| ENTRY SPECIFICATION |
{"name": "BAM-IOP-CSG-SUD",
"columns": 3,
"intro": "Instructions<br />This is a standard set of questions about several areas of your
life such as your health, alcohol and drug use, etc. The questions generally ask
about the past 7 days. Please consider each question and answer as accurately
as possible. ",
"controlWidth": 658, "min": 0, "max": 999},
{"id": "q9157", "type": "IntegerQuestion", "required": false,
"text": "5C. In the past 7 days, on the days that you consumed alcohol, what was the
highest number of drinks you consumed in one day?",
"intro": "Instructions<br />This is a standard set of questions about several areas of your
life such as your health, alcohol and drug use, etc. The questions generally ask
"choices":[
about the past 7 days. Please consider each question and answer as accurately
as possible. ",
"controlWidth": 658, "min": 0, "max": 999},
{"id": "q9138", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "6. In the past 7 days, how many days did you use any illegal or street drugs or
abuse any prescription medications?",
"intro": "Instructions<br />This is a standard set of questions about several areas of your
life such as your health, alcohol and drug use, etc. The questions generally ask
about the past 7 days. Please consider each question and answer as accurately
as possible. ",
{"id": "c2418", "text": "1. Clinician Interview", "quickKey": 1},
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3161", "text": "1. One day", "quickKey": 1},
{"id": "c3162", "text": "2. Two days", "quickKey": 2},
{"id": "c3163", "text": "3. Three days", "quickKey": 3},
{"id": "c3164", "text": "4. Four or more days", "quickKey": 4}
]},
{"id": "i1063", "type": "IntroText",
"text": "7. In the past 7 days, how many days did you use any of the following drugs: "
{"id": "c2419", "text": "2. Self Report", "quickKey": 2},
},
{"id": "q9139", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "7A. Marijuana (cannabis, pot, weed)?",
"intro": "7. In the past 7 days, how many days did you use any of the following drugs: ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3161", "text": "1. One day", "quickKey": 1},
{"id": "c3162", "text": "2. Two days", "quickKey": 2},
{"id": "c3163", "text": "3. Three days", "quickKey": 3},
{"id": "c2420", "text": "3. Phone", "quickKey": 3}
{"id": "c3164", "text": "4. Four or more days", "quickKey": 4}
]},
{"id": "q9140", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "7B. Sedatives and/or Tranquilizers (benzos, Valium, Xanax, Ativan, Ambien, barbs,
Phenobarbital, downers, etc.)?",
"intro": "7. In the past 7 days, how many days did you use any of the following drugs: ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3161", "text": "1. One day", "quickKey": 1},
]},
{"id": "c3162", "text": "2. Two days", "quickKey": 2},
{"id": "c3163", "text": "3. Three days", "quickKey": 3},
{"id": "c3164", "text": "4. Four or more days", "quickKey": 4}
]},
{"id": "q9141", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "7C. Cocaine and/or Crack?",
"intro": "7. In the past 7 days, how many days did you use any of the following drugs: ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "i1062", "type": "IntroText",
{"id": "c3161", "text": "1. One day", "quickKey": 1},
{"id": "c3162", "text": "2. Two days", "quickKey": 2},
{"id": "c3163", "text": "3. Three days", "quickKey": 3},
{"id": "c3164", "text": "4. Four or more days", "quickKey": 4}
]},
{"id": "q9142", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "7D. Other Stimulants (amphetamine, methamphetamine, Dexedrine, Ritalin, Adderall,
speed, crystal meth, ice, etc.)?",
"intro": "7. In the past 7 days, how many days did you use any of the following drugs: ",
"columns": 2,
"text": "Instructions<br />This is a standard set of questions about several areas of your
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3161", "text": "1. One day", "quickKey": 1},
{"id": "c3162", "text": "2. Two days", "quickKey": 2},
{"id": "c3163", "text": "3. Three days", "quickKey": 3},
{"id": "c3164", "text": "4. Four or more days", "quickKey": 4}
]},
{"id": "q9143", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "7E. Opiates (Heroin, Morphine, Dilaudid, Demerol, Oxycontin, oxy, codeine
(Tylenol 2,3,4), Percocet, Vicodin, Fentanyl, etc.)?",
life such as your health, alcohol and drug use, etc. The questions generally ask
"intro": "7. In the past 7 days, how many days did you use any of the following drugs: ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3161", "text": "1. One day", "quickKey": 1},
{"id": "c3162", "text": "2. Two days", "quickKey": 2},
{"id": "c3163", "text": "3. Three days", "quickKey": 3},
{"id": "c3164", "text": "4. Four or more days", "quickKey": 4}
]},
{"id": "q9144", "type": "ChoiceQuestion", "required": false, "inline": true,
about the past 7 days. Please consider each question and answer as accurately
"text": "7F. Inhalants (glues, adhesives, nail polish remover, paint thinner, etc.)?",
"intro": "7. In the past 7 days, how many days did you use any of the following drugs: ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3161", "text": "1. One day", "quickKey": 1},
{"id": "c3162", "text": "2. Two days", "quickKey": 2},
{"id": "c3163", "text": "3. Three days", "quickKey": 3},
{"id": "c3164", "text": "4. Four or more days", "quickKey": 4}
]},
"restartDays": 7,
as possible. "
{"id": "q9145", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "7G. Other drugs (steroids, non-prescription sleep and diet pills, Benadryl,
Ephedra, other over-the-counter or unknown medications)?",
"intro": "7. In the past 7 days, how many days did you use any of the following drugs: ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3161", "text": "1. One day", "quickKey": 1},
{"id": "c3162", "text": "2. Two days", "quickKey": 2},
{"id": "c3163", "text": "3. Three days", "quickKey": 3},
},
{"id": "c3164", "text": "4. Four or more days", "quickKey": 4}
]},
{"id": "q9146", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "8. In the past 7 days, how much were you bothered by cravings or urges to drink
alcohol or use drugs?",
"intro": "7. In the past 7 days, how many days did you use any of the following drugs: ",
"columns": 2,
"choices":[
{"id": "c212", "text": "0. Not at all", "quickKey": 0},
{"id": "c717", "text": "1. Slightly", "quickKey": 1},
{"id": "q9133", "type": "ChoiceQuestion", "required": false, "inline": true,
{"id": "c685", "text": "2. Moderately", "quickKey": 2},
{"id": "c2312", "text": "3. Considerably", "quickKey": 3},
{"id": "c687", "text": "4. Extremely", "quickKey": 4}
]},
{"id": "q9147", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "9. How confident are you in your ability to be completely abstinent (clean) from
alcohol and drugs in the next 7 days?",
"intro": "7. In the past 7 days, how many days did you use any of the following drugs: ",
"columns": 2,
"choices":[
"text": "1. In the past 7 days, how would you say your physical health has been?",
{"id": "c212", "text": "0. Not at all", "quickKey": 0},
{"id": "c717", "text": "1. Slightly", "quickKey": 1},
{"id": "c685", "text": "2. Moderately", "quickKey": 2},
{"id": "c2312", "text": "3. Considerably", "quickKey": 3},
{"id": "c687", "text": "4. Extremely", "quickKey": 4}
]},
{"id": "q9148", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "10. In the past 7 days, how many days did you attend self-help meetings like AA
or NA to support your recovery?",
"intro": "7. In the past 7 days, how many days did you use any of the following drugs: ",
"intro": "Instructions<br />This is a standard set of questions about several areas of your
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3161", "text": "1. One day", "quickKey": 1},
{"id": "c3162", "text": "2. Two days", "quickKey": 2},
{"id": "c3163", "text": "3. Three days", "quickKey": 3},
{"id": "c3164", "text": "4. Four or more days", "quickKey": 4}
]},
{"id": "q9149", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "11. In the past 7 days, how many days were you in any situations or with any
life such as your health, alcohol and drug use, etc. The questions generally ask
people that might put you at an increased risk for using alcohol or drugs (i.e.,
around risky \u0022people, places or things\u0022)?",
"intro": "7. In the past 7 days, how many days did you use any of the following drugs: ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3161", "text": "1. One day", "quickKey": 1},
{"id": "c3162", "text": "2. Two days", "quickKey": 2},
{"id": "c3163", "text": "3. Three days", "quickKey": 3},
{"id": "c3164", "text": "4. Four or more days", "quickKey": 4}
about the past 7 days. Please consider each question and answer as accurately
]},
{"id": "q9150", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "12. Does your religion or spirituality help support your recovery?",
"intro": "7. In the past 7 days, how many days did you use any of the following drugs: ",
"columns": 2,
"choices":[
{"id": "c212", "text": "0. Not at all", "quickKey": 0},
{"id": "c717", "text": "1. Slightly", "quickKey": 1},
{"id": "c685", "text": "2. Moderately", "quickKey": 2},
{"id": "c2312", "text": "3. Considerably", "quickKey": 3},
as possible. ",
{"id": "c687", "text": "4. Extremely", "quickKey": 4}
]},
{"id": "q9151", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "13. In the past 7 days, how many days did you spend much of the time at work,
school, or doing volunteer work?",
"intro": "7. In the past 7 days, how many days did you use any of the following drugs: ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3161", "text": "1. One day", "quickKey": 1},
"columns": 2,
{"id": "c3162", "text": "2. Two days", "quickKey": 2},
{"id": "c3163", "text": "3. Three days", "quickKey": 3},
{"id": "c3164", "text": "4. Four or more days", "quickKey": 4}
]},
{"id": "q9152", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "14. Do you have enough income (from legal sources) to pay for necessities such as
housing, transportation, food and clothing for yourself and your dependents?",
"intro": "7. In the past 7 days, how many days did you use any of the following drugs: ",
"columns": 2,
"choices":[
"choices":[
{"id": "c237", "text": "0. No", "quickKey": 0},
{"id": "c241", "text": "1. Yes", "quickKey": 1}
]},
{"id": "q9153", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "15. In the past 7 days, how much have you been bothered by arguments or problems
getting along with any family members or friends?",
"intro": "7. In the past 7 days, how many days did you use any of the following drugs: ",
"columns": 2,
"choices":[
{"id": "c212", "text": "0. Not at all", "quickKey": 0},
"printTitle": "Brief Addiction Monitor - IOP version for CSG-SUD (BAM-IOP-CSG-SUD)",
{"id": "c1059", "text": "0. Excellent", "quickKey": 0},
{"id": "c717", "text": "1. Slightly", "quickKey": 1},
{"id": "c685", "text": "2. Moderately", "quickKey": 2},
{"id": "c2312", "text": "3. Considerably", "quickKey": 3},
{"id": "c687", "text": "4. Extremely", "quickKey": 4}
]},
{"id": "q9154", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "16. In the past 7 days, how many days were you in contact or spent time with any
family members or friends who are supportive of your recovery?",
"intro": "7. In the past 7 days, how many days did you use any of the following drugs: ",
"columns": 2,
{"id": "c1060", "text": "1. Very good", "quickKey": 1},
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3161", "text": "1. One day", "quickKey": 1},
{"id": "c3162", "text": "2. Two days", "quickKey": 2},
{"id": "c3163", "text": "3. Three days", "quickKey": 3},
{"id": "c3164", "text": "4. Four or more days", "quickKey": 4}
]},
{"id": "q9155", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "17. How satisfied are you with your progress toward achieving your recovery
goals?",
{"id": "c1061", "text": "2. Good", "quickKey": 2},
"intro": "7. In the past 7 days, how many days did you use any of the following drugs: ",
"columns": 2,
"choices":[
{"id": "c212", "text": "0. Not at all", "quickKey": 0},
{"id": "c717", "text": "1. Slightly", "quickKey": 1},
{"id": "c685", "text": "2. Moderately", "quickKey": 2},
{"id": "c2312", "text": "3. Considerably", "quickKey": 3},
{"id": "c687", "text": "4. Extremely", "quickKey": 4}
]}],
"rules":[
{"id": "c1062", "text": "3. Fair", "quickKey": 3},
{"question": "q9136", "operator": "EQ", "value": "c1",
"skips":["q9137","q9156","q9157"]},
{"question": "q9138", "operator": "EQ", "value": "c1",
"skips":["q9139","q9140","q9141","q9142","q9143","q9144","q9145"]}]
}
{"id": "c1063", "text": "4. Poor", "quickKey": 4}
]},
{"id": "q9134", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "2. In the past 7 days, how many nights did you have trouble falling asleep or
staying asleep?",
"intro": "Instructions<br />This is a standard set of questions about several areas of your
"content":[
life such as your health, alcohol and drug use, etc. The questions generally ask
about the past 7 days. Please consider each question and answer as accurately
as possible. ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3157", "text": "1. One night", "quickKey": 1},
{"id": "c3158", "text": "2. Two nights", "quickKey": 2},
{"id": "c3159", "text": "3. Three nights", "quickKey": 3},
{"id": "c3160", "text": "4. Four or more nights", "quickKey": 4}
{"id": "q9131", "type": "DateQuestion", "required": false, "inline": true,
]},
{"id": "q9135", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "3. In the past 7 days, how many days have you felt depressed, anxious, angry or
very upset throughout most of the day?",
"intro": "Instructions<br />This is a standard set of questions about several areas of your
life such as your health, alcohol and drug use, etc. The questions generally ask
about the past 7 days. Please consider each question and answer as accurately
as possible. ",
"columns": 2,
"choices":[
"text": "A. Date of administration:",
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3161", "text": "1. One day", "quickKey": 1},
{"id": "c3162", "text": "2. Two days", "quickKey": 2},
{"id": "c3163", "text": "3. Three days", "quickKey": 3},
{"id": "c3164", "text": "4. Four or more days", "quickKey": 4}
]},
{"id": "q9136", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "4. In the past 7 days, how many days did you drink ANY alcohol?",
"intro": "Instructions<br />This is a standard set of questions about several areas of your
life such as your health, alcohol and drug use, etc. The questions generally ask
"controlWidth": 120, "daysBack": 30, "daysAhead": 0},
about the past 7 days. Please consider each question and answer as accurately
as possible. ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3161", "text": "1. One day", "quickKey": 1},
{"id": "c3162", "text": "2. Two days", "quickKey": 2},
{"id": "c3163", "text": "3. Three days", "quickKey": 3},
{"id": "c3164", "text": "4. Four or more days", "quickKey": 4}
]},
{"id": "q9132", "type": "ChoiceQuestion", "required": false, "inline": true,
{"id": "q9137", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "5A. In the past 7 days, how many days did you have at least 5 drinks (if you are
a man) or at least 4 drinks (if you are a woman)? [One drink is considered one
shot of hard liquor (1.5 oz.) or 12-ounce can/bottle of beer or 5-ounce glass of
wine.]",
"intro": "Instructions<br />This is a standard set of questions about several areas of your
life such as your health, alcohol and drug use, etc. The questions generally ask
about the past 7 days. Please consider each question and answer as accurately
as possible. ",
"columns": 2,
"text": "B. Method of administration:",
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3161", "text": "1. One day", "quickKey": 1},
{"id": "c3162", "text": "2. Two days", "quickKey": 2},
{"id": "c3163", "text": "3. Three days", "quickKey": 3},
{"id": "c3164", "text": "4. Four or more days", "quickKey": 4}
]},
{"id": "q9156", "type": "IntegerQuestion", "required": false,
"text": "5B. In the past 7 days, on the days that you consumed alcohol, what was the
average number of drinks you consumed on those days?",
|
