
File ADDICTION_SEVERITY_INDEX(604) Data List
| ID NUMBER |
NAME |
DATE OF BIRTH |
SSN |
STREET LINE 1 |
ZIP+4 |
STREET LINE 2 |
STREET LINE 3 |
CITY |
STATE |
ZIP |
PHONE |
RESOLVED ADM DATE |
CLASS |
AGE |
DATE OF INTERVIEW |
TIME INTERVIEW BEGAN |
TIME INTERVIEW ENDED |
CONTACT CODE |
GENDER |
INTERVIEWER |
SPECIAL |
RECORD INITIALIZED DATE TIME |
RECORD COMPLETED DATE TIME |
RECORD INITIALIZED BY (TRANS) |
RACE |
RELIGIOUS PREFERENCE |
ELECTRONICALLY SIGNED |
E SIGNATURE INTERVIEWER |
GENERAL COMMENT |
CS MEDICAL |
CS EMPLOYMENT |
CS ALCOHOL |
CS DRUG |
CS LEGAL |
CS FAMILY |
CS PSYCHIATRIC |
E SIGNATURE TRANSCRIBER |
PERSON ALLOWED TO EDIT |
ADMISSION DATE |
ADDR LIVED YRS |
ADDR LIVED MOS |
ADDR OWN |
ALCOHOL ANY USE L30DAYS |
ALCOHOL ANY USE LIFETIME YRS |
ALCOHOL ANY USE ROA |
ALCOHOL INTOX USE L30DAYS |
ALCOHOL INTOX LIFETIME YRS |
ALCOHOL INTOX ROA |
HEROIN L30DAYS |
HEROIN LIFETIME YRS |
HEROIN ROA |
METHADONE L30DAYS |
METHADONE LIFETIME YRS |
METHADONE ROA |
OTHER OPIATES/ANA L30DAYS |
OTHER OPIATES/ANA LIFETIME YRS |
OTHER OPIATES/ANA ROA |
BARBITUATES L30DAYS |
BARBITUATES LIFETIME YRS |
BARBITUATES ROA |
OTHER S H T L30DAYS |
OTHER S H T LIFETIME YRS |
OTHER S H T ROA |
COCAINE L30DAYS |
COCAINE LIFETIME YRS |
COCAINE ROA |
AMPHETAMINES L30DAYS |
AMPHETAMINES LIFETIME YRS |
AMPHETAMINES ROA |
CANNABIS L30DAYS |
CANNABIS LIFETIME YRS |
CANNABIS ROA |
HALLUCINOGENS L30DAYS |
HALLUCINOGENS LIFETIME YRS |
HALLUCINOGENS ROA |
INHALANTS L30DAYS |
INHALANTS LIFETIME YRS |
INHALANTS ROA |
MT1PD L30DAYS |
MT1PD LIFETIME YRS |
MAJOR PROBLEM |
DRUG/ALCOHOL COMMENT |
ABSTINENT MONTHS |
ABSTINENT ENDED MONTHS AGO |
TIMES HAD ALCOHOL D.T.'S |
TIMES OVERDOSED ON DRUGS |
ALCOHOL ABUSE LIFETIME |
DRUG ABUSE LIFETIME |
TIMES DETOX ONLY ALCOHOL |
TIMES DETOX ONLY DRUG |
SPENT L30D ALCOHOL |
SPENT L30D DRUGS |
DAYS TMT D/A L30D OUTP |
DAYS L30D ALCOHOL PROB |
DAYS L30D DRUG PROB |
TROUBLED ALCOHOL L30D |
TMT IMPORTANT ALCOHOL |
TROUBLED DRUG L30D |
TMT IMPORTANT DRUG |
INTERVIEWER'S RATING ALCOHOL |
INTERVIEWER'S RATING DRUG |
PATIENT MISREP D/A |
PATIENT INAB UNDSTND D/A |
ADM PROMPTED BY CJS |
ON PROBATION OR PAROLE |
SHOPLIFTING/VANDALISM |
PAROLE/PROBATION VIOLATIONS |
DRUG CHARGES |
FORGERY |
WEAPONS OFFENSE |
BURGLARY LARCENY B & E |
ROBBERY |
ASSAULT |
ARSON |
RAPE |
HOMICIDE MANSLAUGHTER |
PROSTITUTION |
CONTEMPT OF COURT |
OTHER CHARGES |
CONVICTIONS |
DCVPI |
DRIVING WHILE INTOXICATED |
MAJOR DRIVING VIOLATIONS |
MONTH INCARCERATED LIFETIME |
MONTHS LAST INCARCERATION |
LAST INCARCERATED FOR |
INCARCERATION CODE |
AWAITING CTS |
FOR WHAT |
DETAINED/INCARCERATED L30D |
ILLEGAL ACTIVITIES/PROFIT L30D |
LEGAL PROB SCALE |
LEGAL IMPORTANCE SCALE |
INTERVIEWER'S RATING LEGAL |
PATIENT MISREP LEGAL |
PATIENT INAB UNDSTND LEGAL |
LEGAL COMMENT |
MS GRANDMOTHER ALC |
MS GRANDMOTHER DRUG |
MS GRANDMOTHER PSYCH |
MS GRANDFATHER ALC |
MS GRANDFATHER DRUG |
MS GRANDFATHER PSYCH |
MS MOTHER ALC |
MS MOTHER DRUG |
MS MOTHER PSYCH |
MS AUNT ALC |
MS AUNT DRUG |
MS AUNT PSYCH |
MS UNCLE ALC |
MS UNCLE DRUG |
MS UNCLE PSYCH |
FS GRANDMOTHER ALC |
FS GRANDMOTHER DRUG |
FS GRANDMOTHER PSYCH |
FS GRANDFATHER ALC |
FS GRANDFATHER DRUG |
FS GRANDFATHER PSYCH |
FS FATHER ALC |
FS FATHER DRUG |
FS FATHER PSYCH |
FS AUNT ALC |
FS AUNT DRUG |
FS AUNT PSYCH |
FS UNCLE ALC |
FS UNCLE DRUG |
FS UNCLE PSYCH |
BROTHER ALC |
BROTHER DRUG |
BROTHER PSYCH |
SISTER ALC |
SISTER DRUG |
SISTER PSYCH |
FAMILY HISTORY COMMENT |
MARITIAL STATUS |
MARITIAL STATUS YRS |
MARITIAL STATUS MOS |
SATISFIED WITH SITUATION |
USUAL LIVING ARGMENTS P3Y |
ARRANGEMENTS LOT YRS |
ARRANGEMENTS LOT MOS |
ARRANGEMENTS SATISFACTION |
LIVE W/ ANYONE W/ ALC PROB |
LIVE W/ ANYONE W/ DRUG PROB |
SPEND FREE TIME WITH |
SATISFIED SPENDING FREE TIME |
HOW MANY CLOSE FRIENDS |
CLOSE WITH MOTHER |
CLOSE WITH FATHER |
CLOSE WITH BROTHERS/SISTERS |
CLOSE WITH SEX PARTNER/SPOUSE |
CLOSE WITH CHILDREN |
CLOSE WITH FRIENDS |
PROBLEM W/ MOTHER P30D |
PROBLEM W/ MOTHER LIFE |
PROBLEM W/ FATHER P30D |
PROBLEM W/ FATHER LIFE |
PROBLEM W/ BRO/SIS P30D |
PROBLEM W/ BRO/SIS LIFE |
PROBLEM W/ SEX PARTNER/SP P30D |
PROBLEM W/ SEX PARTNER/SP LIFE |
PROBLEM W/ CHILDREN P30D |
PROBLEM W/ CHILDREN LIFE |
PROBLEM W/ OSF P30D |
PROBLEM W/ OSF SPECIFY |
PROBLEM W/ OSF LIFE |
PROBLEM W/ CF P30D |
PROBLEM W/ CF LIFE |
PROBLEM W/ NEIGHBORS L30D |
PROBLEM W/ NEIGHBORS LIFE |
PROBLEM W/CO WKRS P30D |
PROBLEM W/CO WKRS LIFE |
ABUSE EMOTIONALLY L30D |
ABUSE EMOTIONALLY LIFE |
ABUSE PHYSICALLY L30D |
ABUSE PHYSICALLY LIFE |
ABUSE SEXUALLY L30D |
ABUSE SEXUALLY LIFE |
CONFLICT FAMILY P30D |
CONFILCT OTHER P30D |
TROUBLED FAMILY PROBLEMS |
TROUBLED SOCIAL PROBLEMS |
TREATMENT FAMILY PROBLEMS |
TREATMENT SOCIAL PROBLEMS |
INTERVIEWER'S RATING FAMILY |
FAMILY/SOC CONFIDENCE MISREP |
FAMILY/SOC CONFIDENCE ITU |
FAMILY/SOCIAL COMMENT |
LEISURE TIME ISSUES |
SPIRITUAL ISSUES |
TREATED IN HOSPITAL |
TREATED AS OPT OR PRIV PT |
PENSION FOR PSY DIS |
EXP DEPRESSION P30D |
EXP DEPRESSION LIFE |
EXP ANXIETY P30D |
EXP ANXIETY LIFE |
EXP HALLUCINATIONS L30D |
EXP HALLUCINATIONS LIFE |
EXP UCR L30D |
EXP UCR LIFE |
EXP CONT VIO BEHAVIOR L30D |
EXP CONT VIO BEHAVIOR LIFE |
EXP THOUGHTS SUICIDE L30D |
EXP THOUGHTS SUCIDE LIFE |
EXP ATTEMPTED SUICIDE L30D |
EXP ATTEMPTED SUICIDE LIFE |
MEDS FOR PSY PROB L30D |
MEDS FOR PSY PROB LIFE |
DAYS EXP PROB L30D |
PSY PROB L30D RATING |
PSY TMT RATING |
INTV DEPRESSED/WITHDRAWN |
INTV HOSTILE |
INTV ANXIOUS/NERVOUS |
INTV TROUBLE WITH RTTDPT |
INTV TROUBLE CCR |
INTV SUICIDAL THOUGHTS |
INTERVIEWER'S RATING PSY |
PSY PATIENT'S MISREPRESENTATIN |
PSY PATIENT'S INABILITY TO UND |
PSYCHIATRIC COMMENT |
PROGRAM |
CONTROLLED ENVIRONMENT |
OTHER |
HOW MANY DAYS |
SHIPLEY C.Q. |
SHIPLEY I.Q. |
BECK TOTAL SCORE |
AWAITING TRANSMISSION |
TRANSMISSION DATE |
HOSPITALIZATIONS |
LAST HOSPITALIZATION YRS |
LAST HOSPITALIZATION MOS |
CHRONIC PROBLEM |
CHRONIC MEDICAL SPECIFY |
MEDICATION |
DISABILITY PENSION |
SPECIFY PENSION |
PROBLEM PAST 30 DAYS |
SCALE MED PROBLEM PAST 30D |
IMPORTANCE MEDICAL TREATMENT |
INTERVIEWER'S RATING MEDICAL |
PATIENT MISREP MEDICAL |
PATIENT INAB UNDSTND MEDICAL |
MEDICAL COMMENT |
YEARS EDUCATION COMPLETED |
MONTHS EDUCATION COMPLETED |
MONTHS TRAINING OR TECH |
PROFESSION TRADE OR SKILL |
SPECIFY PTS |
VALID DRIVERS LICENSE |
AUTOMOBILE |
LONGEST FULL-TIME JOB YRS |
LONGEST FULL-TIME JOB MOS |
USUAL OR LAST OCCUPATION |
USUAL OR LAST OCC TEXT |
SUPPORT |
MAJORITY OF SUPPORT |
EMPLOYMENT PATTERN |
DAYS PAID LAST 30 DAYS |
EMPLOYMENT INCOME |
UNEMPLOYMENT COMPENSATION |
WELFARE INCOME |
PENSION |
MATE FAMILY FRIENDS INCOME |
MATE FAMILY FRIENDS SPECIFY |
ILLEGAL INCOME |
NUMBER OF DEPENDENTS |
DAYS EMP PROB LAST 30 |
EMPLOYMENT PROB 30 DAYS |
EMP COUNSELING IMPORTANT |
INTERVIEWER'S RATING EMPL |
PATIENT MISREP EMP |
PATIENT INAB UNDSTND EMP |
EMPLOYMENT COMMENT |