient perceive the purpose of the interview. If it is to be used solely as a clinical
interview it should be described as the first step in understanding the full range of problems for which
the patient is seeking help and the basis for the initial treatment plan. If the ASI is to be used solely for
research purposes then the interviewer should explain that the interview will help to provide a
description of his/her condition before and after the intervention or procedure that he/she will undergo.

This ASI, it’s too long…Hey, could you add a few questions?
One of the two most frequent comments we hear from sites beginning to use the ASI is: “The ASI
is way too long. Could you add these (10, 30, 30…) questions?” The Treatnet ASI is an adaptation of
the ASI-Lite, a version of the ASI with several questions edited and several deleted. The addition or
editing of these ASI items was the result of the collaboration of at least 40 leading researchers and
clinicians in the field. Each question was carefully reviewed during in-person meetings and discussions
as well as through email and web-based discussions. Each was reviewed to evaluate its impact on other
ASI items and composite scores. The ASI Lite was developed in early 1997.

Why was the ASI Lite developed?

To answer this question, we need to remember that the Addiction Severity Index was created in 1980 to
enable clinical researchers to evaluate treatment outcomes in a six-program, substance abuse treatment
network, with patients at the Philadelphia V.A. Medical Center. Its original purpose was to serve as a
standardized data collection instrument. Given its demonstrated reliability and validity, the ASI quickly
became the assessment instrument of choice by substance abuse researchers all over the world. Only
recently have clinicians begun to see its value as an intake assessment instrument that can be used to
develop a treatment plan.

A number of factors entered into the decision to develop the ASI Lite. In keeping with the growing
demand to measure treatment effectiveness, many state substance abuse agencies are now requiring their
funded programs to use the Addiction Severity Index. Since treatment programs need to complete a
number of data collection forms on each patient admitted to treatment, adding a full ASI to their existing
paperwork requirements could be prohibitive. The ASI Lite maintains the necessary items needed for
conducting outcomes research.

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How does the ASI Lite differ from the standard Fifth Edition ASI?

The ASI Lite differs from the standard Fifth Edition ASI in two ways:
(1) It contains 32 fewer questions.
(2) Interviewer Severity Ratings are not used;

How does a treatment program know which version of the ASI to use?

If a treatment program wants to use the ASI as the only (or primary) assessment instrument, it should use
the standard Fifth Edition ASI, developed in 1990. The standard ASI, when used by a properly trained
individual, provides the lifetime and recent history information needed to help the clinician develop an
individualized treatment plan. If, on the other hand, if the ASI is being added to a number of other
assessment / data collection forms, the ASI Lite is recommended.

By the way, the other most frequent comment? “Oh, I’ve been using the ASI for years. Hey, do you have
a manual for that?’

1. Appropriate Populations
Appropriate Populations - Can I use the ASI with samples of Substance Abusing Prisoners or
Psychiatrically Ill Substance Abusers? Because the ASI has been shown to be reliable and valid among
substance abusers applying for treatment, many workers in related fields have used the ASI with
substance abusing samples from their populations. For example, the ASI has been used at the time of
incarceration and/or parole/probation to evaluate substance abuse and other problems in criminal
populations. In addition, because of the widespread substance abuse among mentally ill and homeless
populations, the ASI has also been used among these groups. Over the past decade, there have been many
studies using the ASI with these populations and interested users should review the literature for
reliability and validity studies of the instrument in these populations.

There are many cases where it is likely that the ASI would be a better choice than creating a
totally new instrument. However, it is important to note circumstances that are likely to reduce the value
of data from the ASI among these groups. For example, when used with a treatment seeking sample and
an independent, trained interviewer, there is less reason for a potential substance abuser to misrepresent
(even under these circumstances it still happens). In circumstances where individuals are being
"evaluated for probation/parole or jail" there is obviously much more likelihood of misrepresentation.
Similarly, when the ASI is used with psychiatrically ill substance abusers who are not necessarily seeking
(and possibly avoiding) treatment, there may be reasons to suspect denial, confusion and
misrepresentation. The consistency checks built into the ASI may be of some benefit in these
circumstances. However, it is important to realize the limits of the instrument.

A Special Note on Adolescent Populations - Despite the fact that we have repeatedly published
warnings for potential users of the ASI regarding the lack of reliability, validity and utility of the
instrument with adolescent populations there remain instances where the ASI has been used in this
inappropriate manner. Again, the ASI is not appropriate for adolescents due to its underlying
assumptions regarding self-sufficiency and because it simply does not address issues (e.g. school, peer
relations, family problems from the perspective of the adolescent, etc.) that are critical to an evaluation of
adolescent problems. At this writing, there are several versions of the ASI that have been developed for
adolescent populations. We are not recommending these instruments nor do we have copies, however, the
authors’ names have been provided below.
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 Kathy Meyers, "The Comprehensive Addiction Severity Index-C"
Yifrah Kaminer, "The Teen - Addiction Severity Index"
Al Friedman, "The Adolescent Drug and Alcohol Diagnostic Assessment"

2. Why an Interview?
The Interview Format - Does it have to be an Interview? This is perhaps the most often asked
question regarding the ASI. In the search for faster and easier methods of collecting data many clinicians
and researchers have asked for a self-administered (either by computer or paper and pencil) version of the
instrument. We have not sanctioned the use of a self-administered version for several reasons. First, we
have tested the reliability and validity of the severity ratings by having raters use just the information that
has been collected on the form - without the interview. This has resulted in very poor estimates of
problem severity and essentially no concurrent reliability. Second, we have been sensitive to problems of
illiteracy among segments of the substance abusing population. Even among the literate there are
problems of attention, interest and comprehension that are especially relevant to this population. Finally,
since the instrument is often used as part of the initial clinical evaluation, it has been our philosophy that
it is important to have interpersonal contact for at least one part of that initial evaluation. We see this as
simply being polite and supportive to a patient with problems.

We have seen no convincing demonstration that the interview format produces worse (less reliable
or valid) information than other methods of administration and we have found that particularly among
some segments of the substance abusing population (e.g. the psychiatrically ill, elderly, confused and
physically sick) the interview format may be the only viable method for insuring understanding of the
questions asked. Particularly in the clinical situation, the general demeanor or "feel" of a patient is poorly
captured without person-to-person contact and this can be an important additional source of information
for clinical staff.

There are of course many useful, valid and reliable self-administered instruments appropriate for
the substance abuse population. For example, we have routinely used self-administered questionnaires
and other instruments with very satisfactory results (e.g. Beck Depression Inventory, MAST, SCL-90,
etc.) but these are usually very focused instruments that have achieved validity and consistency by asking
numerous questions related to a single theme (e.g. depression, alcohol abuse, etc.). The ASI is purposely
broadly focused for the purposes outlined above, and we have not been successful in creating a viable
self-administered instrument that can efficiently collect the range of information sought by the ASI.
Thus, it should be clear that at this writing there is no reliable or valid version of the ASI that is self-
administered and there is currently no plan for developing this format for the instrument. We would of
course be persuaded by comparative data from a reliable, valid and useful self-administered version of the
ASI and this is an open invitation to interested parties.

3. Role of the Interviewer

Role of the Interviewer - What are the qualifications needed for an ASI interviewer? Having
indicated the importance of the interview process it follows that the most important part of the ASI is the
interviewer who collects the information. The interviewer is not simply the recorder of a series of
subjective statements. The interviewer is responsible for the integrity of the information collected and
must be willing to repeat, paraphrase and probe until he/she is satisfied that the patient understands the
question and that the answer reflects the best judgment of the patient, consistent with the intent of the
question. It must be emphasized that the interviewer must understand the intent of each question. This is
very important since despite the range of situations and unusual answers that we have described in the
5
manual, a new exception or previously unheard of situation occurs virtually each week. Thus, ASI
interviewers should not expect to find answers in the workbook to all of the unusual situations that they
will encounter in using the ASI. Instead it will be critical for the interviewer to understand the intent of
the question, to probe for the most complete information available from the patient and then to record the
most appropriate answer, including a comment.

There is a very basic set of personal qualities necessary for becoming a proficient interviewer.
First, the prospective interviewer must be personable and supportive - capable of forming good rapport
with a range of patients who may be difficult. It is no secret that many individuals have negative feelings
about substance abusers and these feelings are revealed to the patients very quickly, thereby
compromising any form of rapport. Second, the interviewer must be able to help the patient separate the
problem areas and to examine them individually using the questions provided. Equally important qualities
in the prospective interviewer are the basic intelligence to understand the intent of the questions in the
interview and the commitment to collecting the information in a responsible manner.

There are no clear-cut educational or background characteristics that have been reliably associated
with the ability to perform a proficient ASI interview. We have trained a wide range of people to
administer the ASI, including receptionists, college students, police/probation officers, physicians,
professional interviewers and even research psychologists!! There have been people from each of these
groups who were simply unsuited to performing interviews and were excluded during training (perhaps
10% of all those trained) or on subsequent reliability checks. Reasons for exclusion were usually because
they simply couldn't form reasonable rapport with the patients, they were not sensitive to lack of
understanding or distrust in the patient, they were not able to effectively probe initially confused answers
with supplemental clarifying questions or they simply didn't agree with the approach of the ASI
(examining problems individually rather than as a function of substance abuse). With regard to assisting
the interviewer in checking for understanding and consistency during the interview, there are many
reliability checks built into the ASI. They are discussed in some detail in the workbook and they have
been used effectively to insure the quality and consistency of the collected data

4. Additional Questions?
Can I ask additional questions and/or delete some of the current items? As indicated above, the ASI
was designed to capture the minimum information necessary to evaluate the nature and severity of
patients' treatment problems at treatment admission and at follow-up. For this reason, we have always
encouraged the addition of particular questions and/or additional instruments in the course of evaluating
patients. In our own work we have routinely used the MAST, an AIDS questionnaire, additional family
background questions and some self-administered psychological tests.

For the Treatnet ASI, to accommodate the range, different cultures and life experiences of our users,
we did add a number of questions. We realize that the magnitude of these changes requires additional
attention to the reliability and validity or this “new” instrument and an international study, evaluating the
reliability and validity of the Treatnet Lite-ASI is being planned.

5. Patient Severity Items

It is especially important that the patient develop the ability to communicate the extent to which
he/she has experienced problems in each of the selected areas, and the extent to which he/she feels
treatment for these problems is important. These subjective estimates are central to the patient's
participation in the assessment of his/her condition. In order to standardize these assessments we have
6
 employed a 5 point (0-4) scale for patients to rate the severity of their problems and the extent to which
they feel treatment for them is important.

0 - Not at all
1 - Slightly
2 - Moderately
3 - Considerably
4 - Extremely

For some patients it is adequate to simply describe the scale and its values at the introduction to
the interview and occasionally thereafter. For other patients, it may be necessary to arrive at an
appropriate response in a different fashion. The interviewer's overriding concern on these items is to get
the patient's opinion. Getting the patient to use his/her own language to express an opinion is more
appropriate than forcing a choice from the scale.

Several problems with regard to these ratings can occur. For example, the patient's rating of the
extent of his/her problems in one area should not be based upon his/her perception of any other
problems. The interviewer should attempt to clarify each rating as a separate problem area, and focus
the time period on the previous 30 days. Thus, the rating should be made on the basis of current, actual
problems, not potential problems. If a patient has reported no problems during the previous 30 days,
then the extent to which he/she has been bothered by those problems must be 0 and the interviewer
should ask a confirmatory question as a check on the previous information. "Since you say you have had
no medical problems in the past 30 days, can I assume that, at this point you don't feel the need for any
medical treatment?" Note: If the patient is not able to understand the nature of the rating procedure,
then insert an "X" for those items.

6. Interviewer Severity Items - The Interviewer Ratings are not on the

Treatnet ASI but have been included in the ASI Supplement)
Detail is provided below on why clinicians or researchers may elect to delete Interviewer
Severity Ratings.

Severity Ratings - How important and useful are they? It is noteworthy that the interviewer
severity ratings were historically the last items to be included on the ASI. They were considered to be
clinically desirable but non-essential items that were a summary convenience for people who wished a
quick general profile of a patient's problem status. They were only provided for clinical convenience and
were never intended for research use. It was surprising and interesting for us to find that when
interviewers were trained comparably and appropriately, these severity estimates could produce reliable
and valid ratings across a range of patient types and interviewer types. Further, they remain a useful
clinical summary that we continue to use regularly - but only for initial treatment planning and referral.

It should be understood however that these ratings are only estimates of problem status, derived at
a single point in time and subject to change with alterations in the immediate context of the patient's life.
Further, these ratings cannot take the place of the more detailed information supplied by the patient in
each of the problem areas. Finally, since these are ultimately just ratings, it is recommended that they not
be used as measures of outcome in research or program evaluation studies. More objective,
mathematically based composite scores in each problem area have been developed for research purposes.
(See McGahan, et. al. 1986).

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 The severity ratings derived by the interviewer on each of the individual problem areas can be
useful clinically. Although it is recognized that the interviewer's opinions will affect the severity
ratings, and are often important, they introduce a non- systematic source of variation, lowering the
overall utility of the scale. In order to reduce variation and increase reliability of the estimates, all
interviewers must develop a common, systematic method for estimating severity of each problem.

We have established a two-step method for estimating severity. In the first step, the interviewer
considers only the objective data from the problem area with particular attention to those critical items
in each problem area which our experience has shown to be most relevant to a valid estimate of severity.
Using the "objective" data the interviewer makes a preliminary rating of the patient's problem severity
(need for treatment) based only upon this objective data. In the second step, the patient's subjective
reports are considered and the interviewer can modify the preliminary rating accordingly. However, if a
particularly pertinent bit of information, that is not systematically collected, figures into the derivation
of a severity rating, it must be recorded in the "Comments" section. If the patient suggests that he/she
feels a particular problem is especially severe, and that treatment is "extremely important" to him/her,
then the interviewer may increase his final rating of severity. Similarly, in situations where the patient
convincingly presents evidence that decreases the apparent severity of a problem area, the interviewer
may reduce the final rating.

The ASI interview defines severity as the need for treatment where there currently is none; or for
an additional form or type of treatment where the patient is currently receiving some form of treatment.
These ratings should be based upon reports of amount, duration, and intensity of symptoms within a
problem area. The following is a general guideline for the ratings:

0-1 No real problem, treatment not indicated

2-3 Slight problem, treatment probably not necessary
4-5 Moderate problem, some treatment indicated
6-7 Considerable problem, treatment necessary
8-9 Extreme problem, treatment absolutely necessary

It is important to note that these ratings are not intended as estimates of the patient's potential
benefit from treatment, but rather the extent to which some form of effective intervention is needed,
regardless of whether that treatment is available or even in existence. For example, a patient with
terminal cancer would warrant a medical severity rating of 9 if he/she were not currently receiving
adequate treatment, indicating that treatment is absolutely necessary for this life-threatening condition.
A high severity rating is recorded in this case even though no effective treatment is currently available.
Patients presenting few problem symptoms or controlled symptom levels should be assigned a low level
of problem severity. As amount, duration, and/or intensity of symptoms increase, so should the severity
rating. Very high severity ratings should indicate dangerously (to the patient or others) high levels of
problem symptoms and a correspondingly high need for treatment.

SEVERITY RATING DERIVATION PROCEDURES

STEP 1: Derive a range of scores (2 or 3 points) which best describes the patient's need for
treatment at the present time.

STEP 2: Select a point within the range above, using only the subjective data in that section.

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 1. If the patient considers the problem to be considerable and feels
treatment is important, select the higher point within the range.

2. If the patient considers the problem to be less serious and considers

the need for treatment less important, select the middle or lower rating.

While it is recognized that the criteria for establishing the degree of severity for any problem
varies from situation to situation, we have found the above derivation procedures to produce reliable
and valid ratings (See McLellan et. al., 1985).

Exceptions: In cases where the patient obviously needs treatment and reports no such need, the
interviewer's rating should reflect the obvious need for treatment. E.g., patient reports 30 days of family
arguments leading to physical abuse in some cases, but reports no need for family counseling. The
obvious nature of this need must be stressed. Avoid inferences, hunches or clinical assumptions
regarding this problem in the absence of clear indication. Beware of over interpreting "Denial." Clarify
through probes where necessary.
If the patient has reported no recent or current problems, but does report a need for treatment,
clarify the basis of his rating. E.g., patient reports no use of drugs or alcohol in past 30 days and no
urges or cravings for drugs, but claims treatment in the form of continued AA meetings is "extremely
important" with a rating of 4. Here the patient is currently receiving adequate treatment and does not
need any new, different or additional treatment.

IMPORTANT: Using the method described, there is ample evidence that the severity ratings can
be both reliable and valid estimates of patient status in each problem area. However, we do not
recommend that the severity ratings be used as outcome measures. It is important to remember that
these ratings are ultimately subjective and have been shown to be useful only under conditions where all
data are available and the interview is conducted in person. This is not always the case in a follow-up
evaluation. We have created composite scores in each of the problem areas, composed of objective
items that have been mathematically constructed to provide more reliable estimates of patient status at
follow-up. We have used the severity estimates clinically and as predictors of outcome but we have
used the composite scores as outcome measures. See Section 11 below for additional details.

Again, the Treatnet project is using the “Lite” version of the ASI which does not include Interviewer
Severity Ratings. Instructions are included here for your reference in the event you would like to use
them for internal reasons or in other projects

7. Confidence Ratings
Confidence ratings are the last two items in each section and appear as follows:

Is the above information significantly distorted by:

Patient's misrepresentation? 0 = No 1 = Yes

Patient's inability to understand? 0 = No 1 = Yes

Whenever a "yes" response is coded, the interviewer should record a brief explanation in the
"Comments" section.

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 The judgment of the interviewer is important in deciding the veracity of the patient's statements
and his/her ability to understand the nature and intent of the interview. This does not mean a simple
"gut hunch" on the part of the interviewer, but rather this determination should be based on observations
of the patient's responses following probing and inquiry when contradictory information has been
presented (e.g. no income reported but $1000.00 in drug use). The clearest examples are when there are
discrepancies or conflicting reports that the patient cannot justify, then the interviewer should indicate a
lack of confidence in the information. It is much less clear when the patient's demeanor suggests that
he/she may not be responding truthfully and in situations where the patient will not make eye contact, or
responds with rapid, casual denial of all problems. This should not be over interpreted since these
behaviors can also result from embarrassment or anxiety. It is important for the interviewer to use
supportive probes to ascertain the level of confidence.

NOTE: It is the responsibility of the interviewer to monitor the consistency of information

provided by the patient throughout the interview. It is not acceptable to simply record what is reported.
Where inconsistency is noted (e.g., no income reported but claims of $500 per day spent on drugs) the
interviewer must probe for further information and attempt to reconcile conflicting reports. Where this
is not possible, information should not be recorded and X's should be entered with a written note for the
exclusion of information.

Patient Misrepresentation - We have found that some patients will respond in order to present a
particular image to the interviewer. This generally results in inconsistent or inappropriate responses
which become apparent during the course of the interview. As these responses become apparent, the
interviewer should attempt to assure the patient of the confidentiality of the data, re-explain the purpose
of the interview, probe for more representative answers and clarify previous responses of questionable
validity. If the nature of the responses does not improve, the interviewer should simply discard all data
which seems questionable by entering "X" where appropriate and record this on the ASI. In the extreme
case, the interview should be terminated.

Poor Understanding - Interviewers may find patients who are simply unable to grasp the basic
concepts of the interview or to concentrate on the specific questions, usually because of the effects of
drug/alcohol withdrawal, psychiatric impairment or extreme states of emotion. Poor understanding may
also be the result of a language barrier. If either of these cases becomes apparent, the interview should
be terminated and another session rescheduled.

8. Difficult situations
Previous Incarceration or Inpatient Treatment - Several questions within the ASI require
judgments regarding the previous 30 days or the previous year. In situations where the patient has been
incarcerated or treated in an inpatient setting for those periods it becomes difficult to develop a
representative profile for the patient. That is, it may not give a fully representative account of his/her
general or most severe pattern of behavior. However, it has been our policy to restrict the time period of
evaluation for these items to the 30 days prior to the interview regardless of the patient's status during
that time.

Even with this general understanding there are still individual items that are particularly difficult
to answer for patients who have been incarcerated or in some controlled environment. Perhaps the most
common example is found in the employment section. Here we have defined "days of problems" as
counting only when a patient has actually attempted to find work or when there are problems on the job.
In a situation where the patient has not had the opportunity to work it is, by definition, not possible for
10
 him/her to have had employment problems. In situations like this where the patient has not had the
opportunity to meet the definition of a problem day, the appropriate answer is an "N" in the patient
rating for how troubled or bothered they are since it depends on the problem days question.

9. Using the ASI for Follow-up and Outcomes

If a follow-up interview is to be done at some later point, this also should be included in the
introduction. For example:

"With your permission, we would like to get back in touch with you in about six
months to ask you some similar questions. In that way, we hope to evaluate our program, to see
how helpful it has been."

It is expected that by introducing the interview in a clear, descriptive manner, by clarifying any
uncertainties, and by developing and maintaining continued rapport with the patient, the admission
interview will produce useful, valid information.

Follow-up interviews may be performed no earlier than one month from the previous interview
since the evaluation period is the previous 30 days. The interview may be conducted reliably and
validly over the telephone as long as the interview is conducted in a context where the respondent may
feel free to answer honestly and the interviewer has given an appropriate introduction to the interview,
stressing confidentiality of information (See McLellan et al, 1980; 1985). Some follow-up items are
rephrased and are intended to obtain information regarding experiences that have occurred during the
period since the last ASI was administered. These questions require that the answer reflect the
accumulation of experience since the previous interview. For example, in the employment section,
questions on the amount of formal school or training are asked and intended to reflect the addition of
schooling since the prior interview.

10. Composite Scores

Composite Scores - What are they for, why were they constructed this way and what are the
norms? Users familiar with earlier editions of the ASI know there is a separate manual designed to
describe their use and to show how to calculate them (See Composite Scores from the Addiction Severity
Index at www.tresearch.org). The composite scores have been developed from combinations of items in
each problem area that are capable of showing change (i.e. based on the prior thirty day period, not
lifetime) and that offer the most internally consistent estimate of problem status. The complicated
formulas used in the calculation of these composites are necessary to insure equal weighting of all items
in the composite.

These composites have been very useful to researchers as mathematically sound measures of
change in problem status but have had almost no value to clinicians as indications of current status in a
problem area. This is due to the failure on our part to develop and publish normative values for
representative groups of substance abuse patients (e.g. methadone maintained males, cocaine dependent
females in drug free treatment, etc.). At the risk of being defensive, our primary interest was measuring
change among our local patients and not comparing the current problem status of various patient groups
across the country. Further, we simply did not foresee the range of interest that has been shown in the
instrument.

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 11. Estimates and Clarifications
Estimates: Several questions require the patient to estimate the amount of time he/she
experienced a particular problem in the past 30 days. These items can be difficult for the patient, and it
may be necessary to suggest time structuring mechanisms; e.g., fractional periods (one-half the time, etc.)
or anchor points (weekends, weekdays, etc.). Finally, it is important that the interviewer refrain from
imposing his/her responses on the patient (e.g. "Sounds like you have an extremely serious medical
problem there!"). The interviewer should help the patient select an appropriate estimate without forcing
specific responses.

Clarifications: During the administration of the ASI there is ample opportunity for clarification
of questions and responses and this is considered essential for a valid interview. To insure the quality of
the information, be certain the intent of each question is clear to the patient. Each question need not be
asked exactly as stated, use paraphrasing and synonyms appropriate to the particular patient and record
any additional information in the "Comments" sections.

NOTE: When it is firmly established that the patient cannot understand a particular question, that
response should not be recorded. Enter an "X" in the first block of that item in these cases. In a case
where the patient appears to have trouble understanding many questions, it may be advantageous to
discontinue the interview. In this regard it is far better to wait a day or more for a patient to recover from
the initial confusing, disorienting effects of recent alcohol/drug abuse than to record confused responses.

A Final Note on the Difference between Severity Ratings and Composite Scores?

Severity ratings are subjective estimates of patient status. They were developed to allow a trained
interviewer to estimate problem severity in each of the ASI areas, using a ten-point scale. These ratings
have been shown to produce reliable and valid estimates of patient status in each area (when interviewers
are trained and monitored for inter-rate reliability), and are of great practical value in (1) summarizing the
patient's overall status at treatment admission; and (2) formulating an initial treatment plan. However,
despite their reliability and validity, severity ratings are subjective estimates, are based in part on lifetime
data and, as such, are not appropriate as criteria for measuring change over time.

Composite scores are calculated by combining selected objective data from each ASI problem
area (section). The developers used an empirical method of combining those items from each ASI
problem area which were capable of showing change and which were well related to each other. These
measures are mathematically derived and have shown reliability and validity in several settings. For more
complete information, researchers are encouraged to refer to the ASI Composite Scores Manual.

12
 Introducing the ASI
Prior to beginning the administration of the General Section of the ASI, the interviewer should
properly introduce the instrument. This gives the client a clear idea of what to expect from the interview
and helps to build rapport. The following instructions are on the face page of your ASI. Each of these
points should be included in your introduction:

INTRODUCING THE ASI:

1. All clients receive this same standard interview.

2. Seven Potential problem areas or Domains: Medical, Employment/Support Status, Alcohol, Drug,
Legal, Family/Social, and Psychiatric.

3. The interview will take about 50-60 minutes.

4. Patient Rating Scale: Patient input is important. For each area, I will ask you to use this scale to let
me know how bothered you have been by any problems in each section. I will also ask you how
important treatment is for you for the area being discussed.
The scale is:
0 - Not at all
1 – Slightly
2 – Moderately
3 – Considerably
4 – Extremely

5. All information gathered is confidential

6. Accuracy - You have the right to refuse to answer any question, if you are uncomfortable or feel it is
too personal or painful to give an answer, just tell us, “I want to skip that question.” We’d rather
have no answer than an inaccurate one!

7. There are two time periods we will discuss:

1. The past 30 days
2. Lifetime

When introducing the ASI to your clients, include and explain each of the above points in detail. Note:
It is critical you do more than simply list them in order. A good introduction sets the tone, provides
guidelines and helps prepare the client for what to expect during the interview. In addition, an in-depth
introduction will assist you later in the interview by helping the client stay focused and understand why
you are asking certain questions.

1. Explain that all clients receive the same standard interview – the ASI.

This will be of assistance during the ASI when a client seems surprised by a particular question (e.g.
“Have you ever been arrested and charged with prostitution?”). In cases like this refer the client back to
13
your introduction statement and explain again that you appreciate some of the questions may not apply to
them, but we ask everybody the same questions. It is important to convey the concept of standardization
to the client so they do not feel singled out or discriminated against.

Interviewer Example:
“In order to treat everyone equally, we give everyone who presents for treatment here the same
standard interview. I appreciate your patience and I know some of these may not apply to you.”

2. Seven Potential Problem Areas: Medical, Employment/Support, Alcohol, Drug, Legal,

Family/Social, Psychiatric

Reinforce and explain that your agency is interested in helping the client not only with their alcohol
and/or drug problems, but also with any other problems they may be experiencing.

Interviewer Example:
“We’re going to discuss seven different topic areas today. I’ll be asking you questions about your
medical history, employment situation, alcohol and drug use, legal status, family/social network and
mental health status.”

3. The interview will take approximately 60 minutes.

Acknowledge the importance of the client’s time and input during the interview. Ask if they have enough
time to complete the interview and explain the ASI may take slightly longer or shorter than one hour. If
the intake appointment is scheduled to last longer than the ASI (e.g. you have other information to gather,
etc.), be sure the client is aware the ASI will not take up the entire meeting.

Interviewer Example:
“I want to make sure you have enough time to complete this interview. It takes about an hour to
complete, which is shorter than the hour and a half we have scheduled for this appointment. Your time is
just as important as mine, so please tell me if you have a conflicting commitment.”

4. Your input is important; the Patient Rating Scale

Explain that through out the interview the client will have the opportunity to convey their opinions about
the information being discussed. Inform the client their opinion and perceptions are critical to the
interview and treatment process.

Interviewer Example:
“Throughout this interview you will have the chance to tell me how you’ve been doing in each of
the topic areas we talk about. It’s important for you to know your opinion about these situations is critical
to both this interview and the treatment process as a whole. Your responses are part of the material I will
consider in developing your treatment plan.”

5. All information gathered is confidential.

Explain exactly what “confidential” means in your facility. Who will have access to the information
under what situations and/or procedures? Because confidentiality is defined slightly differently across
facilities (e.g. state agencies, healthcare / correctional facilities, etc.), be sure to note the limitations to
confidentiality as they pertain to your workplace, the client’s safety and that of others.
14
Interviewer Example:
“Of course, all the information you give to me today is strictly confidential. That means only
myself and the other counselors working on your case will be able to see your responses to this
interview.”

6. You may choose to not answer certain questions. Accurate information better equips us to help
the client.

Give clients permission to not answer questions that may be too personal or difficult to answer. Explain in
those cases you will simply place an “X” in the box and move on. Nonetheless, reinforce with the client
the importance of obtaining as much honest information as possible to assist you in developing a more
accurate and comprehensive treatment plan.

Interviewer Example:
“I would appreciate it if you would try to answer all of the questions honestly. However, if a topic
makes you feel uncomfortable or you do not want to answer any of the questions, just let me know and
we’ll move on to the next item. I would rather skip a question than have you feel like you have to provide
a response in order to move on with the ASI.”

7. Two timeframes: Past 30 Days and Lifetime.

Inform the client you will be asking about two distinct time periods; the Past 30 Days, and Lifetime. Note
the Lifetime period includes the client’s entire life up until 30 days ago. Due to these two timeframes
being completely separate, it is possible throughout the ASI for a client to have engaged in a behavior
(overdosing on drug) during the past 30 days but NOT in his/her lifetime, and visa versa.

Interviewer Example:
“I will be asking you about two separate time frames. The first is the “Past 30 Days”. For most of
these questions I will be asking how many days in the past 30 you have done something. I will also be
asking about your “Lifetime”. This time period is completely separate from the past 30 days, and we
typically say “Lifetime begins on the 31st day” meaning that when I ask about your Lifetime you should
not include any information about your activity in the past 30 days. If you have any questions about what
times to include in your responses to any ASI question, feel free to ask during the course of the
interview.”

12. Transitioning from ASI Sections

As the focus of the interview proceeds from one area to the next, it is very important for the
interviewer to introduce each new section and to change the patient's focus form the previous area. For
example:

"Well I've talked with you about your medical problems, now I'm going to ask you some
questions about any employment or support problems you may have."

Thereby the patient will be prepared to concentrate on each of the areas independently. In this
regard it is important that the patient not confuse problems in a particular area with difficulties

15
 experienced in another area, such as confusing psychiatric problems with those due directly to the
physiological effects of alcohol or drug intoxication.

13. General Instructions

The following set of interviewer instructions are on the face-page of your ASI and are explained more
fully here.

INTERVIEWER INSTRUCTIONS:

1. Leave no blanks.
2. Make plenty of Comments (if another person reads this ASI, they should have a relatively complete
picture of the client's perceptions of his/her problems). When noting comments, please write the
question number.

3. X = Question not answered.

4. N = Question not applicable.

5. Terminate interview if client misrepresents two or more sections.

6. Half Time Rule!

If a question asks the number of months, round up periods of 14 days or more to 1 month. Round up 6
months or more to 1 year.

7. Hints and clarification notes in the ASI are bulleted "•".

Probe, cross-check and make plenty of comments!

1. Leave No Blanks! Code all boxes, for example, if the item asks about number of months and the
answer is 1 month; code “01” in the two available boxes.

2. Make plenty of comments (another person reading the ASI should have a clear understanding of
the client's situation and perceptions of his/her problems). Make sure the intent of each question is
clear to the client. Each question need not be asked exactly as written, use paraphrasing and
synonyms appropriate to the particular client and record a brief explanation in the "Comments"
sections. Remember to include the item number when noting information in the “Comments”
sections. Probing and writing comments when you have an unusual or counter-intuitive answer is
considered essential for a valid interview.

3. Code an “X” for items that are not answered (client can not answer or declines to answer). For
example, if a client does not want to answer questions about their relationship with their children;
code “X” for those items.

4. Code an “N” for items that are not applicable. For example, if a client reports they have not been
in a controlled environment in the past 30 days, then the appropriate code for G20: “How many
days have you been in a controlled environment?” would be “NN”.

16
 5. End interview if client misrepresents or cannot comprehend two or more sections.

6. Half time rule: If an item asks the number of months, round up periods of 14 days (2 weeks) or
more to 1 month. If an item asks about years, round up 6 months or more to 1 year.

7. Hints and clarification notes in the ASI are bulleted "•".

We hope the information provided in this Preface and in the Q by Q itself will be helpful in the use of the
interview and in understanding its strengths and limitations. We have made every effort to provide a
comprehensive addition to the original instrument and to share our thinking on those points where
obviously more than one method could have been used.

17
The ASI Q by Q
The Q by Q provides in depth instructions on asking each question on the ASI. We consider the ASI a
guide to a conversation. It is quite simply a set of questions that you may find useful in gathering
information about your patients. We hope that you use this information to create an individual treatment
plan for each patient. The following information about each item (beginning with General information
item # G14) on the ASI is provided for you:

Intent/Key points: The information contained in this section describes why the question was originally
included on the ASI. Sometimes, the reasons are easy to understand. Regardless, understanding the
original intent can help you to use the appropriate judgment about how to code a response. We have
based the conventions that we have adopted and recorded in the Coding Issues section on the original
intent of the question.

Suggested Interviewing Techniques: We recognize that for many patients entering treatment,
answering many seemingly meaningless questions can be tiresome. In this section, we offer what we feel
are the most efficient ways to phrase each question. It has been our experience that patients are more
open to answering questions if they are posed in a direct, non-confrontational manner. In many cases, we
recommend that the interviewer simply read the question off the page as written. In other cases, we offer
examples of effective ways to paraphrase. We hope that the information in this section helps you to help
the patient give you the information you want.

Additional Probes: A probe is a question that does not appear on the ASI. The probe may provide
information that helps you to understand the patient's problems more fully. The ASI has been recognized
by its creators as the minimum number of questions one would need to begin a treatment plan. Within
this section, we offer some additional probes that you may want to ask following each question.
Sometimes, asking many probes in the first part of the problem section helps the interview to flow more
naturally.

Coding Issues: Coding is the term used to describe the act of recording the information you receive from
the patient, into the boxes provided for you, with a numerical "code." Although we have been doing ASI
interviews for over ten years, nearly every day we encounter a new situation that is difficult to code, given
the choices listed on the ASI. For each question or set of questions, we offer some solutions for coding
issues that have arisen at our facility. This should not be considered a complete list of all the potential
coding issues that could arise in other populations.

Cross-check item with: Similar bits of information are gathered in several sections of the ASI. An alert
interviewer can use these internal cross-checks to verify information with the patient throughout the
interview. For some items on the ASI, we provide a list of a few other items that are related to it within
the interview.

18
General Information Q by Q
Introduction: This series of items was designed to provide administrative information.

G1. Patient ID_________________________________________

G2.Country G2a. Center

G2b.Program G2c. Modality
See Back Page of ASI for Country, Center and Program Listings

G3. Will this treatment be delivered in a corrections facility?

0=No 1= Yes

G1. Patient I.D.:

Open item, can be used as needed. Record any ID number assigned to the client.

G2. Country:

As of the writing of this manual 31st December 2006, a list of Countries and Centers has been created.
Additional countries may be added; however, the numbers assigned to each new country should be
provided and documented by an assigned individual or data base manager so as not to duplicate numbers.
As is the case for the U.S.A., there may be 2 Centers in a Country.

There are 19 Countries represented in the first round of Treatnet activities, please use these codes for G2:

1 Australia
2 Brazil
3 Canada
4 China
5 Colombia
6 Egypt
7 Germany
8 India
9 Indonesia
10 Iran
11 Kazakhstan
12 Kenya
13 Mexico
14 Nigeria
15 Russia
16 Spain
17 Sweden
18 United Kingdom
19 USA
20 Open
21 Open
22 Open

19
G2a. Center:

As of the writing of this manual 31st December 2006, a list of the first 20 Centers has been created. A
Center is an active, recognized (by funding or Treatnet leadership) unit that includes any programs,
modalities, off-site providers, affiliated providers (who joined Treatnet as part of a network you are
creating) and any other unit of study that is operating (to any extent) as a part of or an extension of the
Center. As is the case for the U.S.A., there may be 2 Centers in a Country.

Additional Centers may be added through future awards; however, the numbers assigned to each new
Center should be provided and documented by an assigned individual or data base manager so as not to
duplicate numbers.

There are 20 Centers represented in the first round of Treatnet activities, please use these codes for G2a:

1 Asociación Proyecto Hombre, Spain

2 Carisma Centre for Attention and Integral Mental Health, Colombia
3 Centre for Addiction and Mental Health CAMH, Canada
4 Centros de Integración Juvenil A.C., Mexico
5 Cranstoun Drug Services, United Kingdom
6 Drug Rehabilitation Unit, Mathari Hospital, Kenya
7 Fayette Companies, U.S.A.
8 General Secretariat of Mental Health, Egypt
9 Iranian National Prison Organisation /Iranian National Centre for Addiction Studies INCAS, Iran
10 Maria Ungdom, Sweden
11 Mudra, Germany
12 National Research and Clinical Centre on Medical and Social Problems of Drug, Kazakhstan
13 Neuropsychiatric Hospital Aro, Nigeria
14 Psychosocial Attention Centre for Alcohol and other Drugs, Brazil
15 Regional Research Ctr of Narcology & Psychopharm, St. Petersburg Pavlov State Med U. Russia
16 RS Ketergantungan Obat The Drug Dependence Hospital, Indonesia
17 Shanghai Drug Abuse Treatment Centre, China
18 Stanley Street Treatment & Resources (SSTAR) Inc., U.S.A.
19 TT Ranganathan Clinical Research Foundation, India
20 Turning Point Alcohol and Drug Centre Inc., Australia

G2b. Program:

A Center may have any number of Programs or Modalities. At this point we do not have a
comprehensive list of Programs. One will be developed as participants provide their lists. Programs may
be included in your center (at your request only) if they are part of your group of treatment programs, an
extension of your programs (regardless of location) or if they are collaborating with your Center to be part
of Treatnet. It is useful to think of your Center as a Treatnet Center, something possibly larger than your
current group of treatment programs. A center is a place where any number of sites or programs may be
collaborating by combined training, data collection and/or research activities.

20
G2c. Modality:

Enter the number that corresponds to the list for Modality Codes. If you select “other” you must
specify the details of the program in the comments section. The modality codes listed here are described
more fully below:

Modality Codes
1=Outpatient (OP) <5 hours per week
2=Intensive Outpatient (IOP) ≥5 hours per week)
3=Residential/Inpatient (IP)
4=Therapeutic Community (TC) approach
5=Half-way house
6=Detox – Inpatient (typically 3 – 7 days)
7=Detox Outpatient/Ambulatory
8=Opioid Replacement – (OP) Methadone, Buprenorphine, etc.
9=Other (ex: low threshold, GP, Spiritual healers, etc)
Specify_____________________________________

1=Outpatient (OP) <5 hours per week - Includes outpatient programs consisting of less than 5 hours of
services per week. Typically abstinence-oriented, these programs can have individual and group therapy,
educational groups, etc. Outpatient Methadone and Detox treatments will be coded separately (below).

2=Intensive Outpatient (IOP) ≥ 5 hours per week - Includes outpatient programs consisting of 5 or
more hours of services per week. Typically abstinence-oriented, these programs can have individual and
group therapy, educational groups, etc. Outpatient Methadone and Detox treatments will be coded
separately (below).

3=Residential/Inpatient - Includes non-therapeutic community-based treatment programs that deliver

treatment (not just housing) where the patients stay at the treatment program overnight. Typically
abstinence-oriented, these programs can have individual and group therapy, educational groups, etc.
Inpatient Detox treatments will be coded separately (below).

4=Therapeutic Community - Includes therapeutic community style (Phoenix House, Gateway, Daytop,
etc) based treatment programs that deliver treatment (not just housing) where the patients stay at the
treatment program overnight. Always abstinence-oriented, these programs can have individual and group
therapy, educational groups, etc. Inpatient Detox treatments will be coded separately (below).

5=Half-way house – Thought of as half-way between treatment and home, a half-way house is typically a
place where clients reside with minimal professional staff involvement. Clients may attend outpatient
counseling while in a ½-way house, they may also be able to go outside the house on their own or leave
with another member of the house.

6=Detox – Inpatient – Treatment specifically to provide adequate and safe detoxification from addictive
substances. Inpatient Detox can be provided in hospitals, inpatients and residential treatment centers.

7=Detox Outpatient/Ambulatory - Treatment specifically to provide adequate and safe detoxification

from addictive substances. Outpatient or ambulatory Detox can be provided in specialty outpatient
centers, medical centers, methadone programs or even at pain clinics.
21
8=Opioid Replacement (OP) - Includes outpatient programs consisting of an opioid replacement therapy
such a Methadone, Buprenorphine or LAAM. The goal typically includes abstinence from other opiates
and illegal substances. Individual and group therapy and educational groups are often part of Opioid
Replacement therapy.

9=Other (low threshold, GP, spiritual healers, etc.) – It is recognized that all types of treatment
programs cannot be listed. Code “9” for other if the client is receiving SA treatment services that do not
fit into any of the above categories and please specify the services and setting.

G3. Will this treatment be delivered in a corrections facility?

0=No
1=Yes
Code Yes if the patient will be receiving treatment in a corrections facility such as a detention
center, jail or prison.

G4. Date of Admission: Enter the date that the patient will begin treatment at your facility.
G5. Date of Interview: Enter the date of the ASI interview.
This is used to track time between interview and admission. These dates often differ; however, if date of
admission and date of interview are the same, fill in both with the same date.

G6. Time begun: Enter the time you started the ASI.
G7. Time ended: Enter the time you ended or completed the ASI.
To track the length of interviews. Some interviews that take longer than expected may indicate a difficult
client, one who is cognitively challenged, or one with a chronic medical or psychiatric illness.

G8. Class:
Select “Intake” if you are conducting an intake or baseline ASI. Most ASIs fall in this category. Select
“Follow-Up” if you are conducting a follow-up ASI. These are generally conducted for outcome studies,
and occur 30+ days after the intake or discharge. Make sure you distinguish between follow up and
intake. ASIs done on or near admission are intakes.

G9. Contact Code:

Select 1 or “In Person” if you are conducting this interview in person. All intake ASIs must be done in
person. Select 2 -“Telephone” if the interview is being completed over the phone. Follow-up ASIs can be
conducted over the phone.

22
G10. Gender:
For purposes of the Treatnet ASI, the options for gender are limited to male and female. If a patient does
not identify with either category, simply code an “X” put the patient’s comments in the comment section.

Suggested Interviewing Techniques:

Ask, “With what gender do you identify?” Do not assume a client’s gender. This is very important in
order to develop a rapport and establish a relationship early on with the client. Do not force a client to
choose either the male or female gender.

G11. Interviewer Code Number/Initials:

Record your assigned interviewer number given to you by your program. If you do not have an
interviewer code number, enter your initials.

(G12 & G13). Open Spaces for Address.

Enter patients name and address.
Use the address structure or format that is most widely used in your country however, please make sure
the writing is legible and the address is clear.
If the client is currently incarcerated, or living in a recovery house or an inpatient treatment facility, code
the address to which the client expects to return. If the client is homeless, enter their most recent address
or an address where they could be reached.

23
G14. How long have you lived at this address?

Intent/Key Points:
To evaluate the stability of the client's living situation. Enter the length of time the client has resided at
their current address.

Suggested Interviewing Technique:

If the client claims that he/she has lived at an address since birth, probe with questions asking if they ever
spent a length of time away from this address.

For Example:
“Mr. Smith, has there been a period of time when you did not live at this address, perhaps due to being
away at school, incarcerated, or living with another friend or family member?”

Coding Issues:
Only code the actual period of time the client lived at this address. If a 28 year old client claims to have
lived at his/her current address since birth, but has spent 2 years incarcerated, the length of time should be
coded as “26 years and 00 months.”

For G14, what is considered homeless?

‰ Probe to get an accurate picture of the participant's living situation. We generally define
"homeless" as: a) currently living on the streets, or in abandoned buildings; b) staying in a variety of
short-term, or emergency, shelters; c) living continuously in one shelter or halfway house.

If someone is homeless, code the number of years and months he/she has been homeless and enter this
information in G14.

**Cross-check this item with the client’s age.

24
G16. Date of Birth
Enter patient’s date of birth as Day/Month/Year

G16b. Age
Enter patient’s current age in Years

G17. Race:
This is an open-entered question written as:

What race/ethnicity/nationality do you consider yourself?

Specify_____________________________

Please ask as written and code the patient’s response. It is important to note that the patient is not
expected to give a race, ethnicity and nationality. The question is written this way to accommodate
various countries preferences.

G18. Religious Preference?

Please code the religious preference identified by the patient from the options listed:

1. Protestant 4. Muslim 7. Hindu

2. Catholic 5. Other Christian 8. Buddhist
3. Jewish 6. None 9. Other (specify in comments)

Suggested Interviewing Techniques:

Ask the client if he/she currently identifies with a religion and select the corresponding religious and/or
spiritual category. This does not apply simply to the environment in which the client was raised, but
should reflect the current preference of the client.

Coding Issues:
Coded 4 – Muslim/Moslem.

25
G19. Have you been in a controlled environment in the past 30 days?
G20. How many days?

G19 Options: 1. No,

2. Correctional Facility
3. Alcohol/Drug Treat.
4. Medical Treatment
5. Psychiatric Treatment
6. Other: ______________

Intent/Key Points:
To record whether or not the patient has had restricted access to drugs or alcohol in the past 30 days. A
controlled environment will refer to a living situation in which the subject was restricted in his freedom of
movement and theoretically his access to alcohol and drugs. This usually means residential status in a
treatment setting or penal institution. A halfway house is generally NOT a controlled environment.

Suggested Interviewing Technique:

Read the question as written. Provide patient with examples of "controlled environment."

For Example:
"Mr. Smith, in the past 30 days, have you spent any time in a controlled environment...a lock-up situation
like a jail...or a detox program...or a medical hospital...any place where you may not have been able to get
drugs and alcohol as easily as in your neighborhood?"

Additional Probes: Name of the institution, why the patient was there (medical, criminal, etc).

Coding Issues:
Are prisoners on work release considered to be in a controlled environment in G19?
‰ Prisoners on work release are generally not coded as in a controlled environment. The intent is
to identify clients who have (theoretically) had restricted access to alcohol and drugs in the past
30 days. Additional probing regarding the conditions of the work-release program, such as the
degree of monitoring that takes place, is necessary to make an accurate determination.
Many of our participants live in recovery housing - is recovery housing coded as a controlled environment
in G19?
‰ In general, recovery houses are not considered “controlled environments”. Exceptions to this
general guideline would include periods when a participant is on blackout, or when a participant
is staying in a house where testing occurs regularly, and the policy is immediate dismissal from
the house if drug tests are positive, and the policy is enforced.
G20. If the subject was in two types of controlled environments, enter the number corresponding to the
environment in which he/she spent the majority of time. In these cases, time spent in a controlled
environment will reflect the total time in all settings.

Crosscheck this item with:

1. All the items that include information about the past 30 days. If the patient reports using on days in
which he or she was in a controlled environment, record a comment that explains the details.

2. All the items that refer to the specific controlled environment. For example, if the patient reports that
he has been incarcerated for the last six months, the same information should appear in the legal section.

26
Added on the Treatnet ASI:

Who referred you to treatment? (Provide details): ___________

______________________________________________________

______________________________________________________

______________________________________________________

Since this is an open-ended question, different Center’s may use it in different ways.

It can be used as a way to identify the person or the agency (Criminal Justice System, etc) that referred
the client. It can also be used to document how to contact the referral, if ongoing progress notes are
needed for that person or agency, etc.

27
Medical Status
Introduction: The medical status section of the ASI helps you to gather some basic information about
your patient's medical history. It addresses information about lifetime hospitalizations, long term
medical problems and recent physical ailments. We recommend that you add questions that you
consider relevant to your patient's treatment plan.

M1. How many times in your life have you been hospitalized for medical problems?

M1. How many times in your life have you been

hospitalized for medical problems?
• Include O.D.'s and D.T.'s. Exclude detox, alcohol/drug, psychiatric treatment and childbirth (if
no complications).
• Enter the number of overnight hospitalizations for medical problems.

Intent/Key Points: To record basic information about medical history. Enter the number of overnight
hospitalizations for medical problems. Also, include hospitalizations for OD's and DT's but exclude
detoxification or other forms of alcohol, drug or psychiatric treatment.

Suggested Interviewing Techniques: Because this is the first section of the interview, the patient may
be prepared to tell you about psychiatric hospitalizations or treatments for drug detoxification, rather
than hospitalizations for medical problems. If this happens, we recommend that you support his
eagerness to tell you about drug-related problems, suggest that he remind you about those problems
when you get to the drug/alcohol section, and direct him back to the medical status section.

"Mr. Smith, I understand that you may want to tell me about detox treatments. Remind me about those
when we get to the drug/alcohol section. Right now, however, I need to record a little bit of information
about your medical history. How many times in your life have you been hospitalized overnight for
physical medical problems, like for surgery, a broken bone, etc...?"

Note: Don't record a patient's estimate that seems to be offered without much thought, like "I've been in
the hospital probably about five or six times." Instead, ask for some of the details (year in which the
hospitalization occurred, other events in the patient's life at the time) surrounding each hospitalization.
By gathering much information early, through probing, you will more fully understand the patient's
situation. This additional information may help you to move through the interview in a more
conversational fashion.

Additional Probes:
The approximate age of the patient at each hospitalization
The name of each hospital
The types of medications they received for serious injuries

Coding Issues:
Normal childbirth would NOT be counted since it is not a medical problem resulting from sickness or
injury. Complications resulting from childbirth would be counted and noted in the comments section.
Do not include treatment received through emergency room visits unless the patient was kept overnight.

28
 M3. Do you have any chronic medical problems which continue to interfere with your life?

M3. Do you have any chronic medical 0=No 1=Yes

problems which continue to interfere
with your life?
• If "Yes", specify in comments.
• A chronic medical condition is a serious physical condition that requires regular care, (i.e.
medication, dietary restriction) preventing full advantage of their abilities.

Intent/Key Points:
A chronic condition is a serious or potentially serious physical or medical condition that requires
continuous or regular care on the part of the patient (e.g., medication, dietary restrictions, inability to
take part in or perform normal activities). Some examples of chronic conditions are hypertension,
diabetes, epilepsy, and physical handicaps. Focus on and record the presence of a chronic medical
problem if the patient needs continued care, even if the patient has grown accustomed to the care. For
example, a diabetic patient may report that injecting insulin daily doesn't interfere with his or her life
because it has become routine. Regardless, you would count the diabetes as a chronic medical problem.

Suggested Interviewing Techniques:

Provide examples and emphasize the chronic aspect of the problem.

"Do you have a chronic medical problem Mr. Smith...like diabetes or high blood pressure or chronic
back pain?"

Additional Probes:
Medical doctor's recognition of the problem as chronic
Year that the problem was diagnosed

Coding Issues:
If a patient states his/her need for reading glasses or minor allergies is a chronic problem, this is a
misunderstanding of the question. If the patient does report a valid, chronic problem, comment on the
nature of that problem in the space provided.

Cross-check item with:

Medical Status item # 4 (possibly)

29
 M4. Has a health care provider recommended you take any medications by on a regular basis for
a physical problem?

0=No 1=Yes
M4. Has a health care provider recommended you take
any medications on a regular basis for a physical
problem?

• Do not include various remedies given by a non-healthcare provider.

Must be for a medical condition; don’t include psychiatric medicines.
Include medicines prescribed whether or not the patient is currently taking them.
The intent is to verify chronic medical problems.

Intent/Key Points: The purpose of this question is to validate the severity of the disorder by the
independent decision to use medications for the problem by a healthcare provider. Therefore if the
medication was recommended by a medical professional, for a medical (not psychiatric or substance
abuse) condition, it should be counted -- regardless of whether the patient actually took the medication.
Medications prescribed for only short periods of time, or for specific temporary conditions (i.e., colds,
detoxification) should not be counted. Only the continued need for medication should be counted (e.g.,
high blood pressure, epilepsy, diabetes, etc.). Do not include medication for psychiatric disorders, this
will be recorded later.

Suggested Interviewing Techniques: Ask as written, including the name of the chronic problem from
the previous question, if appropriate.

"Mr. Smith, Are you taking any prescribed or recommended medication on a regular basis for any
medical problem? For example, you mentioned that you have high blood pressure. Are you taking any
prescribed medication on a regular basis for the high blood pressure or any other medical problem?"

Additional Probes:
Source of the medication (Name of physician, healthcare provider or pharmacy)
Compliance

Coding Issues:
Medications for sleep problems are usually temporary and generally fall under the psychiatric section.

Cross-check item with:

Drug /Alcohol grid, Items # 1-13 (possibly)
Medical Status, Item #3, (possibly)

30
 M5. Do you receive financial support for a physical disability?

M5. Do you receive financial support for a physical disability?

0 - No 1 - Yes
• If Yes, specify in comments.
• Include Workers' compensation, early retirement for medical disability
● Exclude psychiatric disability.

Intent/Key Points:
To identify if the patient receives any financial support from an institution for a physical (not
psychiatric) disability. Does not include support from family or friends. Can be ongoing alms such as
those from a religious organization.

Suggested Interviewing Techniques: Ask as written, with examples

“Mr. Smith, are you receiving any financial support for any physical disability?”

Additional Probes:
Details of the support such as source and amount.
Details of the medical problem that warranted the support.

Cross-check item with:

Employment/Support item #15

31
 M6. How many days have you experienced medical problems in the past 30 days?

M6. How many days have you experienced

medical problems in the past 30 days?

• Include flu, colds, injuries, etc. Include serious ailments related to drugs/alcohol, which would
continue even if the patient were abstinent (e.g., cirrhosis of liver, HIV, HCV, HBV abscesses
from needles, etc.).

Intent/Key Points: Ask the patient how many days in the past 30 he/she experienced physical/medical
problems. Do not include problems directly caused only by alcohol or drugs. This means problems
such as hangovers, vomiting, or lack of sleep that would be removed if the patient were abstinent.
However, if the patient has developed a continuing medical problem through substance abuse that
would not be eliminated simply by abstinence, include the days on which he/she experienced these
problems such as cirrhosis, phlebitis, or pancreatitis. Include symptoms of minor ailments such as a
cold or the flu.

Suggested Interviewing Technique: Ask as written, with examples.

Help the patient to understand that you need to record the exact number of days that he or she
experienced medical problems. For example, if the patient says that he felt short of breath "some of the
time," ask him to tell you the exact number of days that he felt short of breath. Finally, make sure that
the shortness of breath was a medical problem unrelated to drug or alcohol use.

"Mr. Smith, how many days have you experienced any medical problems...anything from a cold to the
flu to the back pain (or other symptom of a chronic medical problem) which you described earlier?"

Additional Probes:
Enter the exact number of days if possible.

Cross-check item with:

Medical Status items #7 and #8

32
 M7. How troubled or bothered have you been by these medical problems in the past 30 days?
M8. How important to you now is treatment for these medical problems?

For Questions M7 & M8, ask the patient to use the Patient Rating scale.

M7. How troubled or bothered have you been by

these medical problems in the past 30 days?
• Restrict response to problem days of Question M6.
M8. How important to you now is treatment for
these medical problems?
• If client is currently receiving medical treatment, refer to the
need for additional medical treatment by the patient.
Note: The patient is rating their need for additional medical services or referrals from your
agency, above any services they may already be getting.

Intent/Key Points: To record the patient's feelings about how bothersome the previously mentioned
physical ailments have been in the last month and how interested they would be in receiving (additional)
treatment. Be sure to have the patient restrict his/her response to those problems counted in Item 6.

Suggested Interviewing Techniques: When asking the patient to rate the problem, use the name of it,
rather than the term "problems." For example, if the patient reports having trouble with chest pains in
the last thirty days, ask the patient question 7 in the following way:

"Mr. Smith, how troubled or bothered have you been in the past thirty days by the chest pains that you
mentioned...or by any other medical problems?"

Ask the patient question 8 in the following way:

"Mr. Smith, how important would it be for you to get (additional) treatment for the chest pains that you
mentioned, or for any other medical problems?"

If 6=0, we suggest that you ask questions 7 and 8 in the following way, to double-check that the patient
really hasn't had problems.

"So, Mr. Smith, it sounds like you haven't had any medical problems in the past thirty days...may I
assume that you haven't been bothered by any medical problems...?"

Coding Issues:
For item 8, emphasize that you mean additional medical treatment for those problems specified in Item
6.

Cross-check item with:

Medical status, number 6. If Medical Status, number 6 equals 0, then item 7 and 8 must equal 0 also.
You can't rate the extent to which a non-existent problem is bothersome.

33
 M10 and M11 CONFIDENCE RATINGS

CONFIDENCE RATINGS
Is the above information significantly distorted by:

M10. Patient's misrepresentation? 0 - No 1 - Yes

M11. Patient's inability to understand? 0 - No 1 – Yes

Patient Misrepresentation - We have found that some patients will respond in order to present a
particular image to the interviewer. This generally results in inconsistent or inappropriate responses
which become apparent during the course of the interview. As these responses become apparent, the
interviewer should attempt to assure the patient of the confidentiality of the data, re-explain the purpose
of the interview, probe for more representative answers and clarify previous responses of questionable
validity. If the nature of the responses does not improve, the interviewer should simply discard all data
which seems questionable by entering "X" where appropriate and record this on the ASI. In the extreme
case, the interview should be terminated.

Poor Understanding - Interviewers may find patients who are simply unable to grasp the basic
concepts of the interview or to concentrate on the specific questions, usually because of the effects of
drug/alcohol withdrawal, psychiatric impairment or extreme states of emotion. Poor understanding may
also be the result of a language barrier. If either of these cases becomes apparent, the interview should
be terminated and another session rescheduled.

Please see pages 9 – 10 of this manual for complete instructions on Confidence Ratings

34
 M12. Have you ever been tested for hepatitis?
M12a. If Yes, what was the result?
M12b. Would you like help obtaining a hepatitis test?

M12. Have you ever been tested for hepatitis?

0 = No, 1=Yes
M12a. If Yes, what was the result?
1 = Hep Negative (not infected)
2 = Hep positive (infected)
3 = Don’t Know
• If M12=No, M12a =”N”

M12b. Would you like help obtaining a Hepatitis test?

Intent/Key points:
Evaluate if patient has been tested for hepatitis, has hepatitis or desires testing in an effort to evaluate
additional medical services that might be needed.

Suggested Interviewing Techniques:

Ask as written or as part of a general discussion on both hepatitis and HIV (question M13).

Additional Probes:
When tested.
Medications taken.
Any related hospitalizations.

Coding Issues:
If M12 =No, M12a=N
Always ask M12b, even if previously tested negative.

Cross-check item with:

M1 Hospitalizations
M3 Chronic medical problems
M6 Days medical problems
M7 & M8 Patient ratings

35
 M13. Have you ever been tested for HIV?
M13a. If Yes, what was the result?
M13b. Would you like help obtaining an HIV test?

M13. Have you ever been tested for HIV?

0 = No, 1=Yes
M13a. If Yes, what was the result?
1 = HIV Negative (not infected)
2 = HIV positive (infected)
3 = Don’t Know
• If M13=No, M13a =”N”

M13b. Would you like help obtaining an HIV test?

Intent/Key points:
Evaluate if patient has been tested for HIV, has HIV or AIDS or desires testing in an effort to evaluate
additional medical services that might be needed.

Suggested Interviewing Techniques:

Ask as written or as part of a general discussion on both hepatitis and HIV.

Additional Probes:
When tested.
Medications taken.
Any related hospitalizations.

Coding Issues:
If M13 =No, M13a=N
Always ask M13b, even if previously tested negative.

Cross-check item with:

M1 Hospitalizations
M3 Chronic medical problems
M6 Days medical problems
M7 & M8 Patient ratings

36
 M14. Are you currently pregnant?
M14a. If pregnant, do you have prenatal care?
M14b. If unsure, would you like help obtaining a pregnancy test?

If patient is Male, code all “N” 0=No, 1=Yes, 2=Unsure

M14. Are you currently pregnant?

M14a. If pregnant; do you have prenatal care?
M14b. If unsure; would you like help obtaining
a pregnancy test?

• If M14= 0 or 2 (No or Unsure), M14a = N

• If M14= 1 (Yes), M14b = N

Intent/Key points:
Assist patient in obtaining information about possible pregnancy, obtain a pregnancy test and obtain pre-
natal care.

Suggested Interviewing Techniques:

Ask as written or start with need for pregnancy test. For example: “Mary, is there any chance you might
be pregnant?”

Additional Probes:
When tested.
Medications taken.
Prenatal care currently in place?
Is patient taking Vitamins?

Coding Issues:
If patient is male, code “N” in all.
If M14 =No or Unsure, M14a=N
Always ask M14b.

Cross-check item with:

M6 Days medical problems
M7 & M8 Patient ratings
M13 and M13 – Hepatitis and HIV status.

37
Employment/Support Status
Introduction: The employment/support status section of the ASI was designed to help you to gather
some basic information about the resources your patient can record on a job application, as well as his
or her current sources of income, dependents and workforce problems.

E1. Education completed?

This item has been changed to follow UNESCO guidelines (primary, secondary, etc) while allowing for
the original coding in number of years.

E1. Education completed:

• Code Years and Months, Level # or both.
*Level 0 = No education
* Level 1 = Primary 1-6 yrs Yrs. Mos.
* Level 2 = Lower Secondary 7-9 yrs
* Level 3 = Upper Secondary 10-12 yrs
* Level 4 = Post Secondary, non-tertiary OR
(add’l preparation for level 5) Code Level #
* Level 5 = First Stage Tertiary
(+4 -6 years, incl BS, MS)
* Level 6 = Second Stage Tertiary (include doctorate, etc).
• Include formal education only.

E1a. Highest degree earned, specify_________________

Intent/Key points:
To record basic information about the patient's formal education.

Suggested Interviewing Techniques:

Ask as written, however use judgment in deciding the appropriate code.

Additional Probes:
College major if applicable
Name of schools or colleges

Coding Issues:
Use the same format: Code Level or Years/Months on all your ASI’s.

38
 E2. Training or technical education completed

E2.∗ Training or Technical education completed:

• Formal/organized training only. Months

Intent/Key points: For item #E2, record basic information about the patient's formal technical
education or training that could be listed on a job application. Enter the number of months of formal or
organized training that the patient has completed. Try to determine if this is valid training, such as a
legitimate training program or an apprenticeship through a recognized on-the-job training program.

Suggested Interviewing Techniques: It may be helpful to ask two separate questions. The first
question identifies whether the patient has ever received any formal technical training.

"Mr. Smith, have you ever received any job training through a formal on-the-job training program or a
training school like (name of local training school)."

The second question addresses the length of the course.

"How long did that course take to complete?"

Additional Probes:
The name of the training institute
Information about programs that the patient started, but didn't finish
Information about the patient's skills that were acquired without a formal training program

Coding Issues:
Judgment should be used in recording training during military service. Count this training only if it has
potential use in civilian life and is designed to give the patient a marketable skill or trade. That is, cook,
heavy equipment operation, equipment repair will be counted; infantry training or demolition training
generally will not be counted.

39
 Note: ASI items E4 (Do you have a valid driver's license) and E5 (Do you have an automobile
available for your use?) have been deleted from the Treatnet ASI. We have inserted item E4a as
an appropriate replacement.

E4a. Are you job options limited by lack of transportation?

E4a. Are your job options limited by lack of transportation?

0=No 1= Yes

Intent/Key points:
This item is used as an indicator of the patient's ability to get to and from work.

Suggested Interviewing Techniques:

Ask as written, code yes even if the patient reports not wanting to work. If he/she is hindered from
getting a better or better paying job because of difficulty getting to the location, you can also code yes,
even it the patient is currently work at a lower paying job.

Additional Probes:
Ask patient about limitations in obtaining work or getting a better job (if he/she is working currently)
that are the result of transportation problems or limitations.

Coding Issues:
Code Yes if any such problems exist, even if the patient does not necessarily want to travel further for a
new job.

40
 E6. How long was your longest full-time job?

E6. How long was your longest full time job?

• Full time = 35+ hours weekly;
does not necessarily mean most Years Months
recent job.

Intent/Key points: To record basic information about the patient's work history. Stress that you are
interested in the full time job the subject held for the longest time, not a part-time job.

Suggested Interviewing Techniques: Ask as written. Emphasize "full-time."

"Mr. Smith, How long was your longest full-time job?"

It may be helpful, if the patient has a difficult time answering this question as stated, to gather
information about the patient's current job status, and work backwards in time, recording information
about all of his or her full-time jobs. Although it may seem as if you are doing extra work, the
information will help you answer Item #10 (usual employment pattern, past 3 years).

"So, Mr. Smith are you currently working? How long have you been working at this job?
What were you doing before this job? How long were you working at that job?" and so on...

Additional Probes:
Names of places where the patient worked
Job position title
Reasons for leaving jobs
Years that the patient worked at each job
Information about part-time jobs

Cross-check item with:

Employment/Support status, item #10 (possibly)

41
 E7. Usual (or last) occupation

E7.∗ Usual (or last) occupation?

(specify) ___________________________________
(Use International Classification references page 1)
Intent/Key points: To record information about the patient's job, in addition to the classification of the
job as defined by the International Standard Classification of Occupations (ISCO). Record the usual
occupation, even if the patient has recently been working in a different capacity. If the patient does not
have a usual occupation, then record the most recent job.

Suggested Interviewing Techniques: Ask about the patient's usual job. If the patient reports doing
"whatever comes along," ask about his last occupation.
"Mr. Smith, what do you usually do for a living?"
If Mr. Smith does many different things..."Mr. Smith what is the last job that you've held?"

Additional Probes:
Names of places where the patient has worked

Coding Issues:
Code as "N" only when the patient has never worked at all.

Be sure to specify within general classes of work (i.e., if salesman, then computer sales, used car sales,
etc.).

The following table for the ISCO options is on the face page of your ASI. They are listed below in
more detail.

International Standard Classification of Occupations

1. Legislators, officials – Main tasks are forming government policies, laws, regulations and overseeing
implementation.
2. Professionals - Requires high level of professional knowledge in the fields of physical and life sciences,
or social sciences/humanities.
3. Technicians /assoc. professionals - Requires technical knowledge, experience in fields of physical, life
or social sciences, humanities.
4. Clerks - Performs secretarial duties, word processing and other customer-oriented clerical duties.
5. Service & Sales - Includes services related to travel, catering, shop sales, housekeeping, and
maintaining law and order.
6. Skilled agricultural and fishery workers - Consists of growing crops, breeding or hunting animals,
catching or cultivating fish, etc.
7. Craft & Trades - Main tasks consist of constructing buildings and other structures, making various
products. Includes handicrafts.
8. Plant and machine operators - Main tasks consist of driving vehicles, operating machinery, or
assembling products.
9. Elementary Occupations – Includes simple and routine tasks, such as selling goods in streets, doormen,
cleaning, and working laborers.
0. Armed forces - Includes army, navy, air force workers, etc. Excludes non-military police, customs, and
inactive military reserves.

42
1. Legislators, senior officials and managers
This major group includes occupations whose main tasks consist of determining and formulating
government policies, as well as laws and public regulations, overseeing their implementation,
representing governments and acting on their behalf, or planning, directing and coordinating the policies
and activities of enterprises and organizations, or departments. Reference to skill level has not been
made in defining the scope of this major group, which has been divided into three sub-major groups,
eight minor groups and 33 unit groups, reflecting differences in tasks associated with different areas of
authority and different types of enterprises and organizations.

2. Professionals
This major group includes occupations whose main tasks require a high level of professional knowledge
and experience in the fields of physical and life sciences, or social sciences and humanities. The main
tasks consist of increasing the existing stock of knowledge, applying scientific and artistic concepts and
theories to the solution of problems, and teaching about the foregoing in a systematic manner. Most
occupations in this major group require skills at the fourth ISCO skill level. This major group has been
divided into four sub-major groups, 18 minor groups and 55 unit groups, reflecting differences in tasks
associated with different fields of knowledge and specialization.

3. Technicians and associate professionals

This major group includes occupations whose main tasks require technical knowledge and experience in
one or more fields of physical and life sciences, or social sciences and humanities. The main tasks
consist of carrying out technical work connected with the application of concepts and operational
methods in the above-mentioned fields, and in teaching at certain educational levels. Most occupations
in this major group require skills at the third ISCO skill level. This major group has been divided into
four sub-major groups, 21 minor groups and 73 unit groups, reflecting differences in tasks associated
with different fields of knowledge and specialization.

4. Clerks
This major group includes occupations whose main tasks require the knowledge and experience
necessary to organize, store, compute and retrieve information. The main tasks consist of performing
secretarial duties, operating word processors and other office machines, recording and computing
numerical data, and performing a number of customer-oriented clerical duties, mostly in connection
with mail services, money-handling operations and appointments. Most occupations in this major group
require skills at the second ISCO skill level. This major group has been divided into two sub-major
groups, seven minor groups and 23 unit groups, reflecting differences in tasks associated with different
areas of specialization.

5. Service workers and shop and market sales workers

This major group includes occupations whose main tasks require the knowledge and experience
necessary to provide personal and protective services, and to sell goods in shops or at markets. The main
tasks consist of providing services related to travel, housekeeping, catering, personal care, protection of
individuals and property, and to maintaining law and order, or selling goods in shops or at markets.
Most occupations in this major group require skills at the second ISCO skill level. This major group has
been divided into two sub-major groups, nine minor groups and 23 unit groups, reflecting differences in
tasks associated with different areas of specialization.

6. Skilled agricultural and fishery workers

This major group includes occupations whose tasks require the knowledge and experience to produce
farm, forestry and fishery products. The main tasks consist or growing crops, breeding or hunting
43
animals, catching or cultivating fish, conserving and exploiting forests and, especially in the case of
market-oriented agricultural and fishery workers, selling products to purchasers, marketing
organizations or at markets. Most occupations in this major group require skills at the second ISCO skill
level. This major group has been divided into two sub-major groups, six minor groups and 17 unit
groups, reflecting differences in tasks associated with differences between market-oriented and
subsistence agricultural and fishery workers.

7. Craft and related trades workers

This major group includes occupations whose tasks require the knowledge and experience of skilled
trades or handicrafts which, among other things, involves an understanding of materials and tools to be
used, as well as of all stages of the production process, including the characteristics and the intended use
of the final product. The main tasks consist of extracting raw materials, constructing buildings and other
structures and making various products as well as handicraft goods. Most occupations in this major
group require skills at the second ISCO skill level. This major group has been divided into four sub-
major groups, 16 minor groups and 70 unit groups, reflecting differences in tasks associated with
different areas of specialization.

8. Plant and machine operators and assemblers

This major group includes occupations whose main tasks require the knowledge and experience
necessary to operate and monitor large scale, and often highly automated, industrial machinery and
equipment. The main tasks consist of operating and monitoring mining, processing and production
machinery and equipment, as well as driving vehicles and driving and operating mobile plant, or
assembling products from component parts. Most occupations in this major group require skills at the
second ISCO skill level. This major group has been divided into three sub-major groups, 20 minor
groups and 70 unit groups, reflecting differences in tasks associated with different areas of
specialization.

9. Elementary occupations
This major group covers occupations which require the knowledge and experience necessary to perform
mostly simple and routine tasks, involving the use of hand-held tools and in some cases considerable
physical effort, and, with few exceptions, only limited personal initiative or judgment. The main tasks
consist of selling goods in streets, door keeping and property watching, as well as cleaning, washing,
pressing, and working as laborers in the fields of mining, agriculture and fishing, construction and
manufacturing. Most occupations in this major group require skills at the first ISCO skill level. This
major group has been divided into three sub-major groups, ten minor groups and 25 unit groups,
reflecting differences in tasks associated with different areas of work.

0. Armed forces
Members of the armed forces are those personnel who are currently serving in the armed forces,
including auxiliary services, whether on a voluntary or compulsory basis, and who are not free to accept
civilian employment. Included are regular members of the army, navy, air force and other military
services, as well as conscripts enrolled for military training or other service for a specified period,
depending on national requirements. Excluded are persons in civilian employment of government
establishments concerned with defense issues: police (other than military police); customs inspectors
and members of border or other armed civilian services; persons who have been temporarily withdrawn
from civilian life for a short period of military training or retraining, according to national requirements,
and members of military reserves not currently on active service. Reference to a skill level has not been
used in defining the scope of this major group.

44
E9. Does someone contribute the majority if your support?

E9 Does someone contribute the majority of your support?

0 - No 1 - Yes
• Is patient primarily financially supported on a regular
basis from family/friends. Include spouse's contribution; exclude support by an institution.
“Housing” is considered the majority of someone’s support.

Intent/Key points: To record information about additional sources of financial support. Ascertain
whether the patient is receiving any regular support in the form of cash, housing or food from a friend or
family member, not an institution. A spouse's contribution to the household is included.

Suggested Interviewing Techniques: Ask as written, with examples. Stress that you mean financial
support. Help the patient to understand that financial support can mean housing and food, as well as
cash.

"Mr. Smith, is anyone currently contributing to your support? For example, is anyone allowing you to
stay with them? Is anyone putting money toward your bills? Does your wife work?"

"Is the support that you are receiving the majority of your support?"

Note: Clients who are living with their parents may get defensive if you ask them directly about
whether their parents are helping them financially. There is no need to press them to admit that their
parents are helping them. You already have information about their current address (see "Current
Address" on front page). If they report that they aren't paying any room and board, you may code item
#9 as Yes. You might consider asking, "Are you receiving money from any source other than your
parents?”

Coding Issues:
If the information from Item #s 12 to 17 does not confirm the initial response from item #9, then clarify
any discrepancy.

Record information only about financial support from individuals, not institutions, such as the
Department of Public Assistance.

Cross-check item with:

Employment/Support item #s 12-17 (support)

45
E10. Which of these represents how you spent the majority of the past three years?

E10. Which of these represents how you spent the majority of the past three years?

1. Full time (35+ hours) 5. Military

2. Part time (regular hours) 6. Retired/Disability
3. Part time (irregular hours) 7. Unemployed
4. Student 8. In controlled environment
9. Homemaker
• Answer should represent the majority of the last 3 years, not just the most recent selection.
If there are equal times, select category which best represents the current situation.

Intent/Key points:
The interviewer should determine which choice is most representative of the past 3 years, not simply the
most recent. Full time work is regular and greater than 35 hours per week. Regular part-time work is a
job in which the patient has a work schedule less than 35 hours per week but it is regular and sustained.
It doesn’t have to be the same hours each week. Irregular part-time work refers to jobs in which the
patient works on a part-time basis but not has worked on a reliable schedule such as seasonal jobs.
When there are equal times in more than one category, record that which represents the most current
situation.

Suggested Interviewing Techniques: It may take a series of questions to get the correct response to
this item. Depending on the patient, you might consider beginning by asking about their current work
situation, and working backwards in time. Other patients find it easier to think back to what they were
doing three years ago, and work forwards.

If you know he is employed:

"Is your current job full-time? How long have you held this job?
What kind of work did you do before this job? Was that job full-time?"
If you know he is unemployed:
"How long have you been unemployed? What were you doing in your previous job?
How long did you hold that job? Was it a full-time or part-time job?"

Regardless, the information that you finally record will represent the patient's employment pattern during
most of the past three years.

Additional Probes: Names of work places, types of schedules, etc.

Coding Issues:
Record the code that corresponds to the pattern that the patient held during the greatest part of the past
three years. For example, you would code this item, "1" for a patient who worked full-time for two of the
last three years, even if the patient had not worked for the past year. If the patient has been employed for
the past year and a half after being unemployed for a year and a half, record that the patient was "usually"
employed (the periods of employment and unemployment were equal; however the period of employment
was the most recent).

Note: The option “Homemaker” was added to the Treatnet ASI. This should be coded only if the
individual is an active homemaker involved in raising children and/or maintaining a household as
a full-time endeavor.
46
 E11. How many days in the past 30 did you work for pay?

E11. How many days in the past 30 did you work for pay?

• Include days actually worked, paid sick days and paid vacation.

Intent/Key points: To record basic information about current work situation. Record number of days in
which the patient was paid (or will be paid) for working. Jobs held while incarcerated or as a patient in a
hospital are not counted. Paid sick days and vacation days are included here.

Suggested Interviewing Techniques: Ask as written. Emphasize that you're interested in "under the
table" work also. Often patients report that they were paid for working "every day." The interviewer
must clarify whether the patient worked a five day week (20), or a six day week (24). Ask for the exact
number of days worked this month.

"Mr. Smith, how many days were you paid for working, including under the table work, in the past 30?"

Additional Probes:
Name of employer
Explanation for days of work missed
Days of overtime

Coding Issues:
A five day work week will be coded "20"

Cross-check item with:

Employment/Support #10 (possibly)

47
 E12-17. How much money did you receive from the following sources in the past 30 days?

Note: For the Treatnet ASI, each country will code amounts in their own currency. For this
reason, the number of spaces for entering amount has increased from 5 to 7 and spaces are
entered between each 000th.

Please specify type of currency used in the right-and column comments section for later
comparison purposes.

For questions E12-17: How much money did you receive from the following sources in the past 30 days?
* Use your local currency.
E12. Employment?
• Net or "take home" pay, include
any money earned except illegal income

E13. Unemployment Compensation

E14. Social Welfare

• Money given by government to assist with living
expenses.

E15. Pensions, benefits, social security?

• Include disability, pensions, retirement,
& workers' compensation and veterans benefits.

E16. Mate, family, or friends?

• Money for personal expenses. Also code unreliable sources of
income, windfalls (unexpected money) money from loans,
inheritance. (Record cash payments only, etc.).

E17. Illegal?
•Cash obtained from drug dealing, stealing, selling stolen goods,
Illegal gambling, prostitution, etc.
Do not count estimated cash value of drugs or other items
obtained illegally

Intent/Key points:

12. Employment: This is net or take-home pay, any money earned except illegal income.

13. Unemployment Compensation: Money provided by an agency or government due to recent loss
of a job when the loss is not due the employee’s behavior or deficiencies. This would include
employees losing their jobs because of “lay-offs” or “downsizing”

14. Social Welfare: This includes any money provided by a government agency to assist with living
expenses. In cases where this could include coupons or vouchers for food or transportation include the
cash value of these items here.

15. Pension, Benefits or Social Security: This includes pensions or benefits for disability or
retirement, veteran's benefits, workman's compensation, etc.

48
16. Mate, Family or Friends: The purpose of this question is to determine how much additional
pocket money the patient had during the past 30 days -- not to determine whether he/she was supported
with food, clothing and shelter. Record only money borrowed or received from one's mate, family or
friends. These refer only to cash payments given to the patient and not to an estimated value of housing
and food provided. (This was assessed in item 9.). Do not record the earnings of a spouse -- just the
dollars actually given to the patient to spend. This is also the place to code any money received in the
past 30 days from unreliable sources of income such as windfalls (unexpected money) money from
loans, inheritance, etc.

17. Illegal: This includes any money obtained illegally from drug dealing, stealing, selling stolen
goods, gambling (or illicit gambling in places where gambling can be legal), etc. If patient has received
drugs or other items in exchange for illegal activity, do not count the estimated cash value of these
items. Simply note this in the comment sections here and again in the legal section. Again, the focus in
on cash available to the patient, not an estimate of the patient's net worth.

Suggested Interviewing Techniques: Read as written, with examples for each item.

Coding Issues:
Include under "Mate, family or friends" any coincidental or windfall income from licit gambling (where
appropriate), loans, inheritance, tax returns, etc., or any other unreliable source of income.

Cross-check item with:

Employment/Support status, item 9
Drug/Alcohol #19a

49
 E18. How many people depend on your for the majority of their food, shelter, etc.?

E18. How many people depend on you for the majority

of their food, shelter, etc.?
• Must be regularly depending on patient, do include alimony/child support, do not include the
patient or self-supporting spouse, etc.
Intent/Key points: Stress that these people must regularly depend upon the patient for financial
support. These are not simply people to whom the patient has occasionally given money. Do not
include the patient himself or a spouse who is self-supporting. Do include dependents that are normally
supported by the patient but due to unusual circumstances, have not received support recently. Alimony
and child support payments are included as indications of persons depending on the patient, if
appropriate.

Suggested Interviewing Techniques: Read as written, with examples.

"Mr. Smith, how many people depend on you for the majority of their food or shelter? For example, are
any children living with you who depend on you to buy their food for them?"

Additional Probes:
If paying child-support, is the money taken directly out of your pay check?

Cross-check item with:

Other items that refer to children or other dependents.

50
 E19. How many days have you experienced employment problems in the past 30?

E19. How many days have you experienced

employment problems in the past 30 days?

• Include inability to find work, if they are actively looking for work, or problems with present job
in which that job is jeopardized.
• If the patient has been incarcerated or detained all of the past 30 days, code "NN", they can’t
have had problems

Intent/Key points: Include inability to find work (only if patient has tried), or problems with present
employment (if employment is in jeopardy or unsatisfactory, etc.).

Suggested Interviewing Techniques: The way you ask this question depends on the information that
you have about the patient so far. If the patient is working, it is appropriate to ask as written, with
examples.

"Mr. Smith, how many days have you had employment problems in the past 30? For example, have you
been put on probation at work for any reason?"

If the patient has not worked in the past 30 days, you should ask a preliminary question, which is not
coded.

"Have you actively looked for work in the past 30 days?"

If the answer is "yes," ask how many days the patient actively looked for work.
Record that response in item #19 and ask items #20 and #21. Refer to the number of days the patient
couldn't find work as employment problems.

Additional Probes:
Nature of employment problems

Coding Issues:
It is important to distinguish if the problems reported here are simply interpersonal problems on the job
(e.g., can't get along with certain members of the work force), or if the problems are entirely due to
alcohol/drug use. Problems such as these would most likely be counted under the Family/Social or the
Alcohol/Drug section, rather than this section.

Do not include bad feelings about employment prospects or the wish to make more money or change
jobs unless the patient has actively attempted these changes and has been frustrated.

Coding of N (not applicable):

In a situation where the patient has not had the opportunity to work, due to incarceration or other
controlled environment, it is, by definition, not possible for him/her to have had employment problems.
In situations such as this where the patient has not had the opportunity to meet the definition of a
problem day, the appropriate answer is an "N" and the patient rating on how troubled or bothered they
are that follows should also be "N" since it depends on the problem days question.
51
 E20. How troubled or bothered have you been by these employment problems in the past 30
days?

E21. How important to you now is counseling for these employment problems?

For Questions E20 & E21, ask the patient to use the Patient Rating scale.

E20. How troubled or bothered have you been by these employment problems in the past 30 days?
• If E19=N, code N

E21. How important to you now is counseling for these employment problems?
• Stress help in finding or preparing for a job, getting training for a job, not giving them a job.
Note: The patient is rating their need for employment/support services, referrals, etc from
your agency.

Intent/Key points: These ratings are restricted to those problems identified by Item 19. For Item 21,
stress that you mean help finding or preparing for a job -- not giving them a job.

Suggested Interviewing Techniques: The way you ask this question depends on the information that
you have about the patient so far.

In Item #19, if the patient identified either a problem on the job, or a problem finding a job after
actively looking for one, ask the questions as written:

"Mr. Smith, how troubled or bothered have you been by the employment problems that you had in the
past 30 days, such as the time you spent on work probation?"

If the patient reported in Item #19 that he or she has not worked in the past 30 days, you should code
#20, "0" without asking it. We assume that if the patient has not actively looked for work in the past
month, he or she has not been bothered by employment problems. The interviewer should still ask #21
in the following way:

"Mr. Smith, how important would it be for you to get employment counseling?"

Additional Probes:
Job Sources contacted by the patient

Coding Issues:
In a situation where the patient has not had the opportunity to work, due to incarceration or other
controlled environment, it is, by definition, not possible for him/her to have had employment problems.
In situations such as this where the patient has not had the opportunity to meet the definition of a
problem day, the appropriate answer is an "N" in the patient rating for how troubled or bothered they are
since it depends on the problem days question.

Cross-check item with:

Employment/Support item #19

52
 E23 & E24 CONFIDENCE RATINGS

CONFIDENCE RATINGS
Is the above information significantly distorted by:

E23. Patient's misrepresentation? 0-No 1-Yes

E24. Patient's inability to understand? 0-No 1-Yes

Patient Misrepresentation – Remember, this code is not used to designate “minimization” or

“denial”.

Poor Understanding – Remember, top 3 reasons for coding poor understanding:

1. Language barrier
2. Patient is under effects of drugs or alcohol or in withdrawal.
3. Patient is experiencing severe psychiatric or psychotic symptoms.

Please see pages 9 – 10 of this manual for complete instructions on Confidence Ratings

53
 Drug and Alcohol Use
Introduction: The Drug/Alcohol use section of the ASI helps you to gather some basic information
about the patient's substance abuse history. It addresses information about current and lifetime
substance abuse, consequences of abuse, periods of abstinence, treatment episodes, and financial burden
of substance abuse. We recommend that you add extra questions as you deem necessary, to complete
your treatment plan.

The manual addresses the "Drug Grid," Drug and Alcohol items 1-12 in three separate sections:
a. Patient's use in the past 30 days
b. Lifetime use
c. Route of administration

We recommend that for each substance, you ask the questions pertaining to the last thirty days before
you ask about lifetime use.

The following list of instructions appears on the face page of your Treatnet ASI: These will be
discussed in the appropriate Q by Q instructions.

ALCOHOL/DRUG USE INSTRUCTIONS:

The following questions refer to two time periods: the past 30 days and lifetime. Lifetime refers to the
time prior to the last 30 days.

⇒ 30 day questions only require the number of days used.

⇒ Lifetime use is asked to determine extended periods of regular use.
⇒ Regular use =
1. Three or more times per week
2. Binges
3. Problematic irregular use
⇒ Ask these questions with the following sentence stems -
→ “How many days in the past 30 have you used....?”
→ "How many years in your life have you regularly used....?"

D2. Alcohol to intoxication does not necessarily mean "drunk", use the words “to where you felt the
effects", “got a buzz”, “high”, etc. instead of intoxication. As a rule, 3 or more drinks in one sitting or 5 or
more drinks in one day is coded as “intoxication"

54
 The following list of examples of drugs in each category is also on the face page of your Treatnet
ASI.

LIST OF COMMONLY USED DRUGS:

Alcohol: Beer, wine, liquor, grain (methyl alcohol)

Heroin: Smack, H, Horse, Brown Sugar
Methadone: Dolophine, LAAM
Opiates: Opium, Heroin, Fentanyl, Buprenorphine, pain killers - Morphine, Dilaudid,
Demerol, Percocet, Darvon, etc.
Barbiturates: Nembutal, Seconal, Tuinal, Amytal, Pentobarbital, Secobarbital, Phenobarbital,
Fiorinal, Doriden, etc.
Sed/Hyp/Tranq: Benzodiazepines = Valium, Librium, Ativan, Serax, Tranxene, Dalmane, Halcion,
Xanax, Miltown, Other = Chloral Hydrate, Quaaludes
Cocaine: Cocaine Crystal, Free-Base Cocaine or Crack, Rock, etc.
Amphetamines/: Monster, Crank, Benzedrine, Dexedrine, Ritalin, Preludin, Methamphetamine,
Stimulants Speed, Ice, Crystal, Khat
Cannabis: Marijuana, Hashish, Pot, Bango Igbo, Indian Hemp, Bhang, Charas, Ganja, Mota,
Anasha
Hallucinogens: LSD (Acid), Mescaline, Psilocybin (Mushrooms), Peyote, Green, PCP
(Phencyclidine), Angel Dust, MDMA, Ecstasy.
Inhalants: Nitrous Oxide (Whippits), Amyl Nitrite (Poppers), Glue, Solvents, Gasoline,
Toluene, Etc.

*Note: Some “designer” drugs, or synthetic drugs not made in pharmaceutical companies can include
more than one type of active drug. For example, the drug “Ecstasy” may include a combination of
amphetamines and hallucinogenic ingredients. In these cases, code this use in both categories.

55
The Drug and Alcohol Grid:

ALCOHOL/DRUGS
Note: Route of Administration (ROA) Types:

1. Oral (anything swallowed)

2. Nasal (or any other sub- coetaneous membrane administration)
3. Smoking
4. Non-IV injection (such as IM or “skin popping”
5. IV (shooting directly into a vein).

• . In cases where two or more routes are used, the most serious route should be coded. The routes listed are from least severe to most severe.
Lifetime
Past 30 Days (years) ROA

D1 Alcohol (any use at all, 30 days)

D2 Alcohol - to intoxication
D3 Heroin
D4 Methadone
D5 Other Opiates/Analgesics
D6 Barbiturates
D7 Sedatives/Hypnotics/
Tranquilizers
D8 Cocaine
D9 Amphetamines/Stimulants
D10 Cannabis
D11 Hallucinogens
D12 Inhalants
D13 More than 1 substance
(including alcohol)

56
D1-12: Drug and Alcohol Use Past 30 Days.

Intent/Key points: To record information about recent substance use. Record the number of days in
the last thirty that the patient reported any use at all of a particular substance. Note: It is important to
ask all drug grid questions regardless of the presenting problem (e.g., an alcoholic may be combining
drugs with drinking; a cocaine user may be unaware of a drinking problem).

Suggested Interviewing Techniques: Be sure to prompt the patient with examples (using slang and
brand names) of drugs for each specific category. We recommend that you ask this question as written
below.

"Mr. Smith, how many days in the past thirty have you used ______________?"

NOT How many times in the past thirty days.

There may be a big difference between the number of days and the number of times.
NOT...How many drinks or "lines" or "rocks" in the past thirty days.
There may be a big difference between the number of days and the number of drinks.

Note: Item #2 -- Alcohol to Intoxication -- does not necessarily mean getting drunk. In fact, it is not
advisable to use the phrase "to intoxication" in asking the question since patients' interpretations of this
phrase vary so widely. Instead ask the number of days the patient felt the "effects" of alcohol, e.g., got
"a buzz," "high," etc. If the patient gives evidence of considerable drinking yet denies feeling the
effects of the alcohol, get an estimate from the patient of how much he/she has been drinking. (He/she
may be denying the effects or manifesting tolerance.). In such cases, as a rule, the equivalent of 3 or
more drinks in one sitting or 5 or more in a day can be considered heavy alcohol use or "Alcohol to
Intoxication" for Item 02.

Additional Probes:
Quantity of use per day
Estimated amount of money spent on the substance per day
Usage patterns (only on week-ends, for example)

Coding Issues:

1. Prescribed medication is counted if it fits into one of the 12 categories and is coded under the
appropriate generic category.
2. If D5 – other opiates>0, Specify type.
3. LAAM should be recorded under "Methadone." Antagonists, such as Antabuse and Naltrexone are
not recorded under the drug grid but should be noted as comments at the bottom of the page.
4. Cocaine is used in many forms and these often have different names. "Crack" or "rock" cocaine is
simply the "freebased" (smokable) form of cocaine. All different forms of cocaine
(e.g., crystal cocaine - snorted, freebase cocaine - smoked, crystal cocaine - injected) should be
counted under the cocaine category.
5. Code Ecstasy and MDMA in D11 - Hallucinogens

Cross-check Drug/Alcohol Use items 1-12 with:

Drug/Alcohol Use, Item 13
Drug/Alcohol Use, Item 20
Drug/Alcohol Use, Item 22 (possibly)
57
D1-12: Drug and Alcohol Use, Lifetime Use

Intent/Key points: To record information about extended periods of regular use. The "rule of
thumb" for regular when the ASI was developed in the 1980’s was 3 or more times per week. However,
it is true that cocaine, alcohol and even some other drugs can be regularly and severely abused in two-
day binges. Therefore, the interviewer should probe for evidence of regular problematic use, usually to
the point of feeling the effects and to the point where it compromises other normal activities such as
work, school or family life. Problematic use here will generally be obvious and it should be counted
even if it is less than 3 times per week. As stated on the Treatnet ASI face-sheet, the definition now
includes: 1. Three or more times per week, 2. Binge use, and 3. Problematic irregular use. If there is
minor, episodic, irregular use of any drug (patient used Acid for 3 months one summer), please record
this under "Comments" but do not include under Items 1-12 as it does not reflect ongoing, regular use.

Suggested Interviewing Techniques: Generally, you will need to ask a number of questions to get the
information that you will eventually code in the boxes in the grid. With many patients, it is possible to
get a valid response by asking the question the following way:

"Mr. Smith, How many years of your life have you regularly used ______________?
By regularly,

However, when interviewing patients with complicated substance use histories, it may be helpful to ask
them the year that they began to use the substance regularly, and work forward in time from there.

"Mr. Smith, when did you start using alcohol regularly?"

"Since you started, have you ever abstained for over a month?"
"When did you pick up again?"

After you have recorded the periods of time that the patient has used each substance, you know what to
record in the lifetime section of the drug grid. You may consider summarizing it for the patient like
this:

"So Mr. Smith, it sounds like you started using cocaine regularly while you were in high school in 1978.
You continued to use it regularly until 1981, when you got into treatment. You stayed clean until three
months ago, when your brother died. You have been using regularly since then. So, in your lifetime,
you have used it regularly for three years and three months (code three years).

Additional Probes:
Events that occurred at the same time that the patient was using (or abstaining from) a substance.
Differences in route of administration over time

Coding Issues:
1. Six months or more of regular or problematic use will be considered one year; less than six months of
problematic use should be noted in the comments section but not counted as a year.

2. See Coding Issues, Drug and Alcohol Use Past 30 Days for other relevant coding issues.

Cross-check items with:

Drug/Alcohol Use, Item #s 13, 20, 22

58
D1-12: Drug and Alcohol Use, Route of Administration (ROA)

Intent/Key points: To record information about the patient's route of administration for each substance
listed. The code for the administration is listed below:

1) Oral – includes anything swallowed, usually in pill or capsule form.

2) Nasal - also includes any other sub-coetaneous membrane administration such as acid absorbed in the
eye, sublingual administration of pills, or alcohol or other drugs absorbed through rectal tissue.
3) Smoking – includes inhalation of any kind.
4) Non-IV injection – includes “skin-popping”, intramuscular injections, etc.
5) IV injection - injecting directly into a vein.

Suggested Interviewing Techniques: Use the name of the specific drug. Provide examples.

"Mr. Smith, how are you using the cocaine? For example, are you snorting it...or are you freebasing
it...are you injecting it?"

Additional Probes:
Use of drug combinations

Coding Issues:
1. In cases where two or more routes are routinely used, the most serious route should be coded.
2) Nasal includes all mucus membrane absorption
3) Smoking includes inhalation of any kind
4) Non-IV injection includes IM, skin popping, etc.

59
 D1-12: Drug and Alcohol Use, Age of First Use

The Treatnet ASI also has an optional column for “Age of First Use” to the right of the Drug and
Alcohol Grid. A majority of Treatnet participants requested this addition, however, it is entirely
optional.

Intent/Key points: This item helps the interviewer evaluate the patients’ recent use of drugs or alcohol
and therefore, begin to evaluate the need for detoxification services.

Suggested Interviewing Techniques:

Ask only if the patient has used the drug in the past 30 days.

“Mr. Smith, I know you told me that you used heroin 25 days in the past 30, when is the last day you
used heroin?

Additional Probes:
Amount of use.

Coding Issues:
If patient has not used the drug recently, do not ask date of last use. This is only used to measure recent
use and assist in determining detoxification needs.

Optional: Age of First Use

______________________________________________
__
______________________________________________

______________________________________________

If D5>0, Specify ________________________________

______________________________________________

______________________________________________

_______________________________________________

_______________________________________________

_______________________________________________

_______________________________________________

______________________________________________

60
 D13. Multiple Substances:

Intent/Key points: To record information about drug combinations.

Under "Past 30 Days" ask the patient how many days he used more than one (ASI category) substance
including alcohol. Under

Under “Lifetime Use" ask the patient how many years he regularly used more than one substance
including alcohol.

Suggested Interviewing Techniques: By reviewing the information in the drug grid, you should be
able to estimate the number of days that the patient used more than one drug in the past 30, as well as
the number of years he regularly used more than one substance. To insure that you are getting accurate
information, ask the following:

"How many days in the past 30 have you used more than one substance per day?"
and
"How many years have you regularly used more than one substance?"

A useful technique for gathering accurate information for D13 is to begin by asking clients about the
two substances they report using most frequently. For example, if you are asking about the Past 30
Days and a client has reported using Alcohol and Marijuana most frequently (for 20 & 10 days,
respectively) you might ask D13 by saying, “Think about the 20 days during which you used Alcohol.
Were your 10 days of Marijuana use in combination with the Alcohol?” If the usage overlaps, the
lowest number possible for your code in D13 would be 10. If the usage does not overlap, move on to
the next most frequently used substance and repeat your question, trying to tease apart the actual
number of days on which the client used more than one substance simultaneously.

Additional Probes:
The substances which the patient used together.
Substances which the patient used within the same day, but did not use together.
The names of drugs that were prescribed.

Cross-check items with:

Drug/Alcohol Item #s 1-12

Note: Any time the patient has used 2 drugs (or alcohol with any other drug) for 30 of the
past 30 days, the overlap (more than 1 substance per day) will always be 30.

61
D38. Have you ever used needles or works after someone else had used them?
D38a. How many times in the past 30 days?

If any item D3 - D11 Route of Administration = 4 or 5 (injection)

Past 30 days Lifetime
D38. Have you ever used needles or works after someone else had used them?
0=No, 1=Yes.
D38a. How many times in the past 30 days?

Intent/Key points: To evaluate risky behavior associated with drug use.

Suggested Interviewing Techniques: Ask as written with examples.

“Mr. Smith, have you ever used needles, works or any other equipment like cotton balls or spoons, after
someone else had used it?

Additional Probes:
Where do you get your works?
How do you sterilize your equipment?

Coding Issues:
Code N if no drug ROA D1 – D12 is coded 4 or 5.
D38a is number of times, not number of days.

Cross-check item with:

Medical 12 & 13 Hepatitis and HIV questions

62
D14a & D14b: Primary and Secondary Drugs of Abuse

D14a. Identify the primary substance of abuse:

D14b. Identify the secondary substance of abuse:

• Interviewer should determine the primary and secondary drugs

of abuse. Code the number next to the drug in questions 01-12 • D14b can be coded N

Intent/Key points: To record the patient's current primary and secondary substances of abuse.

Enter one of the following codes from D1 – D12:

1 - ALCOHOL 9 - AMPHETAMINES
3 - HEROIN 10 - CANNABIS
4 - METHADONE 11 - HALLUCINOGENS
5 - OTHER OPIATES/ANALGESICS. 12 - INHALANTS
6 - BARBITURATES
7 - OTHER SED/HYP/TRANQ
8 - COCAINE

Suggested Interviewing Techniques: If you have to ask the question, ask it as it appears on the ASI.
Allow the patient to report more than one substance as his major problem.

"Mr. Smith, which substance is your primary drug of abuse?"

Coding Issues:
Refer to the Drugs of Abuse chart on the front of your ASI to find categories that specific drugs may fit
in (i.e. LSD is coded in 11=Hallucinogens). Some patients may report that legal methadone is their
primary drug problem, as in the case of patients who are seeking detoxification and drug-free treatment.
This can be used as the major problem in Item 14a or b in this case.

Cross-check item with:

Coding in Drug/Alcohol Items #1-12 past 30 days and lifetime.

63
 D15. How long was your last period of voluntary abstinence from this major substance?
D16. How many months ago did this abstinence end?

D15. How long was your most recent period of voluntary abstinence from these major substance(s)?
Months
• Most recent sobriety lasting at least one month.
Periods of hospitalization/incarceration do not count.
Periods of Antabuse, methadone, or Naltrexone use do count.
• Code 00 = never abstinent.

D16. How many months ago did this abstinence end?

• If D15 = 00, then D16 = NN. .
• Code 00 = still abstinent. Months

Intent/Key points: To record details about the patient's last successful attempts at abstaining from the
current problem substance. Ask the patient how long he/she was able to remain abstinent from the
major drug(s) of abuse (coded in items D1 – D12). Stress that this was the last attempt (of at least one
month) at abstinence, not necessarily the longest.

Suggested Interviewing Techniques: You may need to ask a series of questions to get accurate
responses to these items.

For example, for Item #15, you may need to ask:

"Have you ever stopped using _____________for over a month?"
"When was the last time you stopped using ___________ for over a month?"
"Did you stay clean on your own, or were you in some sort of a controlled environment at the time?"
"How long did that period of abstinence last?"

For Item #16, you should ask:

"How many months ago did this abstinence end?"

Additional Probes:
Circumstances surrounding the periods of abstinence
Circumstances surrounding the end of the abstinence period

Coding Issues:
Periods of hospitalization or incarceration are not counted. Periods of abstinence during which the
patient was taking Methadone, Antabuse or Naltrexone as an outpatient are included.

If the patient has not been abstinent for one month, enter "00" for Item #15 and "N" for item 16.

If the period of abstinence is current, enter "00" for item #16.

Cross-check item with:

Drug/Alcohol Items #1-12

64
 D17. How many times have you had alcohol DT’s?

D17.∗ How many times have you had:

Alcohol DT's?
• Delirium Tremens (DT's): Occur 24-48 hours after last drink, or significant decrease in alcohol
intake, shaking, severe disorientation, fever, hallucinations, they usually require medical
attention.

Intent/Key points: To record information about use of alcohol heavy enough to cause Alcohol DT’s.

Suggested Interviewing Techniques: Ask as written. Follow-up with additional questions which will
determine how you will code the response.

"Mr. Smith, how many times have you had alcohol DT’s?"
Did you need medical attention?
"Did someone have to help you to the hospital?"

Additional Probes:
Whether or not the patient was hospitalized
Length of Hospitalization.

Coding Issues:

1. Definition of Delirium Tremens (DT's):

DT's occur 24 to 48 hours after a person's last drink. They consist of tremors (shaking) and delirium
(severe disorientation). They are often accompanied by a fever. There are sometimes, but not always,
hallucinations. True DT's are usually so serious that they require some type of medical care or outside
intervention. Impending DT's as diagnosed by a professional would also be considered serious enough
to count as DT's.

2. Problems sometimes mistaken for DT's:

DT's are not to be confused with "the shakes" which occur about 6 hours after alcohol has been
withdrawn and do not include delirium.

Cross-check item with:

1. Medical Status Items #1 & M1a (possibly)

65
 D19a. How many times in your life have you been treated for alcohol or drug abuse?
D21a. How many of these were detox only?

D19a. How many times in your life have you been treated for Alcohol or Drug abuse?

•Include detoxification, halfway houses, in/outpatient

counseling, and AA (if 3+ meetings within one month period).

D21a. How many of these treatments were detox only:

• If D19a = 00, then question D21a = NN

• Note: Code the number of treatments listed in D19a that consisted
only of Detoxification and no other treatment.

Intent/Key points: To record the number of times the patient has received help for their drug or
alcohol problems. The purpose of item #19a is to determine the extent to which the patient has sought
extended rehabilitation versus minimal stabilization or acute crisis care. Therefore, record the number
of treatments in #19a that were detoxification only and did not include any follow-up treatment in item
D21a.

Suggested Interviewing Techniques: Ask as written.

"Mr. Smith, how many times in your life have you been treated for alcohol or drug abuse?"

"How many of those treatments involved a detox with no follow-up?"

Additional Probes:
The names of programs
Reasons for leaving programs

Coding Issues:
1. Count any type of alcohol or drug treatment, including detoxification, halfway houses, inpatient,
outpatient counseling, and AA or NA (if 3 or more sessions) within a one month period.

2. If D19a = 0, then D20a = NN

3. Exclude “Driver's School" for D.W.I. violations.

4. Code as a single episode treatment experiences that occur in different facilities immediately
following one another. For example, a patient who spends two months in a residential program
followed immediately by a six month outpatient program has been involved in one treatment episode,
not two treatment episodes. However, if the patient returns home before being admitted to the
outpatient program, the outpatient program should be counted as a separate treatment episode.

Cross-check item with:

Drug/Alcohol Use, Items 1-13

66
 D23 & D24. How much would you say you spent during the past 30 days on alcohol/drugs?

D23. How much would you say you spent during the past 30 days on
alcohol?
• Only count actual money spent. What is the financial burden caused by alcohol?

D24 How much would you say you spent during the past 30 days on drugs?
• Only count actual money spent. What is the financial burden caused by drugs?

Intent/Key points: This is primarily a measure of financial burden, not amount of use. Therefore,
enter only the money spent, not the street value of what was used (e.g., dealer who uses but does not
buy; bartender who drinks heavily but does not buy, etc.).

Suggested Interviewing Techniques: If you probed sufficiently during the Drug/Alcohol grid, you
should have information about the amount of money that the patient spends daily on each substance. By
multiplying the daily dollar amount by the number of days the patient says he or she used, you will get a
good estimate of the amount of money the patient spent in the last month, without even asking the
question. Regardless, ask the question as written. If a patient responds that he can not possibly estimate
the amount of money he spent in the past month, remind him what he told you in the drug grid.

"How much have you spent on alcohol and drugs in the past 30 days?"
"You told me that you spent about $20 a day on coke...and you used coke on sixteen days...so it sounds
as if you spent at least three hundred twenty dollars on coke."

Sometimes, the patient will argue about the amount of money he spent. He may explain that although
he used $320.00 worth, he only spent $200 worth because he knows people who provide him with
cheap drugs. Code only what the patient reports he spent on drugs.

Additional Probes:
As described above, information that explains differences between the reported amounts of money spent
and amount of drugs used.

Coding Issues:

1. Enter "X" only if patient cannot make a reasonable determination.

2. Don't include the dollar amount of drugs for which the patient provided services (sex for drugs,
acting as a "middle man" for drug deals). Just include the amount of cash the patient put out for the
drugs.

Cross-check item with:

Employment/Support item #s 12-17

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 D25. How many days have you been treated in an outpatient setting for alcohol or drugs in the
past 30 (Include days attended NA, AA).

D25. How many days in the past 30 have you been treated in an outpatient setting for alcohol or
drugs in the past 30 days?

• Include days attended AA/NA, other support groups,

OP detox, methadone or treatment, etc.

Intent/Key points: Treatment refers to any type of outpatient substance abuse therapy. This does not
include psychological counseling or other therapy for non-abuse problems.

Suggested Interviewing Techniques: Ask as written below.

"Mr. Smith, how many days in the past 30 have you been treated in an outpatient setting or attended
self-help groups like AA or NA?"

Additional Probes:
Names of programs
Types of meetings

Coding Issues:

1. Do include methadone maintenance, Antabuse, etc.

The fact that the patient was "officially enrolled" in a program does not count if he/she has not
attended.

2. Include days attended AA, NA, or CA meetings.

3. Treatment requires personal (or at least telephone) contact with the treatment program.

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 D 26 & 27. How many days in the past 30 have you experienced alcohol problems/drug
problems?

D26/D27. How many days in the past 30 have you experienced Alcohol (D26),
Drug (D27) problems?
• Include: Craving, withdrawal symptoms, disturbing effects
of use, or wanting to stop and being unable to.

Intent/Key points: Be sure to stress that you are interested in the number of days the patient had
problems directly related to alcohol or drug use. Include craving for alcohol or drugs, withdrawal
symptoms, disturbing effects of drug or alcohol intoxication, or wanting to stop and not being able to do
so, etc.

Suggested Interviewing Techniques: Ask as written, with plenty of examples based on what the
patient has already told you. Client's "denial" of problems may hinder the interviewer's ability to record
accurate information. The interviewer should focus the question on symptoms or situations already
described by the patient as problematic. For example, a patient may say, "I can handle my alcohol use.
My lawyer said that I should get into treatment because it will help my DUI case." The interviewer
might say, "How many days in the past 30 have you had problems related to alcohol use...such as
worrying about your DUI case?" Another example follows:

"Mr. Smith, how many days in the past 30 have you experienced alcohol problems...such as the fact that
you've been getting in trouble at work because of your drinking, or the fact that you have been spending
all of your money on alcohol.

Additional Probes:
Thinking about using (craving)
Inability to stop using after starting
Consequences of using
Experiencing physical withdrawal symptoms

Coding Issues:
Do not include the patient's inability to find drugs or alcohol as a problem.

Cross-check item with:

Drug/Alcohol section, Items 28 - 31.

If 26=0, then 28 must equal "0" and if D30>0, a comment is needed.
If 27=0, then 29 must equal "0" and if D31>0, a comment is needed.

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 D/A28 & 29. How troubled or bothered have you been in the past 30 days by these alcohol or
drug problems?

D/A30 & 31. How important to you now is treatment for these alcohol or drug problems?

For Questions D28+D30 (Alcohol) and D30 + D31 (Drugs), ask the patient to use the Patient Rating
scale.
The patient is rating the need for additional substance abuse treatment.

D28. How troubled or bothered have you been in the past

30 days by these alcohol/drug problems?

D30. How important to you now is treatment for these

Alcohol/drug problems?

Intent/Key points: To record the patient's feelings about how bothersome the previously mentioned
drug or alcohol problems have been in the last month, and how interested they would be in receiving
(additional) treatment. Be sure to have the patient restrict his/her response to those problems counted in
Items D26 & D27.

Suggested Interviewing Techniques: When asking the patient to rate the problem, provide concrete
examples of them, rather than the term "problems." For example, if the patient reports that besides
worrying about a drunk driving case, he has had physical problems from alcohol, such as hangovers, the
interviewer should ask Item #28 in the following way:

"Mr. Smith, how troubled or bothered have you been in the past thirty days by alcohol problems such as
the hangovers that you mentioned...or the worry over your upcoming case?"

Ask Item #30 in the following way:

"Mr. Smith, important would it be for you to talk to someone about your alcohol problems...such as the
hangovers that you mentioned...or the worry over your upcoming case?"

Cross-check item with:

If 26=0, then 28 must equal "0" and if D30>0, a comment is needed.
If 27=0, then 29 must equal "0" and if D31>0, a comment is needed.

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 D34 & D35 CONFIDENCE RATINGS

CONFIDENCE RATINGS
Is the above information significantly distorted by:
D34. Patient's misrepresentation? 0-No 1-Yes

D35. Patient's inability to understand? 0-No 1-Yes

Patient Misrepresentation – Remember, this code is not used to designate “minimization” or

“denial”.

Poor Understanding – Remember, top 3 reasons for coding poor understanding:

1. Language barrier
2. Patient is under effects of drugs or alcohol or in withdrawal.
3. Patient is experiencing severe psychiatric or psychotic symptoms.

Please see pages 9 – 10 of this manual for complete instructions on Confidence Ratings

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 D36. How many times have you tried to quit using substances without treatment?
(refer to substances coded in D14a & D14b)

D36. How many times have you tried to quit using substances without treatment?

Intent/Key points:
To code the number of times the patient has tried to quit using drugs/alcohol without formal treatment.
Can include quitting “cold-turkey”, going on pilgrimages, penance, with support from a faith-based
group, etc.

Suggested Interviewing Techniques: Ask as written.

Additional Probes:
What supports were used?
Was family helpful?

Coding Issues:
Count any attempt to quit without any paid or professional help.

Cross-check item with:

D14 – Drugs of choice
D15 – Past abstinence
D16 – End of previous abstinence
D19 & D21 – Prior treatment.

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 D37. Nicotine Use

D37. Nicotine Lifetime Route of

Past 30 Days (years) Admin

1. Oral/Chew 2. Nasal 3. Smoking 4. Non-IV injection 5. IV

Intent/Key points: To record information about Nicotine use. Record the number of days in the last
thirty that the patient reported any Nicotine use at all.

Suggested Interviewing Techniques: Be sure to prompt the patient with examples other than
cigarettes (chewing tobacco, the patch, nicotine gum or cigars)

Additional Probes:
Quantity of use per day
Estimated amount of money spent on the substance per day
Usage patterns (only on week-ends, for example).

Coding Issues:
Nicotine is not taken into consideration when coding question D13 (multiple drug use).

Cross-check item with:

None

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 D39. Motivation

D39. Using the patient rating scale, how would you rate your level of agreement with the following statements?
a. I am ready to decrease my drinking.
b. I am ready to decrease my drug use.
c. I believe I can manage my alcohol use.
d. I believe I can manage my drug use.
e. I know I have a drinking or drug problem
and I am motivated to work on it!

Intent/Key points:
To record information about the patient’s level of motivation to quit using substances.

Suggested Interviewing Techniques:

Ask as written.

Additional Probes:
Reasons for motivation.
Previous levels of motivation and results of treatment.

Coding Issues:
Use patient rating scale.
Note D30 & D31 rates importance of receiving treatment, not quitting use.

Cross-check item with:

D28 – D31: Patient Ratings.

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Legal Status
Introduction: The legal status section of the ASI helps you to gather some basic information about
your patient's legal history. It addresses information about probation or parole, charges, convictions,
incarcerations or detainments, and illegal activities. We recommend that you add questions that you
consider relevant to your patient's treatment plan. An interviewer can most efficiently gather accurate
information about a patient’s legal history through extensive probing in the first part of the section. For
example, if a patient reports that he or she was charged with a criminal offense, the interviewer should
ask whether he or she was convicted, and if so, whether any time was spent in prison. By addressing
and recording these details in the early part of the section, the interviewer can move more quickly
through the latter parts of the section.

Glossary of Legal Terms:

For purposes of the Treatnet ASI, the term “police officer” is used to designate any law enforcement
personnel with the authority to detain or arrest someone.

Arrested: An arrest is made any time a person is taken into custody by a police officer. Being arrested
does not necessarily mean that there is evidence that the person committed a crime.

Charged: Once someone is arrested, they may be charged with a crime. A charge can only be made
when there is notable evidence that the person was involved in the commission of a crime.

Expunged: Sometimes a legal record can be expunged. When a record is expunged, it is no longer a
part of someone’s accessible legal record. This may be the case in instances for example when someone
has a first arrest for a minor drug charge. The person may be sent to treatment and upon specific
conditions (completion of treatment, 2 years of providing drug-free tests); the court may expunge their
record. As a result, if the person is arrested again, there will be no record of the prior legal involvement.

Probation/Parole: These conditions are used interchangeably in the ASI. Both include a period of
reporting to officers of the court (parole or probation officers) for monitoring of their whereabouts,
behavior, etc. Generally, probation is given instead of a prison sentence. Parole is a condition that
occurs after a prison sentence is served. Typically, if someone does not contact or present to his/her
probation/parole officer for an extended period of time, the officer has the authority to involve the
police and have the person arrested for “probation/parole violations.” By definition, arrests for
probation/parole violations always constitute a charge and a conviction.

75
 L1. Was this admission prompted or suggested by the criminal justice system?
L2. Are you on probation or parole?

L1. Was this admission prompted or suggested by the criminal justice system?
0 - No 1 -Yes

L2. Are you on parole or probation? 0 - No 1 - Yes

• Note duration and level in comments.

Intent/Key points:
To record information about the relationship between the patient's treatment status and legal status. For
item #1, enter "1" if any member of the criminal justice system was responsible for the patient's current
admission or generally, if the patient will suffer undesirable legal consequences as a result of declining
or not completing treatment. For item #2, enter "1" if the patient is currently on probation or parole.

Suggested Interviewing Techniques:

Ask both questions as written. Provide examples of referral sources that are related to the criminal
justice system to clarify any confusion related to item #1.

For Example:
"Mr. Smith, was your admission to this treatment program prompted or suggested by the criminal
justice system, like a lawyer or probation officer (did you decide to come here on your own, or was it
your family that persuaded you to seek help here)?"

For item #2, if a patient says that he or she is currently on probation or parole, ask for additional details.

For Example:
"What was the charge that resulted in probation?"
"How long have you been on probation? When will your probation period end?"

Additional Probes:
Who suggested to the patient that he/she come to treatment now?
Circumstances surrounding the referral
Federal or State probation or parole
Name of probation or parole officer

Cross-check item with:

Legal Status, Items L3-L16

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 L3-16. How many times have you been arrested and charged with the following?

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

L3 ∗ Shoplift/Vandal L10∗ Assault

L4 ∗ Parole/Probation L11∗ Arson

Violations

L5 ∗ Drug Charges L12∗ Rape

L6 ∗ Forgery L13∗ Homicide/Mansl.

L7∗ Weapons Offense L14∗ Prostitution/Sex

Work
L8∗ Burglary/Larceny/B&E L15∗ Contempt of Court

L9 ∗ Robbery L16∗ Other: _________

• Include total number of counts, not just convictions. Do not include

juvenile (pre-age 18) crimes, unless they were charged as an adult.
• Include formal charges only.

Intent/Key points:
This is a record of the number and type of arrest counts with official charges (not necessarily
convictions) accumulated by the patient during his life. These include only formal charges not times
when the patient was just picked up or questioned. Do not include juvenile (under age of 18) crimes,
unless the court tries the patient as an adult, which may happen in cases of particularly serious offenses.

NOTE: The inclusion of adult crimes only is a convention adopted for our purposes alone. We have
found it is most appropriate for our population. The use of the ASI with different populations may
warrant consideration of juvenile legal history.

Suggested Interviewing Techniques:

If a patient responds that he or she has been charged with an offense, we recommend that you ask for
details (e.g., whether the patient was convicted or not, whether the patient was incarcerated, paid a fine,
or spent time on probation). By gathering information early, it will help to simplify the specifics from
patients with complicated legal histories. We recommend that you ask the question as written, probing
regularly to get the most comprehensive description possible.

For Example:
"Mr. Smith, how many times in your life have you been charged with ________________?"

If the patient reports that he or she was charged:

77
 "What happened with that charge? Was it dropped, or were you convicted of it?"
If the patient reports that he or she was convicted:
"What happened when you were convicted, did you spend time in prison, pay a fine, get probation??"

Additional Probes:
The years in which they were charged with each offense
Details surrounding each criminal act
Significant life events occurring at the same time as each charge

Coding Issues:
1. Include arrests for criminal acts that occurred during military service but do not include those that
have no civilian life counterpart (e.g., AWOL, insubordination). Non-civilian charges should be noted
in the comments section.

2. For L10-L13, include attempts at these crimes (e.g. attempted robbery, attempted rape) in addition to
a charge for the actual crime. (For example, charges of attempted robbery would be coded with
robbery.) This is due to the severity of the infraction.

3 “Contempt of court" is any charge levied by a judge for such behaviors as disruption of court, refusal
to participate when ordered to, failure to pay support or alimony payments, etc.

4. Examples of “other” crimes for item L16 include (but is not limited to) child pornography, aiding
and assisting a felon, and any other criminal charges applicable in your country that do not fit into any
category L1 – L15.

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 L17. How many of these charges resulted in convictions?

L17∗ How many of these charges resulted in convictions?

• If L3-16 = 00, then question L17 = "NN".

• Do not include misdemeanor offenses from questions L18-20 below.
• Convictions include fines, probation, incarcerations, suspended
sentences, guilty pleas, and plea bargaining.

Intent/Key points:
To record basic information about the patient's legal history. Do not include the misdemeanor offenses
(L18-20).

NOTE: Convictions include fines, probation, suspended sentences as well as sentences requiring
incarceration. Convictions also include guilty pleas. If there is a charge for probation violations, it is
automatically counted as a conviction.

Suggested Interviewing Techniques:

If you did not gather information about convictions through probing during L1-L16, ask as written.

"Mr. Smith, how many of these charges resulted in convictions?"

Additional Probes:
Whether or not the patient was incarcerated

Coding Issues:
If L3-L16 are all "00", L17 = “NN"

Cross-check item with:

Legal Status, L24

79
 How many times have you been charged with the following?
L18. Disorderly conduct, vagrancy, public intoxication
L19. Driving while intoxicated
L20. Major driving violations

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

L18. Disorderly conduct, vagrancy, public intoxication?

L19. Driving while intoxicated?

L20. Major driving violations?

• Moving violations: speeding, reckless driving,
no license, etc.

Intent/Key points: Charges included in L18 generally relate to being a public annoyance (without the
commission of a specific crime.) Driving violations counted in L20 are moving violations (speeding,
reckless driving, leaving the scene of an accident, etc.) This does not include vehicle violations,
registration infractions, parking tickets, etc.

Suggested Interviewing Techniques:

Ask as written:

"Mr. Smith, how many times have you been charged with the following: disorderly conduct, vagrancy,
or public intoxication?"

Additional Probes:
Outcomes of the charges

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 L21. How many months were you incarcerated in your life?

L21. How many months were you incarcerated in your life?

• If incarcerated 2 weeks or more, round this up Months

to 1 month. List total number of months incarcerated.

Intent/Key points:
For L21, enter the total number of months spent in jail (whether or not the charge resulted in a
conviction), prison, or detention center in the patient's life since the age of 18. Record months
incarcerated before the age of 18 if the patient was detained as an adult while still a juvenile. If the
number equals 100 months, or more, enter "99," and note the details in the comments section. Count as
one month any period of incarceration two weeks or longer.

Suggested Interviewing Techniques:

Ask as written:
"How many months have you been incarcerated in your life?"

Additional Probes:
Details of unusual periods of incarceration (i.e. serving time for two convictions concurrently)

Coding Issues:
1. Make sure that you code the total number of months that the patient was incarcerated. DO NOT
code the number of individual overnight incarcerations. For example, a client who frequently gets into
fights at bars may report getting thrown in jail over thirty times for a night apiece. Do not count this
situation as 30 incarcerations, as together they would only equal roughly a month of jail time.

2. If the patient has never been incarcerated for over a month, code L21 with "00."

Cross-check item with:

Any questions that would be effected by long periods of incarceration (i.e. the drug/alcohol grid.) For
example, if a patient reports spending a long time in jail, but never reported abstaining from drug use,
you should clarify whether he used drugs in jail. Record the information in the comments section.

81
 L24. Are you presently awaiting charges, trial or sentence?
L25. What for:

L24. Are you presently awaiting charges, trial, or sentencing? 0 - No 1 - Yes

L25. What for?

• Use the number of the type of crime committed 03-16 and 18-20 in previous questions.
• Refers to Q. L24. If L24=No, code NN
If awaiting on more than one charge, choose most severe.

Intent/Key points:
To record information about the patient's current legal status.

Suggested Interviewing Techniques:

Ask as written:
"Are you presently awaiting charges, trial or sentence for any reason?"

Additional Probes:
The date on which the sentencing will take place

Coding Issues:
1. L24 should never be coded with an "N." It should always be asked.

2. If L24 is "0," then L25 should be coded "N."

3. For L25, use the numerical code from L3-L16 that corresponds to the charge. If there are multiple
charges, select the most severe.

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 L26. How many days in the past 30 were you detained or incarcerated?

L26. How many days in the past 30, were you detained or incarcerated?
• Include being arrested and released on the same day.

Intent/Key points:
To record information about whether the patient was detained in the last 30 days.

Suggested Interviewing Techniques:

Ask as written:

"Mr. Smith, How many days in the past 30 were you detained or incarcerated?"

If he asks for the difference between an incarceration and a detainment (i.e. "Hey, didn't you ask me that
question already?"), give him a few examples of detainments. For example, if he was put in jail to sleep
off a binge, or detained and questioned by the police because he looked like someone who had
committed a crime, you would code that he has been "detained or incarcerated in the past 30 days."

Additional Probes:
Reason(s) for being detained

Coding Issues:
Include being detained but released on the same day.

Cross-check item with:

General information, G19 and G20

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 L27. How many days in the past 30 have you engaged in illegal activities for profit?

L27. How many days in the past 30 have you engaged in illegal activities for profit?

• Exclude simple drug possession. Include drug dealing, prostitution, selling stolen goods, etc.
May be cross checked with Employment Question E17.

Intent/Key points:
Enter the number of days the patient engaged in crime for profit. Do not count simple drug possession
or drug use. Include drug dealing, prostitution, burglary, selling stolen goods, etc.

Suggested Interviewing Techniques:

Ask as written:
"Mr. Smith, how many days in the past 30 have you engaged in illegal activities for profit?"

Additional Probes:
The type of illegal activity
Whether the patient received cash or drugs as payment for the illegal activity

Coding Issues:
Include illegal activity as "for profit" even if the patient received drugs or other goods (rather than cash)
in return for the illegal activity.

Cross-check item with:

Employment/Support Status E17

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 L28. How serious do you feel your present legal problems are?
L29. How important to you now is counseling or referral for these legal problems?

For Questions L28-29, ask the patient to use the Patient Rating scale.

L28. How serious do you feel your present legal problems are?
• Exclude civil problems, such as divorce, etc.

L29. How important to you now is counseling or referral for these legal problems?

• NOTE: Patient is rating need for referral (or services) from

your agency to legal counsel for defense against criminal
charges.

Intent/Key Points:
To record the patient's feelings about how serious he or she feels the previously mentioned legal
problems are, and the importance of getting (additional) legal counsel or referral. For L29, the patient is
rating the need for referral to legal counsel so that he can defend himself against criminal charges.

Suggested Interviewing Techniques:

When asking the patient to rate the problem, use the name of it, rather than the term "problems."

For Example:
"Mr. Smith, how serious are your present legal problems...such as your upcoming burglary trial?"
"How important would it be for you to get counseling or referral for the burglary trial that you
mentioned?"

Coding Issues:
Allow the patient to describe their feelings about current legal problems only, not potential legal
problems. For example, if a patient reports selling drugs on a few days out of the past thirty, but has not
been caught, he or she does not have any current legal problem. If the patient gets caught selling drugs,
than he or she will have a legal problem.
L28 – Exclude civil problems such as divorce, etc.

NOTE: For L29, emphasize that you mean additional legal counseling or referral for those
problems specified in L28.

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 L31 & L32 CONFIDENCE RATINGS

CONFIDENCE RATINGS
Is the above information significantly distorted by:

L31. Patient's misrepresentation? 0 - No 1- Yes

L32. Patient's inability to understand? 0 - No 1 - Yes

Patient Misrepresentation – Remember, this code is not used to designate “minimization” or “denial”.

Inability to Understand – Remember, top 3 reasons for coding poor understanding:

1. Language barrier
2. Patient is under effects of drugs or alcohol or in withdrawal.
3. Patient is experiencing severe psychiatric or psychotic symptoms.

Please see pages 9 – 10 of this manual for complete instructions on Confidence Ratings

86
Family/Social Relationships
Introduction: In this section more than any other, there is difficulty in determining if a relationship
problem is due to intrinsic problems or to the effects of alcohol and drugs. In general, the patient should
be asked whether he/she feels that "if the alcohol or drug problem were absent," would there still be a
relationship problem. This is often a matter of some question but the intent of the items is to assess
inherent relationship problems rather than the extent to which alcohol/drugs have affected relationships.

Make sure to access the quality of the relationship from the client’s point of view. Example: If the client
refers to his/her girlfriend as his/her marital partner, then interviewer must consider them as married
throughout the rest of the family/social section.

87
F1. Marital Status:
F3. Are you satisfied with this situation?

F1. Marital Status:

1-Married 3-Widowed 5-Divorced
2-Remarried 4-Separated 6-Never Married
• Common-law marriage = 1. Specify in comments.

F3. Are you satisfied with this situation? 0-No 1-Indifferent 2-Yes
• Satisfied = generally liking the situation.
• Refers to Questions F1 & F2.

Intent/Key points: To record information about the patient’s current marital status and his/her
satisfaction with his current marital status. For item F1, enter the code for current marital status. For item
F3, a "satisfied" response must indicate that the patient generally likes the situation, not that he/she is
merely resigned to it.

Suggested Interviewing Techniques: Ask as written, but follow up with probes. . For instance, the
interviewer should ask if they coded “married” for item #1, “Is this your first marriage?”

"Are you satisfied with being married?"

Additional Probes:
Reasons for dissatisfaction or separation (if applicable)

Coding Issues:

Consider the client married if he refers to his live-in relationship as married for the remainder of the
questions pertaining to marriage or spousal relations.

88
F4. Usual living arrangements? (For the past 3 years).
F6. Are (were) you satisfied with these living arrangements?
F4a. Living arrangements past 30 days?

F4. Usual living arrangements (past 3 years):

1-With partner & children 6-With friends
2-With partner alone 7-Alone
3-With children alone 8-Controlled Environment
4-With parents 9-No stable arrangement
5-With family
• Choose arrangements most representative of the past 3 years

F6. Are/were you satisfied with these arrangements?

0-No 1-Indifferent 2-Yes

F4a. Living arrangements past 30 days? (Use codes above)

Intent/Key points: To record information about the patient’s usual living arrangements during the past
three years F4 and the past 30 days F4a. For item #F4, code the arrangement in which the patient spent
most of the last three years, even if it is different from his or her most recent living arrangement. If the
patient lived in several arrangements choose the most representative of the three year period. If the
amounts of time are evenly split, choose the most recent situation. For patients who usually live with
parents, enter the number of years residing there since age 18 in item #F5. A "satisfied" response in item
#F6 must indicate that the patient generally likes the situation, not that he/she is merely resigned to it.
Code for F5 is based on item F4 only. Code F4a after F5.

Suggested Interviewing Techniques: You may have to ask a number of additional questions to get
accurate responses to these items. For example, you may have to provide a frame of reference (the last
three years). You may consider asking the patient for information about his current living arrangements,
and all previous arrangements for the past three years, as follows:
"Mr. Smith, you mentioned that you are currently living with your mother
“Is this your Mom’s residence?”
"With whom were you living before you moved in with your mom?"
By recording this information, you can figure out not only which living arrangement was the most
representative, but the length of each arrangement, as well.

Additional Probes:
Reasons for leaving each arrangement

Coding Issues:
1. Ask the patient to describe the amount of time spent living in prisons, hospitals, or other institutions
where access to drugs and alcohol are restricted. If this amount of time is the most significant, enter an
"8" for “Controlled Environment.”

Cross-check item with:

General information, item #G14 and G19
All information related to recent controlled environments on the rest of the interview (if the response to
#F4 is "8" Controlled Environment)
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F7 & F8. Do you live with anyone who has a current alcohol problem/uses non-prescribed drugs?

Do you live with anyone who:

F7. Has a current alcohol problem? 0-No 1-Yes

F8 Uses non-prescribed drugs? 0-No 1-Yes

(or abuses prescribed drugs)

Intent/Key points:
Items F7 & F8 address whether the patient will return to a drug and alcohol free living situation. This is
intended as a measure of the integrity and support of the home environment and does not refer to the
neighborhood in which the patient lives. The home environment in question is the one in which the
patient either currently lives (in the case of most outpatient treatment settings) or the environment to
which the patient expects to return following treatment. This situation does not have to correspond to the
environment discussed in items F4 & F6.

Suggested Interviewing Techniques: Since you should already have information about the patient’s
current living situation, you can tailor the question to the patient. For example, if the patient reports living
only with his mother, you may ask this series of questions:

"Mr. Smith, Does your mother drink?" "Do you think she has a problem with alcohol?"
"Does she use non-prescribed drugs or prescribed drugs in a non-prescribed fashion?"
“Is there anyone else living at home who drinks or uses non-prescribed drugs or prescribed drugs in this
way?”

Additional Probes:
Client’s relationship to people who use substances (father/daughter, husband/wife)
Number of people who use substances

Coding Issues:
1. For the alcohol question (F7), code yes only if there is an individual with an active alcohol problem
(i.e., a drinking alcoholic) in the living situation, regardless of whether the patient has an alcohol problem.

2. For the drug use question (F8), code yes if there is any form of drug use in the living situation,
regardless of whether that drug using individual has a problem or whether the patient has a drug problem.

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F9. With whom do you spend most of your free time?
F10. Are you satisfied with spending your free time this way?

F9. With whom do you spend most of your free time?

1-Family 2-Friends 3-Alone

F10. Are you satisfied with spending your free time this way?
0-No 1-Indifferent 2-Yes

• A satisfied response must indicate that the person generally likes the situation.
F10 refers to Question F9.

Intent/Key points: The response to item F9 is usually easy to interpret. Immediate and extended family
as well as in-laws are to be included under "Family" for all items that refer to "Family." "Friends" can be
considered any of the patient’s associates other than family members, and related problems should be
considered "Social."

Suggested Interviewing Techniques: Ask as written, with examples.

"Mr. Smith, with who do you spend most of your free time...your family, friends or alone...?"
Are you satisfied with spending your free time this way?"

Additional Probes:
Details about free time (going to movies, using drugs)

Coding Issues:
A "satisfied" response to item F10 must indicate that the patient generally likes the situation, not that
he/she is merely resigned to it.

IMPORTANT: Some patients may consider a girlfriend/boyfriend with whom they have had a long
standing relationship, as a "family member." In such cases he/she can be considered a family member. If
you have coded this person as a "family member" here, also consider him/her as a family member in
questions F30, F32 and F34 and as a "spouse" in question F21. Don’t consider him a close friend for item
F11.

Cross-check item with:

Family/Social status F11 (possibly)

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F11a. How many of your close friends use drugs or abuse alcohol?

F11a. How many of your close friends use drugs or abuse alcohol?

Note: If patient has no close friends, code “N”

Intent/Key points: Stress that you mean close. Do not include family members or a girlfriend/boyfriend
who is considered to be a family member/spouse.

Suggested Interviewing Techniques:

"Mr. Smith, how many of your close friends, people in your life that your trust (outside of your family)
use drugs or abuse alcohol?"

Additional Probes:
Amount of contact with close friends

Cross-check item with:

Other items in the interview that address close relationships.

Coding Issues:
If patient has no close friend, code F11a as “N”

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F18-26. Have you had significant periods in which you have experienced serious problems getting
along with...?

Have you had significant periods in which you have experienced serious problems getting along
with: 0 – No, 1 - Yes
Past 30 days In Your Life

F18. Mother

F19. Father

F20. Brother/Sister

F21. Partner/Spouse

F22. Children

F23. Other Significant Family

(specify)_________________________

F24. Close Friends

F25. Neighbors

F26. Co-workers
• "Serious problems" mean those that endangered the relationship.
• A "problem" requires contact of some sort, either by telephone or in person.
If no contact code “N” If no relative (ex: no children) Code N.

Intent/Key points: To record information about extended periods of relationship problems. These items
refer to serious problems of sufficient duration and intensity to jeopardize the relationship. They include
extremely poor communication, complete lack of trust or understanding, animosity, constant arguments.

Suggested Interviewing Techniques: It is recommended that the interviewer ask the lifetime question
from each pair, first. For example, "Have you ever had a significant period in your past which you
experienced serious problems with your father?" Regardless of the answer the interviewer should inquire
about the past 30 days. However, the interviewer should first inquire about whether there has been recent
contact. "Have you had any personal or telephone contact with your father in the past 30 days?"
(If "No", record an "N" in the "Past 30 Days" column) If "Yes", ask: How have things been going with
your father recently? Have you had any serious problems with him in the past 30 days?" Remember,
lifetime and the past 30 days are separate and distinct time periods.

Additional Probes:
Nature of the problem. Facts about relationships (Number of siblings, children).

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F18 – F26 Coding Issues:

1. It is possible that a patient could have had serious problems with a father in the past but because of
death, not have a problem in the past month. The correct coding in this case would be "yes" under
lifetime and "N" under past 30 days.

2. Item F21 may include any regular, important sexual relationship.

3. IMPORTANT: Understand that the "Past 30 Days" and the "Lifetime" intervals in items F18 to F29 are
designed to be considered separately. The past 30 days will provide information on recent problems
while lifetime will indicate problems or a history of problems before the past 30 days.

4. It is particularly important for interviewers to make judicious use of the "N" and "X" responses to these
questions. In general, a "yes" response should be recorded for any category where at least one member
of the relative category meets the criterion. In contrast, a "no" response should only be counted if all
relatives in the category fail to meet the criterion.

5. People coded need not be “blood-relatives”. Any father figure, step brother, etc. can count here.

6.If the patient has not been in contact with the person in the past 30 days it should be recorded as "N."
An "N" should also be entered in categories that are not applicable, e.g., in the case of a patient with no
siblings.

7. An "N" should be coded for all categories where there is either no relative for the category or no
contact with the relative.

94
F28 & F29. Has anyone ever abused you:

Has anyone ever abused you? 0- No 1-Yes

Past 30 days In Your Life
F28. Physically?
• Caused you physical harm.
F29. Sexually?
• Forced any sexual advances/acts.

Intent/Key points: These items have been added to assess what may be important aspects of the early
home life for these patients (lifetime answers) and to assess dangers in the recent and possibly future
environment (past 30 days’ answers). It will be important to address these questions in a supportive
manner, stressing the confidentiality of the information and the opportunities for the patient to raise this in
subsequent treatment sessions with an appropriate provider.

Physical abuse will generally be coded by what the patient reports and it is understood that it will be
difficult to judge whether the "actual" abuse reported would be considered abuse to another person. No
attempt should be made to do this since the intent here is to record the patient’s judgment. However, as a
general rule, simple spankings or other punishments should not be counted as abuse unless they were (in
the eyes of the patient) extreme and unnecessary. Sexual abuse is not confined to intercourse but should
be counted if the patient reports any type of unwanted advances of a sexual nature by a member of either
sex. Follow state laws for child or spousal abuse reporting. Disclose to the client that this information will
be reported if collected due to state law. Disclose this before you ask the abuse questions.

Suggested Interviewing Techniques: Ask as written, with examples as written.

"Mr. Smith, have any of the people that I just mentioned ever abused you emotionally? For example, has
anyone ever humiliated you or made you feel ashamed by calling you names?"

Additional Probes:
Others’ knowledge of the abuse

Cross-check item with:

Family/Social F18-F26 (possibly)

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F30 & 31. How many days in the past 30 have you had serious conflicts with your family/with other
people (excluding family)?

How many days in the past 30 have you had serious conflicts:
F30. With your family?

How many days in the past 30 have you had serious conflicts:
F31. With other people (excluding family)?

Intent/Key points: Conflicts require personal (or at least telephone) contact. Stress that you mean serious
conflicts (e.g., serious arguments; verbal abuse, etc.) not simply routine differences of opinion. These
conflicts should be of such a magnitude that they jeopardize the patient’s relationship with the person
involved.

Suggested Interviewing Techniques: Ask as written, with examples.

"Mr. Smith, how many days in the past 30 have you had serious conflicts...by serious, I mean conflicts
which may have put your relationship with someone in your life in jeopardy...for example, a big blow-
up...?"

Additional Probes:
The nature of the conflict (what did you fight about?)

Coding Issues:
Problem days recorded in this section should have their origins in interpersonal conflict, not substance
abuse. They should be primarily relationship problems, not substance abuse problems.

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F32. How troubled or bothered have you been in the past 30 days by these family problems?

F34. How important to you now is treatment or counseling for these family problems?

F33. How troubled or bothered have you been in the past 30 days by these social problems?

F35. How important to you now is treatment or counseling for these social problems?

Ask the patient to use the Patient Rating scale:

How troubled or bothered have you been in the past 30 days by:
F32. Family problems?

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

F34. Family problems
• Patient is rating his/her need for counseling for family
problems, not whether they would be willing to attend
.
Note: The patient is rating their need for you/your program to provide or refer them to family
services, above and beyond any services they may already be getting.

Ask the patient to use the Patient Rating scale:

How troubled or bothered have you been in the past 30 days by:
F33. Social problems?

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

F35. Social problems
• Include patient's need to seek treatment for such social problems as loneliness, inability to
socialize, and dissatisfaction with friends.
Patient rating should refer to dissatisfaction, conflicts, or other serious problems.

Note: The patient is rating their need for you/your program to provide or refer them to these
types of services, above and beyond treatment they may already be getting somewhere else.

Intent/Key Points: To record the patient’s feelings about how bothersome any previously mentioned
family or social problems have been in the last month, and how interested they would be in receiving
(additional) counseling. These refer to any dissatisfaction, conflicts, or other relationship problems
reported in the Family/Social section.

Suggested Interviewing Techniques: When asking the patient to rate the problem, mention it
specifically, rather than using the term "problems." For example, if the patient reports being troubled by
problems with his mother in the last thirty days, ask the patient question F32 in the following way:

"Mr. Smith, how troubled or bothered have you been in the past thirty days by the problems that you have
had with your mother?"
Ask the patient question F34 in the following way:
97
"Mr. Smith, how important is it for you to talk to someone about the problems that you and your mother
have been having?"

Additional Probes:
Details of the problems

Coding Issues:

Do include the patient’s need to seek treatment for such social problems as loneliness, inability to
socialize, and dissatisfaction with friends.

For Item F34, be sure that the patient is aware that he/she is not rating whether or not his/her family
would agree to participate, but how badly he/she needs counseling for family problems in whatever form.

Cross-check item with:

Other items in the section that refer to problems. Problems related to family and social relationships may
be recorded in many places throughout the section. For example, dissatisfaction with marital status (item
F3) living arrangements (item F6), or free time (item F10) may be reported. In addition, patients may
indicate a need for treatment to address serious problems (item F18-F26), or serious conflicts (item #s
F30, F31).

98
F39. How many children do you have?
F39a. How many of these are under age 18?

Living Living
with you outside your home
F39. How many children do you have?

F39a. How many of these are under age 18

Intent/Key points:
Identify the number of children the patient has or had who are both living with them or living outside
their home. This also gives an indication of the number of people who may depend on the patient and
the dynamics at home.

Suggested Interviewing Techniques:

Ask a written or in a general conversation about children.

“Mr. Jones, How many children have you had? What are their ages? Do they all live with you?”

Additional Probes:
Ask children’s names, ages.
Do any children have drug or alcohol problems?

Coding Issues:
Code any child the patient has helped raised or provided shelter for (biological children, step children,
etc.).
If no children, code “NN”

Cross-check item with:

E18 – Number of dependents
F4 and F4a – Living situation

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 F37 & F38: CONFIDENCE RATINGS

CONFIDENCE RATING

Is the above information significantly distorted by:

F37. Patient's misrepresentation? 0-No 1-Yes

F38. Patient's inability to understand? 0-No 1-Yes

Patient Misrepresentation – Remember, this code is not used to designate “minimization” or “denial”.

Inability to Understand – Remember, top 3 reasons for coding poor understanding:

1. Language barrier
2. Patient is under effects of drugs or alcohol or in withdrawal.
3. Patient is experiencing severe psychiatric or psychotic symptoms.

Please see pages 9 – 10 of this manual for complete instructions on Confidence Ratings

100
Psychiatric Status
Introduction: When administering this section, it is important to remember that the ASI should be
considered a screening tool rather than a diagnostic tool. Therefore, a patient need not meet diagnostic
criteria for a symptom to have experienced the symptom. Further, the ASI will not provide definitive
information on whether drug problems preceded psychiatric problems, or vice versa. All symptoms
other than those associated with drug effects should be counted in this section. For example, depression
and sluggishness related to detoxification should not be counted, whereas depression and guilt
associated with violating a friend's trust or losing a job should be counted.

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How many times have you been treated for any psychological or emotional problems?
P1. In a hospital or inpatient setting?
P2. Outpatient/private patient?

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

P1∗ In a hospital or inpatient setting?

P2∗ Outpatient/private patient?

• Do not include substance abuse, employment, or family counseling.
• Treatment episode = a series of continuous visits or treatment days, not the number of visits.

Intent/Key points:
This includes any type of treatment for any type of psychiatric problem. This does not include substance
abuse, employment, or family counseling. The unit of measure is a treatment episode (usually a series of
fairly continuous visits or treatment days), not the specific number of visits or days in treatment.

If the patient is aware of his/her diagnosis, enter this in the comments section.

Suggested Interviewing Techniques: Ask as written.

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

Additional Probes:
Names of programs, length of time at program, reasons for leaving each program

Coding Issues: Count any psychiatric treatment received while the client was in a hospital or inpatient
setting. The patient does not need have to be in a psychiatric hospital, s/he simply needs to be receiving
psychiatric services while in a hospital or residential setting. Do not include simple psychiatric
evaluations (not followed by actual treatment) regardless of setting.

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P3. Psychiatric Disability?

P3. Do you receive financial support for a psychiatric disability?

Can be from government or employer, etc.
0-No 1-Yes

Intent/Key points:
To identify if the patient receives any financial support from an institution for a psychiatric disability.
Does not include support from family or friends. Can be ongoing alms from a religious institution etc.

Suggested Interviewing Techniques: Ask as written, with examples

"Mr. Smith, are you receiving any financial support for any psychiatric problems from any source such as
the government, employer, ongoing alms or anything like that?”

Pensions for physical problems of the nervous system (e.g., epilepsy, etc.) should be counted under Item
5 in Medical Section, not here. Can be from government or employers, ongoing alms, etc.

Additional Probes:
Details of the support such as source and amount.
Details of the psychological problem that warranted the support.

Cross-check item with:

Employment/Support item #15

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 P4. Depression
P5. Anxiety

Have you had a significant period of time (that was not a direct result of alcohol/drug use) in which
you have:
0-No 1-Yes
Past 30 Days Lifetime
P4. Experienced serious depression-
sadness, hopelessness, loss of interest?

P5. Experienced serious anxiety/tension

uptight, unreasonably worried,
inability to feel relaxed?

P4. Experienced serious depression suggested by sadness, hopelessness, significant loss of interest,
listlessness, difficulty with daily function, guilt, "crying jags," etc.

P5. Experienced serious anxiety or tension suggested by feeling uptight, unable to feel relaxed,
unreasonably worried, etc.

Intent/Key points: These lifetime items refer to serious psychiatric symptoms experienced over a
significant time (at least 2 weeks). The patient should understand that these periods refer only to times
when he/she was not under the direct effects of alcohol, drugs or withdrawal. This means that the
behavior or mood is not due to a state of drug or alcohol intoxication, or to withdrawal effects.

Suggested Interviewing Techniques: We recommend that you ask the lifetime questions before you ask
the questions pertaining to the last 30 days. Regardless of the answer, the interviewer should inquire
about the past 30 days.
For example:
"Mr. Smith, have you had a significant period in your life in which you have experienced
serious depression?"
If the patient responds positively, then qualify his answer. You may find it helpful to ask him about the
circumstances surrounding the time when he was experiencing the symptom:
"What was going on in your life that made you feel that way?"
You may decide to ask him directly.
"During that time, were you doing drugs that made you feel anxious, or was it an anxiety that
occurred even when you weren't doing drugs?"
Finally, ask him about the last 30 days:
"Have you experienced any anxiety during the last 30 days?"

Additional Probes:
Circumstances surrounding the time when the patient experienced the symptom

Coding Issues:
Again, understand that the "Past 30 Days" and the "Lifetime" intervals are designed to be considered
separately. The past 30 days will provide information on recent problems while lifetime will indicate
problems or a history of problems prior to the past 30 days.

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 P6. Hallucinations
P7. Trouble Concentrating

Have you had a significant period of time (that was not a direct result of alcohol/drug use) in which
you have:
0-No 1-Yes
Past 30 Days Lifetime

P6. Experienced hallucinations-saw things/

heard voices that others didn’t see/hear?
Code other psychotic symptoms here also.

P7. Experienced trouble understanding,

concentrating, or remembering?

P6. Experienced hallucinations (saw things or heard voices that were not there)
Remember the definition of “not the direct result of alcohol/drug use!

P7. Experienced trouble understanding, concentrating or remembering.

Again, not the direct result of ingestion of or withdrawal from alcohol/drugs.

Intent/Key Points: P7 refers to serious psychiatric symptoms over a significant time (at least 2 weeks).
P6 is of sufficient importance that even its brief existence warrants that it be recorded. For P6 and P7,
the patient should understand that these periods refer only to times when he/she was not under the direct
effects of alcohol, drugs or withdrawal. This means that the behavior or mood is not due to a state of
drug or alcohol intoxication, or to withdrawal effects. It has been our experience that the patient will
usually be able to differentiate a sustained period of emotional problem from a drug or alcohol induced
effect. Therefore in situations where doubts exist, the patient should generally be asked directly about
his/her perception of the symptoms or problems.

Suggested Interviewing Techniques: We recommend that you ask the lifetime questions before you
ask the questions pertaining to the last 30 days.

"Mr. Smith, have you had a significant period in your life in which you have experienced
hallucinations...when you were not doing drugs or using alcohol?"

Finally, ask him about the last 30 days:

"Have you experienced any hallucinations during the last 30 days?"

Additional Probes:
The nature of the hallucination (what the patient saw or heard)

Coding Issues:
Understand that the "Past 30 Days" and the "Lifetime" intervals are designed to be considered
separately. The past 30 days will provide information on recent problems while lifetime will indicate
problems or a history of problems prior to the past 30 days.

105
 P8. Trouble controlling: violent behavior
P9. Serious thoughts of suicide
P10. Attempted suicide

Note: Patient can be under the influence of alcohol/drugs for these questions.
Have you had a significant period of time (regardless of alcohol and drug use) in which you have:
0-No 1-Yes
Past 30 Days Lifetime
P8. Experienced trouble controlling violent
behavior including episodes of rage, or violence?

P9. Experienced serious thoughts of suicide?

• Patient seriously considered a plan for
taking his/her life.

P10. Attempted suicide?

• Include actual suicidal gestures or attempts.

Intent/Key Points: P8, P9 and P10 are of sufficient importance that even their brief existence warrants
that they be recorded. Further, the seriousness of item P8, P9, and P10 warrant inclusion even if they
were caused by or associated with alcohol or drug use. Reports of recent suicide attempts or thoughts
should be brought to the attention of supervisor from the treatment staff as soon as possible, even if this
violates normal confidentiality guidelines.

IMPORTANT: For P9 Ask the patient if he/she has recently considered suicide. If the answer is
"Yes" to this question, and/or the patient gives the distinct impression of being depressed to the point
where suicide may become a possibility, notify a member of the treatment staff of this situation as soon
as possible.

Suggested Interviewing Techniques: We recommend that you ask the lifetime questions before you
ask the questions pertaining to the last 30 days.

"Mr. Smith, have you had a significant period in your life in which you have experienced trouble
controlling violent behavior?"

Finally, ask him about the last 30 days:

"Have you experienced trouble controlling violent behavior during the last 30 days?"

Additional Probes:
Circumstances surrounding the symptom (What made you get violent?)
Details of their suicide plan (How were you going to do it?)

Coding Issues:
Understand that the "Past 30 Days" and the "Lifetime" intervals are designed to be considered
separately. The past 30 days will provide information on recent problems while lifetime will indicate
problems or a history of problems prior to the past 30 days.

106
P11. Has a healthcare provider recommended you take any medications for psychological or
emotional problems?

0-No 1-Yes
Past 30 Days Lifetime
P11. Has a health care provider recommended
you take any medications for
psychological or emotional problems?

• Recommended for the patient by a physician or other health care provider as appropriate. Record
"Yes" if a medication was recommended even if the patient is not taking it.

Intent/Key Points: To record information about whether the patient has had psychiatric problems that
warrant medication.

Suggested Interviewing Techniques: It is recommended that the interviewer ask the lifetime question
from each pair, first. For example:

"Have you ever taken medication for any psychological or emotional problem?"

Regardless of the answer, the interviewer should inquire about the past 30 days.

"How about more recently? Have you taken any psychiatric medication in the past 30 days?"

Additional Probes:
The types of medication taken
The patient's perception of the reason for the medication to be taken
Whether or not the patient has been taking it as recommended.

Coding Issues:
Understand that the "Past 30 Days" and the "Lifetime" intervals are designed to be considered
separately. The past 30 days will provide information on recent use while lifetime will indicate a
history of medications before the past 30 days.

107
 P12. How many days in the past 30 have you experienced these psychological or emotional
problems?

P12. How many days in the past 30 have you experienced these psychological or emotional problems?
• This refers to problems noted in Questions P4-P10.

Intent/Key Points: To record the number of days that the patient has experienced the previously
mentioned psychological or emotional problems. Be sure to have the patient restrict his/her responses
to those problems counted in Items P4 through P10.

Suggested Interviewing Techniques: Although many patients admit experiencing some of the
individual symptoms, they may not identify them as "psychological or emotional problems." For
example, they may say that although they have had trouble controlling violent behavior in the past 30
days, they have not experienced any emotional problems. ("Hey, I 'm not crazy...People mess with me,
I defend myself.") Therefore, we have found it helpful to target the question to the specific symptoms
reported in Items P4 – P10. For example:

"Mr. Smith, how many days in the past 30 have you experienced the anxiety (or the depression, or the
trouble controlling violent behavior) that you mentioned?"

Additional Probes:
Duration of the symptom
Trigger for the symptom (if applicable)

108
 P13. How much have you been troubled or bothered by these psychological or emotional
problems in the past 30 days?

P14. How important to you now is treatment for these psychological problems?

For Questions P13-P14, ask the patient to use the Patient Rating scale

P13. How troubled or bothered have you been by these psychological or emotional
problems in the past 30 days?
• Patient should be rating the problem days from Question P12.

P14. How important to you now is treatment for these psychological or emotional problems?

Note: The patient is rating their need for you/your program to provide or refer them to
psychological/psychiatric services, above and beyond treatment they may already be getting
somewhere else.

Intent/Key Points: To record the patient's feelings about how bothersome the previously mentioned
psychological or emotional problems have been in the last month and how interested they would be in
receiving (additional) treatment. Be sure to have the patient restrict his/her response to those problems
counted in Items P4 through P10.

Suggested Interviewing Techniques: When asking the patient to rate the problem, use the name of it,
rather than the term "psychological problems." For example, if the patient reports having trouble with
serious anxiety in the last thirty days, ask the patient question P13 in the following way:

"Mr. Smith, how troubled or bothered have you been in the past thirty days by the anxiety that you
mentioned?"

Ask Item P14 in the following way:

"Mr. Smith, how important would it be for you to get (additional) treatment for the anxiety that you
mentioned?"

Coding Issues:
Referring to item 11, have the patient rate the severity of those problems in the past 30 days. Be sure
that patient understands that you do not necessarily mean transfer to a psychiatric ward, or psychotropic
medication.

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 P22 & P23 CONFIDENCE RATINGS

CONFIDENCE RATING
Is the above information significantly distorted by:
P22 Patient's misrepresentation? 0-No 1-Yes

P23. Patient's inability to understand? 0-No 1-Yes

Patient Misrepresentation – Remember, this code is not used to designate “minimization” or “denial”.

Inability to Understand – Remember, top 3 reasons for coding poor understanding:

1. Language barrier
2. Patient is under effects of drugs or alcohol or in withdrawal.
3. Patient is experiencing severe psychiatric or psychotic symptoms.

Please see pages 9 – 10 of this manual for complete instructions on Confidence Ratings

110
TREATNET ASI CLOSING ITEMS

G12. Special Code - If ASI is not completed:

1. Interview terminated by interviewer
2. Patient refused to finish interview
3. Patient unable to respond (language or intellectual barrier, under
the influence, etc.)

Code “N” if Interview completed.

Code the answer as ‘1’ if you terminate the interviewee. This may be due to a lack of cooperation or
understanding by the client, if you feel the client is misrepresenting himself or herself, or any other reason
that you determine the client to be unable to complete the interview.

Code a ‘2’ if the client refuses to complete the interview.

Code a ‘3’ if the client is unable to respond. This can be interpreted as an inability to comprehend the
questions and answer accordingly due to being under the influence of drugs and/or alcohol, being in
severe withdrawal from drugs and/or alcohol, psychological reasons, a language barrier, or an intelligence
barrier.

Code ‘N’ if the interview was completed.

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G50. Expected Treatment Modality most appropriate for patient?

G50. Expected treatment modality most appropriate for patient:

G50. Modality Codes:

1=Outpatient (<5 hours per week)
2=Intensive Outpatient (≥ 5 hours per week)
3=Residential/Inpatient
4=Therapeutic Community
5=Half-way house
6=Detox – Inpatient (typically 3 – 7 days)
7=Detox Outpatient/Ambulatory
8=Opioid Replacement, outpatient (Methadone, Buprenorphine, etc)
9=Other (low threshold, GP, spiritual healers, etc.)
Specify_______________________________________________

Enter the number that corresponds to the list for Modality Codes. If you select “other” you must specify
the details of the program in the comments section.

112
 APPENDICES

1. ASI Introduction

2. Instructions for using “N” on the ASI

3. ISCO Abbreviated Categories

4. List of Commonly Used Substances

5. The “Final Three”

113
 Introducing the ASI

Prior to beginning the administration of the General Section of the ASI, the
interviewer should properly introduce the instrument. It is critical you do more
than simply list these details in order. A good introduction sets the tone,
provides guidelines and helps prepare the client for what to expect during the
interview. In addition, an in-depth introduction will assist you later in the
interview by helping the client stay focused and understand why you are asking
certain questions. For more details, see the section on “Introducing the ASI in
the Q by Q.

INTRODUCING THE ASI:

1. All clients receive this same standard interview.

2. Seven Potential problem areas or Domains: Medical, Employment/Support Status, Alcohol, Drug,
Legal, Family/Social, and Psychiatric.

3. The interview will take about 50-60 minutes.

4. Patient Rating Scale: Patient input is important. For each area, I will ask you to use this scale to let
me know how bothered you have been by any problems in each section. I will also ask you how
important treatment is for you for the area being discussed.
The scale is:
0 - Not at all
1 – Slightly
2 – Moderately
3 – Considerably
4 – Extremely

5. All information gathered is confidential

6. Accuracy - You have the right to refuse to answer any question, if you are uncomfortable or feel it is
too personal or painful to give an answer, just tell us, “I want to skip that question.” We’d rather
have no answer than an inaccurate one!

7. There are two time periods we will discuss:

1. The past 30 days
2. Lifetime

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 Where can I code “Not Applicable (N) on the ASI?

General Information:
If G19 = No, then G20 = N.
If G20 = 30, the E19 = NN

Medical Section:
If M12 = No, then M12a = N but remember to ask M12b!
If M13 = No, then M13a = N but remember to ask M13b!
M14 = N if patient is Male
If M14 = If coded No or Unsure (0 or 2), then M14a = N
If M14 = Yes, then M14b = N

Employment/Support:
If G20 in the General Section = 30, E19 = NN
If E19 = N, E20 = N

Drug/Alcohol Section:
D1 – D12: For any item D1 through D12:
if past 30 days and lifetime use both =00, then Route of administration = N.
If D15 = 00, then D16 = NN
If D19a = 00, then D21a = NN
If D37 past 30 days & lifetime use both = 00, then Route of Administration = NN

Legal Section:
If L3 through L16 all = 00, then L17 = NN
If L24 is coded "No,” L25 is coded "N.”

Family/Social Section:
F11a: If patient reports having no friends, F11a = N
If F11a = N, F24 “Past 30 Days” = N.
F18 – F26 – Code N if the family/social contact does not exist
(i.e. for F22, a client with no children or F20 for a client with no siblings).
If E11 in the Employment Section is coded 00, F26 past 30 days = N
If F39 = 00, F39a = NN

Psychiatric Section:
There are no circumstances under which an "N” would be coded in this section.

Close ASI Section:

G12 “Special Code” If the interview has been completed, G12 = N.

115
 International Standard Classification of Occupations

1. Legislators, officials – Main tasks are forming government policies, laws,

regulations and overseeing implementation.

2. Professionals - Requires high level of professional knowledge in the fields of

physical and life sciences, or social sciences/humanities.

3. Technicians /assoc. professionals - Requires technical knowledge,

experience in fields of physical, life or social sciences, humanities.

4. Clerks - Performs secretarial duties, word processing and other customer-

oriented clerical duties.

5. Service & Sales - Includes services related to travel, catering, shop sales,
housekeeping, and maintaining law and order.

6. Skilled agricultural and fishery workers - Consists of growing crops,

breeding or hunting animals, catching or cultivating fish, etc.

7. Craft & Trades - Main tasks consist of constructing buildings and other
structures, making various products. Includes handicrafts.

8. Plant and machine operators - Main tasks consist of driving vehicles,

operating machinery, or assembling products.

9. Elementary Occupations – Includes simple and routine tasks, such as selling

goods in streets, doormen, cleaning, and working laborers.

0. Armed forces - Includes army, navy, air force workers, etc. Excludes non-
military police, customs, and inactive military reserves.

116
LIST OF COMMONLY USED DRUGS:

Alcohol: Beer, wine, liquor, grain (methyl alcohol)

Heroin: Smack, H, Horse, Brown Sugar

Methadone: Dolophine, LAAM

Opiates: Opium, Fentanyl, Buprenorphine, pain killers - Morphine,

Dilaudid, Demerol, Percocet, Darvon, etc.

Barbiturates: Nembutal, Seconal, Tuinal, Amytal, Pentobarbital,

Secobarbital, Phenobarbital, Fiorinal, Doriden, etc.

Sed/Hyp/Tranq: Benzodiazepines = Valium, Librium, Ativan, Serax

Tranxene, Dalmane, Halcion, Xanax, Miltown,
Other = Chloral Hydrate, Quaaludes

Cocaine: Cocaine Crystal, Free-Base Cocaine, Crack, Rock, etc.

Amphetamines Monster, Crank, Benzedrine, Dexedrine, Ritalin,

Stimulants Preludin, Methamphetamine, Speed, Ice, Crystal, Khat

Cannabis: Marijuana, Hashish, Pot, Bango Igbo, Indian Hemp, Bhang,

Charas, Ganja, Mota, Anasha

Hallucinogens: LSD (Acid), Mescaline, Psilocybin (Mushrooms), Peyote,

PCP, MDMA, Ecstasy, Angel Dust

Inhalants: Nitrous Oxide (Whippits), Amyl Nitrite (Poppers),

Glue, Solvents, Gasoline, Toluene, Etc.

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 Addiction Severity Index (ASI)

“THE FINAL THREE”

REFERENCE GUIDE

This convention applies primarily to

the medical, alcohol, drug, and
psychiatric sections.

118
 The Final 3 - Medical

z M6 “How many days have you

experienced medical problems in the
past 30?”
z M7 “How troubled or bothered have you
been by these medical problems in the
past 30 days?”
z M8 “How important to you now is
treatment for these medical problems?”

The Addiction Severity Index 48

M6 Includes ANY medical (or dental) problems reported in past 30 days in items M1 –
M5 or discussed in conversation. When asking these 3 items, refer to specific
symptoms provided, i.e., your asthma problems, your cold symptoms, etc.

M7 Refers to symptoms reported in M6. Record the patient’s self assessment, or rating,
of the degree to which s/he has been bothered by these symptoms in the past 30
days.

M8 This item again refers to symptoms reported in M6. Record patient’s rating of the
degree to which s/he is interested in treatment for these symptoms- or additional
treatment, if currently receiving services.

If the patient reports “No days of problems” in M6, then they should not have been troubled or bothered
by or want treatment for medical problems.

M6, M7 & M8 are linked items. The patient can’t be troubled or bothered by non-existent problems

If the patient reports 0 days of problems and then reports being troubled or bothered, or wanting
treatment, ask them what they are troubled or bothered by or what they want treatment for, then go back
to M6 and identify the number of days they have had these problems or symptoms in the past 30 days.

Conversely, if the patient has 1 or more days of problems, you would expect that they were at least
slightly troubled or bothered, but you cannot assume that treatment is important to them at this time. It is
possible that the patient has already received treatment.

Remember – M7& M8 refer specifically to problems reported in M6.

119
The Final 3 Scoring - Medical

If M6 = 0, then
M7 = 0 and
M8 should be 0

If M6 > 0, then
M7 > 0, and
M8 can be any number

The Addiction Severity Index 49

120
 The Final 3 - Employment

z The “Final Three” convention does not

apply to the Employment/Support
section.
z Only items E19 (days of problems) and
E20 (troubled/bothered rating) are linked.
z E21 is an independent rating of the
patient’s desire for assistance with
employment issues.

The Addiction Severity Index 70

E19 Includes inability to find work if they are actively looking for work, problems with
the present job or problems finding additional training or education.
If patient has been incarcerated or detained all of the past 30 days, code “NN”, they
didn’t have the opportunity to have problems.

E20 If E19 = “NN”, Code E20 N

E21 This item can refers to any type of job related meetings, education, training
assistance desired by the patient. Record patient’s rating of the degree to which s/he
is interested in treatment for these services at your program.
Stress help finding or preparing for a job or working with the current employer, not
giving them a job.

The “Final Three” convention does not apply to the Employment/Support section. Only items E19 (days
of problems) and E20 (troubled/bothered rating) are linked.

E21 is an independent rating of the patient’s desire for assistance with employment issues. This is
because days of Employment problems are coded in only 2 situations:

1. The patient is out of work and actively looking for employment (submitting
applications/forwarding resumes), or
2. The patient is employed and experiencing serious problems on the job (written reprimand,
suspension, significantly underemployed) that jeopardize their continued employment

Given that the definition of problem days is so narrowly defined on the ASI, item E21 is not linked to E19
and may exceed “0” even when E19=0. For example, if the patient has not had the opportunity to work

121
(i.e., incarceration, hospitalization), it is not possible for her/him to have experienced problem days
regarding employment, however, it is possible for him/her to desire treatment for employment problems
(lack or skills, unemployed, etc).

Therefore, if the patient reports “No days of problems” in E19, then they should not have been troubled or
bothered by employment problems in the past 30 days, but they may report wanting treatment for
employment problems (job training, job interviewing skills, GED or other educational desires, etc).

Conversely, if the patient has 1 or more days of problems, you would expect that they were at least
slightly troubled or bothered, but you cannot assume that treatment is important to them at this time. It is
possible that the patient has already received treatment.

Remember – Only E19 and E20 are linked in the Employment Section “Final Three”

E19 – E21: “Final 3”

z E19 & E20 are linked

z If E19=“0”, then E20=“0”
z E21 is coded independently of E19 & E20

The Addiction Severity Index 71

122
 The Final 3 – Alcohol/Drug

z D26/27 “How many days in the past 30 have

you experienced Alcohol/Drug problems?”

z D28/29 “How troubled or bothered have you

been in the past 30 days by these
Alcohol/Drug problems?”

z D30/31 “How important to you now is

treatment for these Alcohol/Drug problems?”

The Addiction Severity Index 88

D26/27 Includes ANY medical (or dental) problems reported in past 30 days in items M1
– M5 or discussed in conversation. When asking these 3 items, refer to specific
symptoms provided, i.e., your asthma problems, your cold symptoms, etc.

D28/29 Refers to symptoms reported in M6. Record the patient’s self assessment, or
rating, of the degree to which s/he has been bothered by these symptoms in the past
30 days.

D30/31 Refers to symptoms reported in M6. Record patient’s rating of the degree to which
s/he is interested in treatment for these symptoms- or additional treatment, if
currently receiving services.
In the Drug & Alcohol sections, there are 2 “Final Three” questions:
D26, D28, and D30 refer only to alcohol
D27, D29, and D31 refer only to other drugs

If the patient reports “No days of problems” in M26 and/or M27, then they should not have been troubled
or bothered by or want treatment for alcohol or drug problems.

If the patient reports 0 days of problems and then reports being troubled or bothered, or wanting
treatment, ask them what they are troubled or bothered by or what they want treatment for, then go back
to either D26 or D27 and identify the number of days they have had these problems or symptoms in the
past 30.

Conversely, if the patient reports 1 or more days of problems, you would expect that they were at least
slightly troubled or bothered and, since they are presenting for treatment, that treatment is at least slightly
important to them at this time.

123
Remember: D 28 – 31 refer specifically to problems reported in D26 & D27.

The Final 3 Scoring – Alcohol

If D26 = 0, then
D28 = 0 and
D30 should be 0.

If D26 > 0, then

D28 > 0, and
D30 can be any number

The Addiction Severity Index 89

The Final 3 Scoring – Drug

If D27 = 0, then
D29 = 0 and
D31 should be 0.

If D27 > 0, then

D29 > 0, and
D31 can be any number

The Addiction Severity Index 90

124
 The Final 3 – Legal?

z L26 “How many days in the past 30 were you

detained or incarcerated?”
z L27 “How many days in the past 30 have you
egaged in illegal activities for profit?”
z L28 “How serious do you feel your present
legal problems are?”
z L29 “How important to you now is counseling
or referral for these Legal problems?”

The Addiction Severity Index 104

L26 Includes being arrested and released on the same day.

L27 Includes any type of activities where there was some form or profit, not just cash.
For example, having sex for cash and trading sex for drugs.

L28 Does not depend on ratings in L26 or L27. Refer to any problems the patient has
been bothered by in the past 30 days.

L29 Note that the patient is rating the need for legal referral or services related to current
criminal involvement.

The “Final Three” convention does not apply to the Legal section. Unlike the Medical, D/A, and Psych
sections, the Legal section has no single “days of problems” question.
L26 (days detained/incarcerated) and L27 (days of illegal activity) are asked and may influence the
patient’s ratings for L28/L29, but are not linked to those items. For example, someone could be presenting
for trial for an incident that happened 6 months ago and may currently need legal council even though
they were not detained or incarcerated in the past 30 days.

125
 The Final 3 - Legal

z Note: A patient can report no days

incarcerated or engaged in illegal activity
for profit in the past 30, but he/she may
still request counseling or referral for
legal problems that occurred in prior
months.

The Addiction Severity Index 104

The Final 3 Scoring – Legal

zL 26 and L27 are not related to L28 and

L29!

z Note that patient is rating need for Legal

referral or services from your agency
related to problems with current criminal
charges.

The Addiction Severity Index 106

126
 The Final 3 – Family/Social

z F30/31 “How many days in the past 30 have

you had serious conflicts with Family/Others?”

z F32/33 “How troubled or bothered have you

been in the past 30 days by these
Family/Social problems?”

z F34/35 “How important to you now is

treatment for these Family/Social problems?”

The Addiction Severity Index 118

F30/31 Includes only to serious conflicts, not minor disagreements.

F32/33 Does not depend on a rating in F30 or F31. Refer to any problems the patient has
been bothered by in the past 30 days.

F34/35 Note that the patient is rating the degree to which s/he is interested in treatment for
these problems - or for additional treatment, if s/he is currently receiving services.

F34 Family – Patient rating is not dependent on whether or not the family will attend
treatment!
F35 – Social – Include patients need to seek treatment for such social problems as
isolation, loneliness, inability to socialize, dissatisfaction with friends, etc.
In the Family/Social section, there are 2 sets of “Final Three” questions:

F30, F32, F34 refer only to problems with family

F31, F33, F35 refer only to problems with others, not family

The “Final Three” convention does not apply to the Family/Social section. Unlike the Medical, D/A, and
Psychiatric sections, the Family/Social section does not have a general “days of problems” question.
Instead, F30 and F31 ask the number of days the patient experienced serious conflicts with family and
with others (non-family).

This is a very narrow definition of family problems as it is limits the coding to days of “serious conflicts”
and by definition, includes contact (phone, or in person) with the individual(s). “Conflict” is defined as a

127
confrontational interaction, such as yelling, fighting, physical/verbal abuse, loss of control, etc. Conflict
as defined here, also must be serious enough to “jeopardize the relationship”.

The patient rating items for Family/Social, F32/F34 and F33/35 are independent of the days of conflict
items and can refer to any problem(s) reported throughout the Family/Social section. Therefore, it is
likely that someone may not have had “serious conflicts” in the past 30 days, but might be troubled or
bothered or want treatment or counseling for other significant family problems.

Remember–This is no link between F30 & F31 with F34–F35.

The Final 3 – Family/Support

z The “Final Three” convention does not apply to

this section.

z Unlike Medical, D/A, and Psychiatric, the

Family/Social questions on “days of problems”
are limited to days of “serious conflicts.”

z As a result, it would seem inappropriate to limit

a patient’s rating for treatment simply because
they had no “serious conflicts.”

The Addiction Severity Index 119

Additional hints –

F30, 32, 34: “Final 3” Family Problems

z Here Days of Family Conflict differs from F18 – F26. It

refers to more immediate confrontational action, such as
yelling, fighting, physical/verbal abuse and loss of
control.
z Rating importance of treatment for family problems does
not always mean family needs to attend counseling.

The Addiction Severity Index 120

128
F31, 33, 35: “Final 3” Social Problems

z Here Days of Social Conflict also refer to immediate

confrontational actions, such as yelling, fighting, physical/verbal
abuse and loss of control with people outside of the family.
z F33. Refers to social problems that are defined by ASI questions
not related to Family.
z F31-F35. Include feelings of loneliness, inability to socialize,
dissatisfaction with friends.

The Addiction Severity Index 121

129
 The Final 3 - Psychiatric
z P12 “How many days in the past 30 have you
experienced these psychological or emotional
problems?”

z P13 “How much have you been troubled or

bothered by these psychological or emotional
problems in the past 30 days?”

z P14 “How important to you now is treatment

for these psychological or emotional
problems”?

The Addiction Severity Index 130

P12 Includes ANY psychological or emotional problems reported in past 30 days in

items P4 – P10. Avoid use of term psychological/emotional “problems” when
asking these 3 items. Refer to specific symptoms provided, i.e., depression, anxiety,
etc.

P13 Refers to symptoms reported in P12. Record the patient’s self assessment, or rating,
of the degree to which s/he has been bothered by these symptoms in the past 30
days.

P14 This item again refers to symptoms reported in P12. Record patient’s rating of the
degree to which s/he is interested in treatment for these symptoms- or additional
treatment, if currently receiving services.

If the patient reports “No days of problems” in P12, then they should not have been troubled or bothered
by or want treatment for these psychological or emotional problems.

P12, P13 and P14 are linked items. One can’t rate the degree bothered by non-existent problems.

If the patient reports 0 days of problems and then reports being troubled or bothered, or wanting
treatment, ask them what they are troubled or bothered by or what they want treatment for, then go back
to P12 and identify the number of days they have had these problems in the past 30. Probe accordingly.
If new information is obtained, correct the # days recorded in P12 and obtain Patient Ratings for P13/P14.

130
Conversely, if the patient has 1 or more days of problems, you would expect that they were at least
slightly troubled or bothered, but you cannot assume that treatment is important to them at this time. It is
possible that the patient has already received treatment

Remember – P13 & P14 refer specifically to problems reported in P12.

Final 3 Scoring - Psychiatric

If P12 = 0, then
P13 = 0 and
P14 should be 0

If P12 > 0, then

P13 > 0, and
P14 can be any number

The Addiction Severity Index 132

131