Enhancing Motivation for Change in Substance Abuse Treatment
Treatment Improvement Protocol (TIP) Series 35

Alcohol and Drug Consequences Questionnaire (ADCQ)

1. Your drinking

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

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

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

ONE STANDARD DRINK IS:
Beer	10 oz	Wine	4 oz	80 proof liquor	1 oz	100 proof liquor	1 oz

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

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

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

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

2. Level of intoxication

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

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

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

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

3. Risk factors

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

4. Negative consequences

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

5. Blood tests

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

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

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

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

6. Neuropsychological tests

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

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

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

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

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

Summary

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

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

SOCRATES Scoring Form (19-Item Version 8)

SOCRATES Profile Sheet (19-Item Version 8A)

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

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

Guidelines for Interpretation of SOCRATES-8 Scores

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

Instructions

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

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

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

0	NO	means that you definitely do NOT want or need this from treatment.
1	?	means that you are UNSURE. MAYBE you want this from treatment.
2	YES	means that you DO want or need this from treatment.
3	YES!	means that you DEFINITELY want or need this from treatment.

FOR EXAMPLE:

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

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

What I Want From Treatment

DO YOU WANT THIS FROM TREATMENT? NO 0 Maybe 1 Yes 2 YES! 3 1. I want to receive detoxification, to ease my withdrawal from alcohol or other drugs. 0 1 2 3 2. I want to find out for sure whether I have a problem with alcohol or other drugs. 0 1 2 3 3. I want help to stop drinking alcohol completely. 0 1 2 3 4. I want help to decrease my drinking. 0 1 2 3 5. I want help to stop using drugs (other than alcohol). 0 1 2 3 6. I want to stop using tobacco. 0 1 2 3 7. I want to decrease my use of tobacco. 0 1 2 3 8. I want help with an eating problem. 0 1 2 3 9. I want help with a gambling problem. 0 1 2 3 10. I want to take Antabuse (a medication to help me stop drinking). 0 1 2 3 11. I want to take Trexan (a medication to help me stop using alcohol or heroin). 0 1 2 3 12. I want to take methadone. 0 1 2 3 13. I want to learn more about alcohol/drug problems. 0 1 2 3 14. I want to learn some skills to keep from returning to alcohol or other drugs. 0 1 2 3 15. I would like to learn more about 12-Step programs like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA). 0 1 2 3 16. I would like to talk about some personal problems. 0 1 2 3 1. I need to fulfill a requirement of the courts. 0 1 2 3 17. I would like help with problems in my marriage or close relationship. 0 1 2 3 18. I want help with some health problems. 0 1 2 3 19. I want help to decrease my stress and tension. 0 1 2 3 20. I would like to improve my health by learning more about nutrition and exercise. 0 1 2 3 21. I want help with depression or moodiness. 0 1 2 3 23. I want to work on my spiritual growth. 0 1 2 3 24. I want to learn how to solve problems in my life. 0 1 2 3 25. I want help with angry feelings and how I express them. 0 1 2 3 26. I want to have healthier relationships. 0 1 2 3 27. I would like to discuss sexual problems. 0 1 2 3 28. I want to learn how to express my feelings in a more healthy way. 0 1 2 3 29. I want to learn how to relax better. 0 1 2 3 30. I want help in overcoming boredom. 0 1 2 3 31. I want help with feelings of loneliness. 0 1 2 3 32. I want to discuss having been physically abused. 0 1 2 3 33. I want help to prevent violence at home. 0 1 2 3 34. I want to discuss having been sexually abused. 0 1 2 3 35. I want to work on having better self-esteem. 0 1 2 3 36. I want help with sleep problems. 0 1 2 3 37. I want help with legal problems. 0 1 2 3 38. I want advice about financial problems. 0 1 2 3 39. I would like help in finding a place to live. 0 1 2 3 40. I could use help in finding a job. 0 1 2 3 41. Someone close to me has died or left, and I would like to talk about it. 0 1 2 3 42. I have thoughts about suicide, and I would like to discuss this. 0 1 2 3 43. I want help with personal fears and anxieties. 0 1 2 3 44. I want help to be a better parent. 0 1 2 3 45. I feel very confused and would like help with this. 0 1 2 3 46. I would like information about or testing for HIV/AIDS. 0 1 2 3 47. I want someone to listen to me. 0 1 2 3 48. I want to learn to have fun without drugs or alcohol. 0 1 2 3 49. I want someone to tell me what to do. 0 1 2 3 50. I want help in setting goals and priorities in my life. 0 1 2 3 51. I would like to learn how to manage my time better. 0 1 2 3 52. I want help to receive SSI/disability payments. 0 1 2 3 53. I want to find enjoyable ways to spend my free time. 0 1 2 3 54. I want help in getting my child(ren) back. 0 1 2 3 55. I would like to talk about my past. 0 1 2 3 56. I need help in getting motivated to change. 0 1 2 3 57. I would like to see a female counselor. 0 1 2 3 58. I would like to see a male counselor. 0 1 2 3 59. I would like to see the counselor I had before. 0 1 2 3 60. I would like to see a doctor or nurse about medical problems. 0 1 2 3 61. I want to receive medication. 0 1 2 3 62. I would like my spouse or partner to be in treatment with me. 0 1 2 3 63. I would like to have private, individual counseling. 0 1 2 3 64. I would like to be in a group with people who are dealing with problems similar to my own. 0 1 2 3 65. I need someone to care for my children while I am in treatment. 0 1 2 3 66. I want my treatment to be short. 0 1 2 3 67. I believe I will need to be in treatment for a long time. 0 1 2 3

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