ALCOHOL AND DRUG USE INTAKE ASSESSMENT
(Modified Michigan Alcohol Screening Test)

1. Tell me about your drinking pattern. What do you drink? Do you drink/drug every day? How
many drinks? How much alcohol do you put in each drink? Do you measure the alcohol?

2. How much alcohol do you consume in a week?

3. Was there ever a time in your life when you worried about your alcohol or drug intake? Have you ever tried to control amount/frequency?

4. Have you ever taken any drugs? (Mention pot, cocaine, speed, acid, PCP, tranquilizers.) Has a doctor ever prescribed tranquilizers for you? (Get name and dosage.)

5. Does anyone in your family have a problem with drinking or taking drugs?

6. Is anyone in your family concerned about your drinking/drugging?

7. What do you do to relax or unwind or calm down? What do you do if you can't get to sleep at night?

8. Have you ever taken a drink/drug in the morning?

9. Do you have any health problems that may relate to alcohol/drugs? (Suggest specific problems.)

10. Are your caregivers concerned about your drinking/drugging?

11. Have you gotten in trouble at your treatment program due to alcohol/drugs? Have you been suspended or terminated?

12. Have alcohol and drugs led to ER visits? To hospitalization?

13. Have you ever lost time from work because of drinking or because you were sick from drinking?

14. Have you ever been in a motor vehicle accident or dangerous situation where alcohol/drugs were involved? Who was driving? Was alcohol or drugs involved?

15. Have you ever been arrested for DUI (Driving Under the Influence)?

16. Do you know what a blackout is? Have you ever had a blackout when you drink?

17. Does it annoy you if someone tells you that you drink too much?

18. Has there been an increase in the amount of alcohol/drugs you use in the last 6-12 months?

19. Do you seem to be able to "hold your liquor" better than others you know? Does it take more alcohol or drugs to get you "feeling good" than it does others?

20. Have you ever tried to cut down on the amounts or kinds of alcohol and/or drugs? (See #3) 21. Have you ever tried to quit?

22. Have you ever felt guilty after drinking or drugging?

23. Have you ever lied about drinking the amounts you drank?

24. Have you ever "gotten drunk" even when you planned not to?

25. If you drink or use drugs, what do you like about it? What, if anything, don't you like?

26. Do you find that drugs and alcohol are helpful or unhelpful in dealing with your mental illness? In what ways?

27. What effect does getting drunk or high have on your symptoms? How about when you are coming down, hung over, or crashing?

AFTER ASKING THESE QUESTIONS, ASK YOURSELF (INTERVIEWER) HOW YOU FEEL. DO YOU FEEL THAT THE PERSON HAS BEEN DEFENSIVE OR UNCOMFORTABLE WHEN ANSWERING THE QUESTIONS? DOES YOUR "GUT" FEELING TELL YOU THERE IS PROBABLY MORE TO THE STORY THAN HE/SHE IS LETTING ON? IF SO, THERE PROBABLY IS.