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pdf2017-2020 NSDUH Methodological Field
Tests, Supporting Statement
Appendix A – 2015 National Survey on Drug
Use and Health: DSM-5 Final Report
2015 NATIONAL SURVEY ON
DRUG USE AND HEALTH:
DSM-5 FINAL REPORT
Substance Abuse and Mental Health Services Administration
Center for Behavioral Health Statistics and Quality
Rockville, Maryland
May 2016
2015 NATIONAL SURVEY ON
DRUG USE AND HEALTH: DSM-5
DRAFT REPORT
Contract No. HHSS283201000003C
RTI Project No. 0213757.004.107.008.004.026
RTI Authors:
RTI Project Director:
Cristie Glasheen
Emily Geisen
David Hunter
SAMHSA Project Officer:
Peter Tice
For questions about this report, please email [email protected].
Prepared for Substance Abuse and Mental Health Services Administration,
Rockville, Maryland.
Prepared by RTI International, Research Triangle Park, North Carolina.
May 2016
Acknowledgments
This report was prepared for the Substance Abuse and Mental Health Services Administration
(SAMHSA), Center for Behavioral Health Statistics and Quality, by RTI International (a trade
name of Research Triangle Institute International). Contributors to this report at RTI include
Elizabeth Ball, Gretchen McHenry, Jeanne Snodgrass, Patty LeBaron, Rosanna Quiroz, Doug
Currivan, and Dave Hunter. Contributors to this report at SAMHSA include Rebecca Ahrnsbrak,
Herman Alvarado, Peggy Barker, Joel Kennet, Grace Medley, and Dicy Painter.
ii
Table of Contents
Chapter
Page
1.
Introduction ......................................................................................................................... 1
2.
Review and Development of Draft Items ........................................................................... 3
2.1
English-Language Items ......................................................................................... 3
2.1.1 Marijuana/Hashish Withdrawal Symptoms ................................................ 3
2.1.2 Using a Pharmacologically Similar Substance to Prevent or Avoid
Withdrawal Symptoms................................................................................ 4
2.1.3 Craving........................................................................................................ 4
2.2
Spanish-Language Items ......................................................................................... 5
3.
Expert Review ..................................................................................................................... 7
3.1
English-Language Expert Review .......................................................................... 7
3.2
Spanish-Language Expert Review ........................................................................ 11
4.
Cognitive Interviews ......................................................................................................... 13
4.1
Purpose .................................................................................................................. 13
4.2
Methods................................................................................................................. 14
4.2.1 Recruitment and Participant Selection ...................................................... 14
4.3
Approach ............................................................................................................... 19
4.4
Round 1 Findings .................................................................................................. 20
Final Revisions Made for Round 2 ....................................................................... 25
4.5
Round 2 Findings .................................................................................................. 26
Final Revisions Made for Round 3 ....................................................................... 31
4.6
Round 3 Findings .................................................................................................. 31
4.7
Conclusions ........................................................................................................... 36
References ..................................................................................................................................... 37
Appendixes
A
Substantive Reviewer Feedback ..................................................................................... A-1
B
DSM-5 Cognitive Testing R3 Protocol........................................................................... B-1
C
DSM-5 Testing Adult Cognitive Interview Participant Informed Consent Form
and Parental Permission and Informed Consent Form ................................................... C-1
D
DSM-5 R1 Memo ........................................................................................................... D-1
E
DSM-5 R2 Memo ............................................................................................................E-1
F
DSM-5 R3 Memo ............................................................................................................ F-1
G
DSM-5 Dependence Module – English .......................................................................... G-1
H
DSM-5 Dependence Module – Spanish .......................................................................... H-1
iii
iv
List of Tables
Table
Page
4.1
Cognitive Testing Goals by Survey Question................................................................... 13
4.2.
Participant Characteristics ................................................................................................ 16
4.3.
English-Language Participant Characteristics .................................................................. 17
4.4.
Spanish-Language Participant Characteristics .................................................................. 18
4.5.
English-Language Participant Characteristics .................................................................. 18
4.6.
Spanish-Language Participant Characteristics .................................................................. 19
v
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1. Introduction
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a manual used to
classify mental disorders, including substance use disorders (SUDs). It provides a classification
system for clinicians, insurance providers, researchers, and policymakers to use in matters
related to the diagnosis, research, and treatment of mental illness. In 2013, the DSM, 4th edition
(DSM-IV), which had been used for over a decade, was replaced with the 5th edition (DSM-5)
(American Psychological Association [APA], 1994, 2013). This revision contained changes in
organization and numerous changes to the diagnostic criteria of nearly every DSM-IV disorder,
including SUDs.
The Substance Abuse and Mental Health Services Administration’s (SAMHSA's) annual
National Survey on Drug Use and Health (NSDUH1) currently uses the DSM-IV criteria to
develop questions from which national- and state-level data on SUDs are produced. The
substances included are alcohol, cocaine (including crack), hallucinogens, heroin, inhalants,
marijuana/hashish, methamphetamine, and (misuse of) prescription sedatives, stimulants,
tranquilizers, and pain relievers. Each year, NSDUH collects substance use and SUD information
from approximately 70,000 residents of households and non-institutional group quarters (e.g.,
shelters, rooming houses, dormitories) and from civilians living on military bases. NSDUH data
provide the substance abuse prevention, treatment, and research communities with current,
relevant information on the nation's SUD status. These data provide information to stakeholders
and policymakers about disease burden, temporal trends, and consequences of substance use, and
they are also used to help identify high-risk groups.
In response to the DSM-IV to DSM-5 revisions, SAMHSA initiated a project to develop
and test revisions to the Substance Dependence and Abuse module in NSDUH to enable the
production of DSM-5-based estimates of SUDs. Development and testing consisted of the
following steps:
•
review of diagnostic changes and development of draft English- and Spanishlanguage items;
•
expert review of the English- and Spanish-language draft items; and
•
iterative cognitive testing and revision of the English- and Spanish-language items.
The purpose of this report is to present the overarching findings and recommendations for
potential modification of NSDUH to produce estimates of SUDs consistent with the DSM-5
criteria.
1
NSDUH is sponsored by SAMHSA and supervised by SAMHSA's Center for Behavioral Health Statistics
and Quality.
1
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2. Review and Development of Draft Items
2.1
English-Language Items
Review of the revised diagnostic criteria resulted in an extensive report on the changes
and implications for each substance (SAMHSA, in press). The report identified several areas for
revision, three of which were the focus of this project: (1) marijuana/hashish withdrawal
symptoms, (2) using a pharmacologically similar substance to prevent or avoid withdrawal
symptoms, and (3) craving. Details regarding each of these areas and the questions affected are
presented below.
2.1.1
Marijuana/Hashish Withdrawal Symptoms
Prior to DSM-5, marijuana/hashish abuse and dependence (also called cannabis use
disorder) did not include withdrawal symptoms as a diagnostic criterion. Research conducted
after the publication of DSM-IV has identified a cluster of symptoms associated with cannabis
withdrawal, and this new information has been included in DSM-5 (APA, 2013). Cannabis
withdrawal syndrome is defined by the presence of three or more symptoms developing within
approximately 1 week of cessation of heavy and prolonged cannabis use. Symptoms can include
(1) irritability, anger, or depression; (2) nervousness or anxiety; (3) sleep difficulties (e.g.,
insomnia or disturbing dreams); (4) decreased appetite or weight loss; (5) restlessness;
(6) depressed mood; and (7) at least one physical symptom that causes significant discomfort
(abdominal pain, shakiness/tremors, sweating, fever, chills, or headache).
New items were drafted for expert review to capture these revisions. The first draft of the
questions (see Appendix A) is presented below. The items were based on existing NSDUH
withdrawal questions for other substances.
DRMJ11a [IF DRMJ09 = Yes (i.e., endorsed being able to cut down or stop using marijuana
or hashish every time they wanted to or tried to during the past 12 months) or DRMJ10 = Yes
(i.e., endorsed cutting down or stopping use of marijuana or hashish at least one time during
the past 12 months)] Please look at the symptoms listed below. During the past 12 months, did
you have 1 or more of these symptoms after you cut down or stopped using marijuana or
hashish?
Abdominal pain
Shakiness or tremors
Sweating
Fever
Chills
Headache
3
DRMJ11b [IF DRMJ09 = Yes or DRMJ10 = Yes] During the past 12 months, did you have
[IF DRMJ11a = Yes (i.e., endorsed experiencing 1 or more of the listed symptoms after
cutting down or stopping use of marijuana or hashish in the past 12 months) then fill 2, IF
DRMJ11a = No, DK/REF (i.e., did not endorse experiencing any of the listed symptoms after
cutting down or stopping use of marijuana or hashish in the past 12 months) then say 3] or
more of these symptoms after you cut down or stopped using marijuana or hashish?
Feeling irritable or angry
Feeling anxious
Having trouble sleeping
Having a smaller appetite than usual or losing weight without trying to
Feeling like you couldn’t sit still
Feeling depressed
2.1.2 Using a Pharmacologically Similar Substance to Prevent or Avoid Withdrawal
Symptoms
Both the DSM-IV and the DSM-5 define substance withdrawal as either: A. Having the
substance-specific withdrawal syndrome, or B. Taking the substance or a closely related
substance to relieve or avoid the substance-specific withdrawal symptoms. These criteria have
not changed between DSM-IV and DSM-5. However, NSDUH currently does not assess Part B
of the withdrawal criteria. Therefore, additional questions were tested for possible inclusion in
future NSDUHs.
New questions to address the additional component of withdrawal (B, above) were tested
with all substances. The wording for the marijuana question was provided for expert review as an
example.
DRMJX1: [IF DRMJ09 = Yes or DRMJ10 = Yes] During the past 12 months, when you cut
down or stopped using [marijuana or hashish], did you start using [marijuana or hashish] again
or use any illegal substance to get rid of or prevent any of these symptoms?
DRMJX2: [IF DRMJ09 = Yes or DRMJ10 = Yes] [Fill if DRMJ11a or DRMJ11b = yes (i.e.,
endorsed having at least 3 of the listed symptoms from 11a and 11b after cutting down or
stopping use of marijuana or hashish during the past 12 months): You just mentioned that you
experienced symptoms after cutting down or stopping marijuana or hashish.] During the past
12 months, did you use [marijuana or hashish] again or any illegal substance to avoid or get
over these symptoms?
2.1.3
Craving
Craving is a new DSM-5 criterion added for all SUDs. There is some discrepancy in how
the craving criterion is described in DSM-5. In the introduction to substance use disorders,
craving is described as “an intense desire or urge for the drug that may occur at any time but is
more likely when in an environment where the drug was previously obtained or used. . . .
Craving is queried by asking if there has ever been a time when they had such strong urges to
4
take the drug that they could not think of anything else” (APA, 2013, p. 483). Later in the
chapter, the criteria tables for substance use disorder note the criterion as “craving, or a strong
desire or urge to use [the drug]” (APA, 2013, p. 509).
Due to this discrepancy, three versions of new questions to assess craving were tested
with all substances, with wording shown for marijuana/hashish. Versions 1 and 3a use phrasing
directly from the DSM-5, whereas Versions 2 and 3b include the word "overwhelming." The
word "overwhelming" was included due to concern over the imprecise connotation of the word
"urge" and a desire to probe the expert reviewers’ opinions on alternative wordings.
Version 1. During the past 12 months, did you often have a strong desire or urge to use
[marijuana or hashish]?
Version 2. During the past 12 months, did you often have a strong desire or overwhelming
urge to use [marijuana or hashish]?
Version 3. This is a two-part question. If A is yes, B is not asked. If the respondent answers
yes to A or B, then the craving criterion is met:
A. During the past 12 months, did you want [marijuana or hashish] so badly you couldn't
think of anything else?
B. During the past 12 months, did you have a strong desire or overwhelming urge to use
[marijuana or hashish]?
2.2
Spanish-Language Items
To efficiently draft both English- and Spanish-language items, Spanish translation was
completed after the first round of cognitive testing revisions were made to the English-language
items. Translation occurred in two steps. First, a language methodologist produced a forward
translation and made pertinent revisions on the English items, making use of reference materials,
glossaries, and existing translated materials related to the project for consistency. Then, a
consulting American Translators Association–certified translator performed a review of the
translated documents, making any adjustments, as needed. The goal of the translation was to
convey the meaning of the original English versions with a translation that is easily understood
by a native speaker of the target language. The Spanish translation is targeted to native Spanish
speakers across the United States, using broadcast (or standard) language versus subgroup- or
region-specific language. By broadcast (or standard) language, we mean the use of language that
has a basic vocabulary, grammar, and syntax that cannot be attributed to a single region/country
and is understood by the majority of speakers in the target language. Once the Spanish versions
were developed, they were reviewed by two Spanish-language substance abuse experts with
credentials in assessing substance use disorders in Hispanic or Latino populations, and they were
then tested in cognitive interviews (described in more detail below).
5
6
3. Expert Review
3.1
English-Language Expert Review
After drafting initial English items, the items were reviewed by a panel of substance
abuse experts and survey methodologists with experience in large-scale, household-based
assessments. Reviewers included the following:
•
Dr. Alan Budney, Professor at the Geisel School of Medicine at Dartmouth College,
Board of Directors for the College on Problems of Drug Dependence, who was
selected based on his work in marijuana abuse and dependence and his work on the
DSM-5 Substance Use Disorder Work Group.
•
Dr. Wilson Compton, Deputy Director, National Institute on Drug Abuse, was
selected for his substantial experience in SUD research and SUD assessment.
•
Dr. Paul Beatty, Chief, Center for Survey Measurement at the U.S. Census Bureau,
was selected for his knowledge of large-scale survey design and implementation.
•
Dr. Gordon Willis, Cognitive Psychologist, National Institutes of Health, was selected
based on his expertise in cognitive interviewing and survey design.
•
Dr. Prudence Fisher was also selected as a reviewer due to her experience in mental
health and SUD assessment in children; however, she did not provide feedback.
Reviewers were asked to provide written responses to questions about the proposed
survey items, their ability to capture the DSM-5 SUD criteria, and whether they would be
understood correctly among a household sample of youths and adults aged 12 or older. For
context, the full marijuana/hashish module was provided so that they could see the survey
questions that preceded and followed the targeted draft questions.
Reviewers provided feedback on many of the items in the module, including items that
were not targeted for revision. For example, Dr. Compton questioned the addition of the phrase
"a month or more" to DRMJ01 (which asks, "During the past 12 months, was there a month or
more when you spent a lot of your time getting or using marijuana or hashish?"), as the DSM
does not specify this timeframe. Additionally, the substance abuse experts recommended that the
separate tranquilizer and sedative modules be combined because there was not a pharmacological
reason to keep them separated, and this combination would save time. This report focuses only
on the main questions being considered for revision (see Section 2). However, Appendix A
includes the full set of questions in the SUD module and also the specific feedback provided by
the reviewers.
Expert responses were used to revise items prior to cognitive interviewing. In addition to
feedback on the three sets of items for testing (new withdrawal criteria for marijuana/hashish,
assessing additional aspects of withdrawal for all substances, and craving criteria), expert
reviewers noted a potential concern with an existing skip pattern within NSDUH. DR(DRUG)08
and DR(DRUG)09 ask about a DSM SUD criterion regarding people’s ability to cut down or set
limits on their drug use:
7
DRMJ08.
During the past 12 months, did you want to or try to cut down or stop using
marijuana or hashish? [DSM-5 Criterion 2]
DRMJ09.
[IF DRMJ08 = Yes (i.e., endorsed wanting to or trying to cut down or stop
using marijuana or hashish during the past 12 months)] During the past
12 months, were you able to cut down or stop using marijuana or hashish every
time you wanted to or tried to? [DSM-5 Criterion 2]
These two items precede DR(DRUG)10, which is used as a skip into or out of the
withdrawal items.
DRMJ10.
[IF DRMJ08 = No, DK/REF (i.e., did not endorse wanting to or trying to cut
down or stop using marijuana or hashish during the past 12 months) or
DRMJ09 = No, DK/REF (i.e., did not endorse being able to cut down or stop
using marijuana or hashish every time they wanted to or tried to during the past
12 months)] During the past 12 months, did you cut down or stop using
marijuana or hashish at least one time?
People can only develop withdrawal symptoms if they have gone without a substance;
therefore, this skip pattern is a logical addition. However, the phrasing of the DRMJ08 may
cause respondents to consider only intentional times of cutting down or stopping use and may
overlook unintentional times (e.g., if they were unable to buy more of the substance or were at
work, jail, or in treatment and unable to use). As a result of these concerns, alternate wording for
question DR(DRUG)10 was tested in cognitive interviewing.
The draft English version of the survey questions used for the first round of cognitive
interviewing are presented below for marijuana/hashish.
DRMJ10
[IF DRMJ08 = No, DK/REF or DRMJ09 = No, DK/REF] During the past
12 months, whether you wanted to or not, did you cut down or stop using
marijuana or hashish at least one time?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12-MONTH CALENDAR
DRMJ11a
[IF DRMJ09 = Yes (i.e., endorsed being able to cut down or stop using
marijuana or hashish every time they wanted to or tried to during the past
12 months) or DRMJ10 = Yes (i.e., endorsed cutting down or stopping use of
marijuana or hashish at least one time during the past 12 months)] Please look
at the symptoms listed below. During the past 12 months, did you have any of
these symptoms after you cut down or stopped using marijuana or hashish?
Pain in the stomach area
Shaking or tremors
8
Sweating
Fever
Chills
Headache
1 Yes
2 No
DK/REF
DRMJ11b
[IF DRMJ09 = Yes or DRMJ10 = Yes] During the past 12 months, did you
have [IF DRMJ11a = Yes (i.e., endorsed experiencing 1 or more of the listed
symptoms after cutting down or stopping use of marijuana or hashish in the
past 12 months), then fill 2; IF DRMJ11a = No, DK/REF (i.e., did not endorse
that they experienced any of the listed symptoms after cutting down or stopping
use of marijuana or hashish in the past 12 months), then fill 3] or more of these
symptoms after you cut down or stopped using marijuana or hashish?
Feeling irritable or angry
Feeling anxious
Having trouble sleeping
Losing your appetite or losing weight without trying to
Feeling like you couldn’t sit still
Feeling depressed
1 Yes
2 No
DK/REF
DRMJX1
[IF DRMJ11a = Yes or DRMJ11b = Yes (i.e., endorsed having at least 3 of the
listed symptoms from 11a and 11b after cutting down or stopping use of
marijuana or hashish during the past 12 months)] You just mentioned that you
experienced symptoms after you cut down or stopped using marijuana or
hashish. During the past 12 months, did you use marijuana or hashish again or
any illegal substance to avoid or get over these symptoms?
1 Yes
2 No
DK/REF
DRMJX2
[IF (DRMJ11a = No, DK/REF) and (DRMJ11b = No, DK/REF (i.e., did not
endorse at least 3 of the listed symptoms from 11a and 11b after cutting down
or stopping use of marijuana or hashish during the past 12 months))] During the
past 12 months, did you use marijuana or hashish again or any illegal
substance to avoid these symptoms?
1 Yes
2 No
DK/REF
9
DRMJ23a
During the past 12 months, was there ever a time when you wanted to use
marijuana or hashish so much that you couldn’t think of anything else?
1 Yes
2 No
DK/REF
DRMJ23b
[IF DRMJ23a = No, DK/REF (i.e., did not endorse there being a time during
the past 12 months when they wanted to use marijuana or hashish so much that
they couldn’t think of anything else)] During the past 12 months, was there ever
a time when you had a strong desire or urge to use marijuana or hashish?
1 Yes
2 No
DK/REF
One additional point of feedback from the expert review of withdrawal items involved
the DSM description of withdrawal symptoms resulting from cessation after “heavy and
prolonged use.” Diagnostic Criterion A for withdrawal requires the cessation of substance use
but also includes other descriptive text that varies by substance. For example, for alcohol
withdrawal, Criterion A states “Cessation of (or reduction in) alcohol use that has been heavy
and prolonged." For Marijuana, it states “Cessation of cannabis use that has been heavy and
prolonged (i.e., usually daily or almost daily use over a period of at least a few months)." For
opioids, the wording is "Cessation of (or reduction in) opioid use that has been heavy and
prolonged (i.e., several weeks or longer)." For sedatives, the wording is “Cessation of (or
reduction in) sedative, hypnotic, or anxiolytic use that has been prolonged." Each wording varies
slightly. Some provide a time period for defining prolonged use that varies by substance, and
others omit this specification entirely. For sedatives, prolonged use is indicated for inducing
withdrawal; heavy use is not.
The expert reviewers noted that NSDUH assesses withdrawal for everyone who endorsed
cessation after a basic level of substance use in the past year and that assessment is not
predicated on heavy or prolonged use. For alcohol and marijuana, respondents were routed to the
substance dependence and abuse module if they used on more than 5 days in the past year,
regardless of the quantity of use. For all other substances, a respondent was routed to the
substance dependence and abuse module if he or she used illicit substances or misused
prescription drugs at least once in the past year. This was noted as an important component for
assessing withdrawal. However, the reviewers also noted that there was no strong research on
specific quantities and amounts of time that would be considered heavy and prolonged for any of
the substances and also that these thresholds would vary by substance and for individuals (due to
biological variation). Dr. Willis argued that if withdrawal symptoms can only be experienced
after prolonged and heavy use, then predicating the withdrawal questions on level of use is
unnecessary because respondents with lower-level usage would answer no, provided that the
question was understood.
10
3.2
Spanish-Language Expert Review
In addition to review of the English-language items, further expert review was conducted
on the first draft of the Spanish-language items to ensure that the translations were culturally
appropriate and that they correctly assessed the concepts in DSM-5. This was conducted after the
first round of English cognitive interviewing, so recommendations for revision were
implemented in Round 2. Spanish-language reviewers included the following:
•
Dr. Margarita Alegrίa, Director of the Center for Multicultural Mental Health
Research, Harvard Medical School; and
•
Dr. Glorisa Canino, Professor and Director, University of Puerto Rico Behavioral
Sciences Research Institute.
A brief summary of the feedback is provided here, and the draft questions and specific
feedback provided by these reviewers are presented in Appendix A.
For the most part, changes recommended by the Spanish-language reviewers involved
minor changes to translations, selecting words that were more appropriate to the NSDUH
sampling frame (aged 12 or older), maintaining consistency across questions, and ensuring
clarity.
Specific feedback on marijuana withdrawal included Dr. Canino noting that nervousness
(DSM-5 states "anxious or nervous") and aggression (DSM-5 states "irritable, angry, or
aggressive") were left out of the marijuana withdrawal symptom list. "Nervousness" was added
to both the English and Spanish versions next to "aggression" in the symptom list. However,
there was concern over including "aggression" because the negative connotation may lead
individuals to disregard that symptom set and as to whether providing aggression with its own
bullet would interfere with the appropriate counting of symptoms. Additionally, Dr. Alegrίa
indicated an alternate phrasing for “cut down.” This involves changing “usar menos,” which
means “using less,” to “reducir el uso,” which means “reduce the use.” This variation may have
implications to interpretation and be closer to the DSM-5 definition of cutting down; therefore,
the question was modified to enable cognitive interview testing.
Feedback on DR(DRUG)X1 and DR(DRUG)X2 included several translational changes
for these questions. First, that “get over” is better translated with “recuperarse de” ("recover
from") instead of “superar” ("to beat") because it is also more easily understood by low-income
people. She also noted that there are different ways of operationalizing relief of symptoms
(which is what the criterion is about) and that it is better described with the wording “get over.”
In Spanish, the translation of “get over” versus “relieve” involves two different meanings. “Get
over” is associated with “getting rid of,” with “eliminating”; “relieve” is associated with “getting
better,” with “diminishing.”
Spanish-language review of the craving items mirrored challenges for the English version
in the subjective nature of the words used to describe craving and the multiple definitions
provided by the DSM-5. Both reviewers provided two different translational suggestions.
Dr. Canino provided an alternate translation for this item ("¿hubo alguna ocasión cuando usted
tuvo un deseo fuerte o un deseo apremiante de usar marihuana o hachis?"), which she believes
11
captures better the intent of the question. However, like the English version, a proper translation
of the word "urge" is crucial for this item because it is the translation of the crux of the criterion.
Dr. Alegría’s recommended alternate translation for “strong desire or urge” is “fuerte deseo o
necesidad” ("strong desire or need”). However, it appears that the term “necesidad” ("need")
may not closely convey the English version “urge.”
12
4. Cognitive Interviews
4.1
Purpose
The general purpose of cognitive testing was to evaluate whether the survey questions
accurately assess the DSM-5 criteria. To do this, we evaluated respondents’ cognitive processing
when answering the survey questions to detect problems related to comprehension, recall,
decisions and judgment, and response processes.2
To better evaluate the effectiveness of the survey questions, we developed specific goals
for determining whether the question addressed the DSM-5 criteria as intended or not. These
goals are listed in Table 4.1.
Table 4.1 Cognitive Testing Goals by Survey Question
Survey Question
DRMJ10. During the past 12 months, whether you
wanted to or not, did you cut down or stop using
marijuana or hashish at least one time?
DRMJ11a. Please look at the symptoms listed
below. During the past 12 months, did you have
any of these symptoms after you cut down or
stopped using marijuana or hashish?
DRMJ11b. During the past 12 months, did you
have [2 or 3] or more of these symptoms after you
cut down or stopped using marijuana or hashish?
2
Goal of Testing
Withdrawal of a substance can only be assessed of
those who have cut down or stopped using a
substance. Verify that this question is capturing
people who have cut down, stopped, or gone without
the substance for a sufficient time to experience
withdrawal.
Are respondents considering both intentional and
unintentional times that they cut back or stopped using
a substance?
Are respondents thinking about any time they cut back
or stopped, not just intentional times?
Do respondents understand the symptoms provided?
Are respondents attributing the symptoms to cutting
down or stopping?
Do respondents understand that they only need
1 symptom to answer yes?
Are respondents thinking about any time they cut back
or stopped, not just intentional times?
Do respondents understand the symptoms provided?
Are respondents attributing the symptoms to cutting
down or stopping?
Do respondents understand that they need 2 or
3 symptoms to answer yes?
Can respondents accurately recall what symptoms
they had?
(continued)
Based on the four-stage model of the survey response process as outlined by Tourangeau, Rips, and
Rasinksi (2000).
13
Table 4.1 Cognitive Testing Goals by Survey Question (continued)
Survey Question
DRMJX1. You just mentioned that you
experienced symptoms after you cut down or
stopped using marijuana or hashish. During the
past 12 months, did you use marijuana or hashish
or any illegal substance to avoid or get over these
symptoms?
DRMJX2. During the past 12 months, did you use
marijuana or hashish or any illegal substance to
avoid these symptoms?
DRMJ23a. During the past 12 months, was there
ever a time when you wanted to use marijuana or
hashish so much that you couldn’t think of
anything else?
DRMJ23b. During the past 12 months, was there
ever a time when you had a strong desire or urge to
use marijuana or hashish?
Goal of Testing
Do respondents answer yes specifically to avoid or get
over symptoms or for some other reason?
Do respondents remember the symptoms from the
previous questions?
Are respondents thinking of the symptoms from both
of the previous questions and not different symptoms?
Are respondents thinking of all symptoms, not just
ones they had (because this question also asks about
avoiding)?
Are respondents thinking about all times they cut
down or stopped and not just intentional times?
When respondents say yes, are they using substances
specifically to avoid symptoms or for some other
reason?
Do respondents remember the symptoms from the
previous questions?
Are respondents thinking of the symptoms from both
of the previous questions and not different symptoms?
Are respondents thinking of all symptoms, not just
ones they had (because this question also asks about
avoiding)?
Do respondents’ understanding of this question match
the DSM-5 craving criteria?
Do respondents’ understanding of this question match
the DSM-5 craving criteria?
DSM-5 = Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
4.2
Methods
Once the survey instrument was updated based on the feedback from the survey
methodologists and substantive experts, RTI conducted three rounds of cognitive testing between
April and September 2015. Changes were made to the questionnaire based on the findings from
each prior round. All three rounds were conducted with the English version of the questionnaire.
The last two rounds of testing also were conducted with the Spanish version of the questionnaire.
A copy of the protocol used in Round 3 is provided in Appendix B.
4.2.1
Recruitment and Participant Selection
The cognitive interviews were conducted with individuals who had used alcohol or
marijuana/hashish at least six times in the past year; or cocaine, methamphetamine, or heroin at
least once in the past year; or misused prescription pain relievers, tranquilizers, stimulants, or
sedatives at least once in the past year. To test the new marijuana withdrawal questions as well as
other revised SUD questions, RTI selected a majority of marijuana/hashish users. Since NSDUH
14
is designed to produce SUD estimates for the civilian population aged 12 or older, cognitive
interviews were conducted with both adolescents (aged 12 to 17) and adults (aged 18 or older).
English-language participants aged 12 to 17 were recruited from outpatient drug
treatment centers in Research Triangle Park, North Carolina; Washington, DC; and Chicago,
Illinois. RTI staff contacted the treatment centers via e-mail, telephone, or in person. Staff
explained the purpose of the study and provided any additional details about NSDUH or the
cognitive interviews, as requested. RTI staff asked treatment center staff to identify adolescents
who met the eligibility criteria (past 12 month use of alcohol, marijuana/hashish, or other drugs)
and to provide these individuals with a copy of the study advertisement, which references the
$40 incentive. Interested adolescents then called the number provided and completed a brief
telephone screener to verify eligibility. Prior to completing the telephone screener with the
adolescents, recruiters obtained consent to complete the screener from a parent or guardian.
Because adolescents are required to have parental consent to participate and must have used
substances in the past 12 months, all adolescents were recruited from drug treatment facilities.
This allowed us to access a population where parents were aware of youths’ illicit substance use.
All adolescent interviews were conducted in a private room at the facility. Adolescents were
required to have a parent or guardian accompany them to the interview to provide consent, but
parents were not allowed to observe the interview.
English-language adult participants were recruited from outpatient drug treatment centers
in the relevant geographic areas and from advertisements posted in the classified sections of
internet sites such as Craigslist (https://www.craigslist.org/). All recruitment advertisements
referenced the $40 incentive. Participants recruited from outpatient substance abuse treatment
programs were interviewed onsite at their program or at a nearby RTI office.
Adult participants who were recruited using online advertisements completed a web
recruitment screener, and adults recruited from other means completed a telephone screener to
determine if they were eligible to participate in the study. This web screener was not available
for respondents younger than 18. The web screener was programmed using SurveyGizmo
(SurveyGizmo, 2015). SurveyGizmo allows surveys to be accessed by users via secure (https)
share links, which keeps responses secure. It also has a Project Data Encryption feature that
allows projects to encrypt all survey data that are received so that those data cannot be accessed
without a password key.
Spanish-language participants were recruited from outpatient treatment centers and
Hispanic community center organizations and via word of mouth. Spanish-language adults
completed the screening over the telephone or in person. Eligible participants were interviewed
in private locations such as a private room in a public library or community center.
Participant Selection Round 1
For Round 1, the survey recruited 10 adult participants through advertisements placed on
Craiglist in three cities: Chicago, Illinois; Washington, DC; and Portland, Oregon. Three
adolescent participants were recruited from treatment facilities in Durham, North Carolina.
Participant characteristics are described below.
15
Table 4.2 shows the cognitive interview participants by demographics and the substance
dependence modules received.
Table 4.2. Participant Characteristics
Age
CaseID Range Gender
Race
1000030 35-54
Female White
1000093 55 or
older
Ethnicity
Not Hispanic
Not Hispanic
1000149 18-34
Female Black or
African
American
Male
White
2000042 35-54
Female White
Not Hispanic
2000053 18-34
Female White
Not Hispanic
2000101 55 or
older
3000027 55 or
older
Female White
Not Hispanic
Not Hispanic
4000001 12-17
Female Black or
African
American
Male
Black or
African
American
Female Black or
African
American
Male
Black or
African
American
Male
White
4000015 12-17
Female White
Not Hispanic
4000030 12-17
Male
Not Hispanic
3000033 35-54
3000038 55 or
older
3000055 55 or
older
White
Not Hispanic
Received Substance Dependence
Education
Modules for:
Some college, but Alcohol, marijuana/hashish,
no degree
cocaine
Some college, but Alcohol
no degree
Some college, but
no degree
Bachelor's degree
(BA, BS)
Bachelor's degree
(BA, BS)
Some college, but
no degree
High school
diploma or GED
Alcohol, marijuana/hashish
Not Hispanic
High school
diploma or GED
Alcohol, marijuana/hashish,
cocaine, heroin
Not Hispanic
Some college, but Alcohol
no degree
Not Hispanic
Some college, but Alcohol, cocaine
no degree
Not Hispanic
Less than high
school
Less than high
school
Less than high
school
Alcohol, marijuana/hashish,
methamphetamine
Alcohol, marijuana/hashish,
cocaine
Alcohol, marijuana/hashish
Alcohol
Alcohol, marijuana/hashish,
cocaine
Alcohol, marijuana/hashish
Alcohol, marijuana/hashish,
cocaine, methamphetamine
Participant Selection Round 2
For the Round 2 English-language cognitive interviews, nine adult participants were
recruited in Chicago, Illinois; Research Triangle Park, North Carolina; and Portland, Oregon.
Three of these adults were recruited from a treatment facility in Chicago, and the rest were
recruited via Craigslist ads. Six adolescent participants were recruited from treatment facilities in
Durham, North Carolina, and the Washington, DC, area. Table 4.3 presents a list of the Englishlanguage cognitive interview participants by demographics and the substance dependence
modules received.
16
Table 4.3. English-Language Participant Characteristics
Age
CaseID Range Gender
Race
1000166 18-34
Male
White
Ethnicity
Not Hispanic
1000175 18-34
Male
Not Hispanic
1000185 18-34
Male
Other:
Jewish
White
9878900 35-54
Male
White
Not Hispanic
2000221 55 or
older
4000401 12-17
Female White
Not Hispanic
Male
White
Not Hispanic
2000270 55 or
older
4000267 55 or
older
2000289 18-34
3000102 12-17
Male
Other
Hispanic
Male
White
Not Hispanic
2000356 55 or
older
3000101 12-17
3000103 12-17
3000104 12-17
4000402 12-17
Not Hispanic
Received Substance
Dependence Modules for:
Alcohol, marijuana/hashish,
illegal drugs, prescription drugs
Alcohol, illegal drugs,
prescription drugs
Alcohol, marijuana/hashish,
illegal drugs, prescription drugs
Alcohol, marijuana/hashish,
prescription drugs
Alcohol, marijuana/hashish,
illegal drugs, prescription drugs
High school or less Alcohol, marijuana/hashish,
illegal drugs
Associate’s degree Alcohol, marijuana/hashish
Education
High school
diploma or GED
Some college, but
no degree
High school
diploma or GED
Some college, but
no degree
Graduate degree
Female White
Male
Black or
African
American
Female White
Not Hispanic
Not Hispanic
Some college, but
no degree
Graduate degree
High school or less
Not Hispanic
Bachelor’s degree
Male
Hispanic
High school or less Alcohol, marijuana/hashish,
prescription drugs
High school or less Alcohol, marijuana/hashish,
prescription drugs
Male
White
Black or
African
American
Female Black or
African
American
Male
White
Not Hispanic
Alcohol, marijuana/hashish,
illegal drugs
Alcohol, marijuana/hashish
Alcohol, marijuana/hashish
Alcohol
Not Hispanic
High school or less Alcohol, marijuana/hashish,
prescription drugs
Not Hispanic
High school or less Alcohol, marijuana/hashish,
illegal drugs
For the Round 2 Spanish-language cognitive interviews, six adults were recruited in
Research Triangle Park, North Carolina, by posting flyers in treatment centers and conducting
in-person recruitment at local Hispanic organizations, such as community centers and Hispanic
grocery stores. Participants were also recruited via word of mouth. Table 4.4 provides the same
information for Spanish-language participants.
17
Table 4.4. Spanish-Language Participant Characteristics
Age
Country of
CaseID Range Gender Ethnicity
Origin
5000001 55 or older Male
Hispanic Peru
5000002 18-54
Male
Hispanic El Salvador
5000003 18-54
Female Hispanic Mexico
5000004 18-54
Male
Hispanic Mexico
5000005 18-54
Male
Hispanic Mexico
5000006 55 or older Male
Hispanic Mexico
Education
High school
Some college
Less than high
school
Some college
Less than high
school
Less than high
school
Received Substance
Dependence Modules for:
Alcohol
Alcohol
Alcohol
Alcohol, marijuana/hashish,
illegal drugs
Alcohol, marijuana/hashish
Alcohol, marijuana/hashish
Participant Selection Round 3
For the Round 3 English-language cognitive interviews, 10 adult participants were
recruited in Chicago, Illinois; Research Triangle Park, North Carolina; and Portland, Oregon.
One of these adults was recruited from a treatment facility in Chicago, and the rest were
recruited via Craigslist advertisements. Four adolescent participants were recruited from
treatment facilities in Durham, North Carolina, and the Washington, DC, area. Table 4.5 presents
a list of the English-language cognitive interview participants by demographics and the
substance dependence modules received.
Table 4.5. English-Language Participant Characteristics
CaseID
1000101
1000333
1000438
1000685
1000721
2000391
2000425
2000512
3000401
Age
Range Gender Race
12-17 Male
White
Male
White
Not Hispanic
Received Substance
Education
Dependence Modules for:
High school or less Alcohol, marijuana/hashish,
prescription pain relievers
Bachelor’s degree Alcohol, marijuana
Male
Black
Not Hispanic
Bachelor’s degree
Male
White
Female White
Not Hispanic
Not Hispanic
55 or
older
35-54
Male
White
Not Hispanic
Female White
Not Hispanic
55 or
older
12-17
Female White
Not Hispanic
Alcohol, marijuana/hashish,
prescription pain relievers
High school or less Alcohol, marijuana/hashish
High school or less Marijuana/hashish, cocaine,
prescription pain relievers
Some college, but Alcohol, marijuana/hashish,
no degree
prescription pain relievers
Some college, but Alcohol, marijuana/hashish
no degree
Associate’s degree Alcohol
Male
Not Hispanic
High school or less Marijuana/hashish
55 or
older
55 or
older
12-17
12-17
Black
Ethnicity
Not Hispanic
(continued)
18
Table 4.5. English-Speaking Participant Characteristics (continued)
3000499
4000534
Age
Range Gender
Male
55 or
older
18-34
Female
35-54
Male
4000542
18-34
Male
White Not Hispanic
4000553
35-54
Male
White Hispanic
CaseID
3000477
Race
Ethnicity
Black Not Hispanic
Education
High school or less
Black Not Hispanic
Black Not Hispanic
High school or less
Associate’s degree
Received Substance
Dependence Modules for:
Alcohol, marijuana/hashish
Alcohol
Alcohol, marijuana/hashish,
cocaine, heroin
Some college, but no Alcohol
degree
Associate’s degree Alcohol
For the Round 3 Spanish-language cognitive interviews, six adults were recruited in
Research Triangle Park, North Carolina, by posting flyers in treatment centers and conducting
in-person recruitment at local Hispanic organizations, such as community centers and Hispanic
or Latino grocery stores. Participants were also recruited via word of mouth. Table 4.6 provides
the same information for Spanish-language participants.
Table 4.6. Spanish-Language Participant Characteristics
CaseID
5000007
Age
Range
35-54
Gender
Male
Ethnicity
Hispanic
Country of
Origin
Mexico
5000008
18-34
Male
Hispanic
Mexico
5000009
18-34
Male
Hispanic
Mexico
5000010
35-54
Male
Hispanic
Mexico
5000011
18-34
Male
Hispanic
5000012
18-34
Male
Hispanic
4.3
Education
Less than high
school
Less than high
school
High school
Received Substance
Dependence Modules for:
Alcohol
Marijuana/hashish, alcohol
Marijuana/hashish
Alcohol, cocaine
Guatemala
Less than high
school
High school
Honduras
High school
Alcohol
Marijuana/hashish, alcohol
Approach
Before the interview began, the interviewer read to the participant the relevant Participant
Informed Consent (adults) or Assent Form (adolescents) and asked if the participant agreed to
participate in the study (see Appendix C). For adolescents, the interviewer required parents or
guardians to provide consent, in person, allowing their child to participate in the study. The
interview commenced after the participant (and parent or guardian, if applicable) gave his or her
consent. The interviewer began by asking the participant for demographic information (to
determine how the interview program should route the participant through questions in the
interview) and then showed each participant how to navigate through the interview program.
Participants then completed the NSDUH tutorial that taught participants how to complete the
audio computer-assisted self-interviewing (ACASI) portion of the survey.
For all rounds, participants completed an abbreviated version of the core substance use
modules—alcohol, marijuana/hashish, cocaine, heroin, methamphetamine and the four
19
prescription drug screening modules (with the corresponding main modules if any past year use
of these prescription drugs). These modules included the same questions that were used in the
2015 NSDUH, except that certain questions that were not necessary for cognitive testing (age at
first use) were removed. No new questions were added to these modules for cognitive testing.
Answers that participants give to questions about use of substances determine whether they are
asked more detailed questions about substance dependence and withdrawal.
For all rounds, participants completed the core drug screening modules via ACASI.
However, for Rounds 2 and 3, instead of using the headphones, participants were asked to allow
the questions to be played over the speakers so that the cognitive interviewer could follow along.
For the SUD module, the cognitive interviewer gave participants the option of having the
questions played over the computer’s speakers or turning off the sound and reading the questions
aloud. These procedures were required, compared with traditional ACASI administration, so that
the cognitive interviewers could stop the participant after certain questions to ask cognitive
interview probes. Providing participants with the option of hearing the questions or reading them
allowed the cognitive interview process to mimic more closely an actual interview, where
participants can turn down the volume and read the questions, if desired.
Cognitive interviewers followed a series of probes and questions that explored the quality
of responses and whether these responses met the researchers’ goals, as identified in Table 4.1.
Interviewers used the probes as a guideline but were not required to use all of them, be limited
by them, or to read them exactly as written. Interviewers probed based on the content of the
interview and participant responses.
Both adult and adolescent participants were provided $40 in cash at the completion of the
interview. The cognitive interviews lasted, on average, 60 minutes for English interviews and
75 minutes for Spanish interviews.
4.4
Round 1 Findings
A summary of the Round 1 cognitive interview findings are presented below. The
findings and recommendations for each item are noted first, followed by an overall summary of
SAMHSA decisisons regarding the recommendations and changes made for the subsequent
round of cognitive interviewing. More detailed findings and recommendations are provided in
the Appendix D Round 1 memo.
DR(DRUG)10
DR(Drug)10. [IF DRMJ08 = No, DK/REF (i.e., did not endorse wanting to or trying to cut
down or stop using marijuana or hashish during the past 12 months) or DRMJ09 = No,
DK/REF (i.e., did not endorse being able to cut down or stop using marijuana or hashish every
time they wanted to or tried to during the past 12 months)] During the past 12 months, whether
you wanted to or not, did you cut down or stop [using DRUG] at least one time?
Overall, this question did not work as intended because participants were thinking
primarily about intentionally cutting down or stopping. This led to a high number of likely false
20
negatives, based on cognitive testing. Incorrectly answering “no” means that participants will not
get subsequent questions about experiencing symptoms of substance withdrawal.
False negatives appeared to occur for three main reasons:
•
Participants were thinking only about intentionally stopping and not just periods of
time when they might have gone without the substance for other reasons.
•
Participants thought this question was asking about successfully cutting down or
stopping.
•
Participants did not use the substance often enough to cut down. While participants
should have answered “yes” to this question, these participants’ infrequent use would
likely not have prompted withdrawal symptoms; therefore, no important diagnostic
information on withdrawal would be missed.
When the participants above answered “no,” they were asked if there was ever a time
they went without the substance for a while. Many of these participants indicated that they did go
without the substance for periods of time because they had to work, could not get a hold of any,
did not have any money, or just that they did not use the substance very often.
The phrase “whether you wanted to or not” was added prior to the first round of cognitive
testing to encourage participants to think about both intentional and unintentional times that they
might have cut down or stopped using. However, it does not appear that participants understood
this phrase as intended and often caused additional confusion.
Recommendations made for possible testing in Round 2 included removing item
DR(Drug)10 from all modules and eliminating the skip pattern for withdrawal items so all
respondents in the substance abuse modules receive the withdrawal questions or testing two
alternative versions of DR(Drug)10 to observe differences in responses:
•
During the past 12 months, did you go without [using DRUG] at least one time, for
any reason?
•
During the past 12 months, did you go without [using DRUG] for at least [drug
specific amount of time]?
DRMJ11a and DRMJ11b
DRMJ11a. [IF DRMJ09 = Yes (i.e., endorsed being able to cut down or stop using marijuana
or hashish every time they wanted to or tried to during the past 12 months) or DRMJ10 = Yes
(i.e., endorsed cutting down or stopping use of marijuana or hashish at least one time during
the past 12 months)] Please look at the symptoms listed below. During the past 12 months, did
you have any of these symptoms after you cut down or stopped using marijuana or hashish?
Pain in the stomach area
Shaking or tremors
Sweating
Fever
21
Chills
Headache
1 Yes
2 No
DK/REF
In general, this question appeared to work well, although several participants did not
think these symptoms were likely to occur from marijuana/hashish withdrawal. Participants
would then volunteer other symptoms that they thought were more likely to occur for marijuana
like trouble sleeping or anxiety, which were asked about in DRMJ11b.
Although participants did not have many of the symptoms listed, they appeared to
understand them for the most part. However, one participant said that “pain in the stomach area”
sounded archaic and would recommend “stomach ache” instead.
DRMJ11b. [IF DRMJ09 = Yes or DRMJ10 = Yes] During the past 12 months, did you have
[IF DRMJ11a = Yes (i.e., endorsed experiencing 1 or more of the listed symptoms after
cutting down or stopping use of marijuana or hashish in the past 12 months), then fill 2; IF
DRMJ11a = No, DK/REF (i.e., did not endorse that they experienced any of the listed
symptoms after cutting down or stopping use of marijuana or hashish in the past 12 months),
then fill 3] or more of these symptoms after you cut down or stopped using marijuana or
hashish?
Feeling irritable or angry
Feeling anxious
Having trouble sleeping
Losing your appetite or losing weight without trying to
Feeling like you couldn’t sit still
Feeling depressed
1 Yes
2 No
DK/REF
The symptoms in question 11b resonated more with participants than the symptoms in
question 11a. However, for some participants, it was difficult to tell if these symptoms were
specifically a result of withdrawal because they indicated that they had some of these symptoms
already and that using marijuana/hashish helped alleviate those symptoms.
All but one participant answered “yes” to this question. However, one of the participants
who answered “yes” answered incorrectly because she only had one of the reported symptoms
and did not notice that it said “3 or more symptoms.”
All participants seemed to understand the symptoms listed, although some participants
had suggestions for how some of the questions regarding these symptoms could be improved.
22
We also asked participants what they thought of the word “symptom” as it was used in
these questions. While some participants offered suggestions such as “consequence,” “feeling,”
or “event,” only two participants had particular concerns with the word “symptoms,” but it did
not appear to affect their understanding of the question.
Recommendations made for changes to DRMJ11a and DRMJ11b for Round 2 included
revising “cut down or stopped” to “went without” for both questions; bolding the number of
symptoms (as is done in other modules) to ensure that respondents notice them more easily; and
using Round 2 to probe respondents further on the word "symptoms" and asking if they prefer
alternatives such as “after you went without . . . , did you have any of these feelings?” or “after
you went without . . . , did you experience any of the following?”
DR(DRUG)X1 and DR(DRUG)X2
DR(DRUG)X1. [IF DR(DRUG)11a = Yes (i.e., endorsed experiencing 1 or more of the listed
symptoms after cutting down or stopping use of (DRUG) in the past 12 months) or
DR(DRUG)11b = Yes (i.e., endorsed having endorse at least 3 of the listed symptoms from
11a and 11b after cutting down or stopping use of (DRUG) during the past 12 months)] You
just mentioned that you experienced symptoms after you cut back or stopped [using DRUG].
During the past 12 months, did you use [DRUG LIST] or any illegal substance to avoid or get
over these symptoms?
DR(DRUG)X1 is asked when respondents have endorsed withdrawal symptoms. There
was a high number of false positives for this item based on the intended DSM-5 criteria with
only one participant correctly answering “yes.” The reasons for false positives are summarized
below:
•
The respondent used a substance that was not pharmacologically similar.
•
The respondent used another substance to continue to get high (as opposed to
avoiding or getting over withdrawal symptoms).
•
The respondent was thinking of symptoms that were not a result of withdrawal.
All participants but one thought that it might help to have the symptoms repeated on the
screen. No participants mentioned the physical symptoms (from DRMJ11a) when asked what
symptoms they were thinking about when hearing this question, but most participants did not
experience physical symptoms.
We also asked participants if they preferred the phrase “to get rid of or prevent” to the
wording “to avoid or get over.” Two preferred “to get rid of or prevent,” but four preferred “to
avoid or get over”; one person thought “prevent or get over” sounded even better.
DR(Drug)X2. [IF DR(Drug)11a = No, DK/REF (i.e., did not endorse experiencing 1 or
more of the listed symptoms after cutting down or stopping use of (DRUG) in the past
12 months)] During the past 12 months, did you use [DRUG LIST], or any illegal substance to
avoid these symptoms?
23
DR(DRUG)X2 is asked when respondents have not endorsed withdrawal symptoms. All
but one participant answered “no” to this question. The one participant who answered “yes”
appeared to misunderstand the question. Her responses indicated that she used marijuana/hashish
to self-medicate her anxiety rather than using it to avoid a symptom of marijuana/hashish
withdrawal because she did not note that she had anxiety as a result of stopping or cutting down
in DRMJ11b.
Several participants who answered “no” appeared to misunderstand the intent of the
question or indicate that they found it confusing. However, their response of “no” did not appear
to be incorrect. For alcohol, some participants seemed to be thinking about hangover symptoms
instead of withdrawal symptoms
Similar to DRMJX1, when asked, participants thought it would be helpful to include the
symptoms on this screen.
Recommendations for DR(DRUG)X1 and DR(DRUG)X2 revisions included showing the
symptom list on the screen to ensure that respondents think about all of the symptoms from the
previous one or two questions (depending on the substance); making the question clearly indicate
that a respondent might use the same substance again or a substance with a similar effect—as
opposed to any substance; specifically indicating that these symptoms occur as a result of not
using the substance; and indicating that use of a similar substance is a result of “going without”
as opposed to “cutting down or stopping” because many respondents were thinking only of
intentionally cutting down or stopping and not just any time they went without the substance.
DR(DRUG)23a and DR(DRUG)23b
DR(Drug)23a. During the past 12 months, was there ever a time when you wanted to use
[DRUG] so much that you couldn’t think of anything else?
DR(Drug)23b. [IF DR(Drug)23a = No, DK/REF (i.e., did not endorse there being a time
during the past 12 months when they wanted to use (DRUG) so much that they couldn’t think
of anything else)] During the past 12 months, was there ever a time when you had a strong
desire or urge to use [DRUG]?
Overall, participants understood the language of the questions, but the subjective nature
of the wording led to inconsistent responses. For example, several participants interpreted
question 23a as slightly more severe than intended, interpreting it to mean strong urges to the
point where the person could not do anything else rather than that they could not think of
anything else.
The cognitive testing results suggested that there may be a slight risk of false negatives
for the wording of question 23a and a high risk of false positives for question 23b. Interpreting
these results, however, is complicated by the vague and slightly inconsistent description of
craving in the DSM-5. False positives are a great concern for this item because it is part of the
diagnostic algorithm for scoring substance abuse symptoms, and a respondent needs only to
endorse two items to meet DSM-5 criteria for a substance use disorder.
24
Cognitive testing about the meaning and use of the term “craving” indicated that the word
meant different levels of severity to different people and therefore should not be used in the
question wording.
Recommendations for DR(DRUG)23a and DR(DRUG)23b were made after consulting
with clinicians and reviewing the literature (specifically, Alcohol: Science, Policy, and Public
Health, which notes that “craving is thus explained as pathologically amplified incentive salience
in the presence of drug associated cues that leads to an exaggerated motivation for drugs and
probably to compulsive drug taking” [Sommer, 2013, p. 88]) to replace the word “strong” with
“intense” in question 23b.
Final Revisions Made for Round 2
DR(DRUG)10: Results from Round 1 revealed that the phrase “whether you wanted to or
not” was confusing to participants (particularly, adolescents). For Round 2, the phrase was
removed, and the original question wording was used. Because this item is an existing question
and is not included in the SAMHSA management directive for NSDUH modification, it cannot
be deleted at this time.
DRMJ11a and DRMJ11b: Changes for Round 2 included bolding the symptom number
and changing "pain in the stomach area" to "stomach ache." No changes were made to address
the concern over the phrase “cut down or stopped” due to concern that “went without” could
create more false positives. Therefore, Round 2 cognitive interviewing specifically included
more probing for misunderstanding of the questions and to try and determine whether the
symptoms actually resulted from stopping or cutting down on the substance.
DR(DRUG)X1 and DR(DRUG)X2: The following changes were made to questions X1
and X2:
•
for X1, changed “you experienced symptoms” to “you had symptoms”;
•
for X1/X2, added the word “again” after the substance of interest (e.g., “During the
past 12 months, did you use marijuana or hashish again, or . . .”);
•
for X1/X2, bolded the phrase “avoid or get over” or “avoid”;
•
for X1/X2, provided an F2 hot key so that they could see all symptoms again, if
needed; and
•
for X2, added the phrase “After you cut down or stopped using [substance].”
The Round 1 cognitive interviews also identified a skip pattern problem within the
cognitive interview protocol with stimulant-type drugs (cocaine/crack, methamphetamine, and
prescription stimulants). If respondents indicated that they did not “feel kind of blue or down”
[question 10a]), they were skipped out of the remaining withdrawal questions and therefore were
not asked the DR(DRUG)X1 and DR(DRUG)X2 questions. To address this problem,
question 10b was added for stimulant substances only. Question 10b asked respondents who
answered "no" to question 10a, “This question is also about the times during the past 12 months
after you cut down or stopped [using DRUG]. During any of those times, did you use [DRUG]
25
again, methamphetamine, prescription stimulants, or any illegal substance to avoid feeling blue
or down?”
DR(DRUG)23a and DR(DRUG)23b: No revisions were made to these questions for
Round 2, but the probing strategy was revised to determine whether these questions suffered
from false negatives or false positives.
4.5
Round 2 Findings
A summary of the Round 2 cognitive interview findings are presented below. More
detailed findings and recommendations are provided in the Appendix E Round 2 memo.
DR(DRUG)10
DR(DRUG)10. [IF DRMJ08 = No, DK/REF (i.e., did not endorse wanting to or trying to cut
down or stop using marijuana or hashish during the past 12 months) or DRMJ09 = No,
DK/REF (i.e., did not endorse being able to cut down or stop using marijuana or hashish every
time they wanted to or tried to during the past 12 months)] During the past 12 months, did you
cut down or stop [using DRUG] at least one time?
DR(DRUG)10 English-Language Findings
In general, people understood the wording of the DR(DRUG)10 question. This is an
improvement compared with Round 1, in which some participants found the “whether you
wanted to or not” clause to be confusing. However, the majority of participants reported that they
were thinking only of intentional times of cutting down or quitting when they answered this
question.
Notably, when participants with polysubstance use were probed a second time on the
wording of this question, most recognized the actual intent of this question and also considered
times that they went without using the drug for any reason. Their understanding was likely an
artefact of the cognitive interview process because interviewers specifically probed people on
whether they went without using the substance for any reason.
Furthermore, several participants did not think to include visits to rehabilitation as times
they cut back or stopped using a substance. This pattern was also seen in Round 1.
There are two concerns regarding the misinterpretation of the question. The first concern
is that a respondent who does not endorse this item but should do so is not asked the withdrawal
question(s), which may lead to a false negative (technically, a lost endorsement) for withdrawal
symptoms. However, if casual users who do not have a history of heavy or prolonged use
endorse this item and then misunderstand and misreport withdrawal symptoms (the 11 series of
questions), they may have a false positive for withdrawal symptoms that could have been
avoided if they had not endorsed DR(DRUG)10.
Most participants who answered “no” to this question indicated that they had gone
without the drug at some point. However, it was usually due to infrequent or sporadic use of the
26
substance, suggesting that they did not have heavy or prolonged use and would not meet the
level required to induce withdrawal.
In summary, although most participants interpreted the question as asking about cutting
back or stopping use of the substance intentionally, only one participant provided a false
negative for withdrawal, although it was for three substances.
DR(DRUG)10 Spanish-Language Findings
Spanish-language participants did not appear to have difficulty with the question, and
there was no evidence of false negatives for withdrawal.
DRMJ11a. [IF DRMJ09 = Yes (i.e., endorsed being able to cut down or stop using marijuana
or hashish every time they wanted to or tried to during the past 12 months) or DRMJ10 = Yes
(i.e., endorsed cutting down or stopping use of marijuana or hashish at least one time during
the past 12 months)] Please look at the symptoms listed below. During the past 12 months, did
you have any of these symptoms after you cut down or stopped using marijuana or hashish?
Stomach ache
Shaking or tremors
Sweating
Fever
Chills
Headache
1 Yes
2 No
DK/REF
DRMJ11b. [IF DRMJ09 = Yes or DRMJ10 = Yes] During the past 12 months, did you have
[IF DRMJ11a = Yes (i.e., endorsed experiencing 1 or more of the listed symptoms after
cutting down or stopping use of marijuana or hashish in the past 12 months), then fill 2; IF
DRMJ11a = No, DK/REF (i.e., did not endorse that they experienced any of the listed
symptoms after cutting down or stopping use of marijuana or hashish in the past 12 months),
then fill 3] or more of these symptoms after you cut down or stopped using marijuana or
hashish?
Feeling irritable or angry
Feeling anxious or nervous
Having trouble sleeping
Losing your appetite or losing weight without trying to
Feeling like you couldn’t sit still
Feeling depressed
1 Yes
2 No
DK/REF
27
DRMJ11a and DRMJ11b
DRMJ11a and DRMJ11b English-Language Findings
All participants appeared to understand both question 11a and question 11b as intended.
Interviewers were asked to verify that participants were counting the correct number of
symptoms to endorse question 11b because incorrect responses emerged as a problem in the first
round of cognitive interviewing. This time, participants appeared to be indicating the correct
number of symptoms, probably as a result of the bolding added to the number of symptoms in
the question text.
DRMJ11a and DRMJ11b Spanish-Language Findings
Spanish-language participants had no difficulty with these items.
DR(DRUG)X1 (STIMULANTS AND NONSTIMULANTS). [IF DR(DRUG)11a = Yes
(i.e., endorsed experiencing some of the listed symptoms after cutting down or stopping use of
(DRUG) in the past 12 months)] You just mentioned that you had symptoms after you cut
down or stopped [using DRUG]. During the past 12 months, did you use [DRUG] again,
methamphetamine, prescription stimulants, or any illegal substance to avoid or get over these
symptoms?
DR(DRUG)X2 (STIMULANTS). [IF DR(DRUG)11a = No, DK/REF (i.e., did not endorse
experiencing some of the listed symptoms after cutting down or stopping use of (DRUG) in
the past 12 months)] This question is also about the times during the past 12 months after you
cut down or stopped [using DRUG].
During any of those times, did you use [DRUG] again, methamphetamine, prescription
stimulants, or any illegal substance to avoid these symptoms?
DR(DRUG)X2 (NONSTIMULANTS). [IF (DR(DRUG)11a = No, DK/REF) AND
(DR(DRUG)11b = No, DK/REF (i.e., did not endorse having endorsed at least 3 of the listed
symptoms from 11a and 11b after cutting down or stopping use of (DRUG) during the past
12 months))] After you cut down or stopped [using DRUG] during the past 12 months, did you
use [DRUG] again or any illegal substance to avoid these symptoms?
DR(DRUG)10b (STIMULANTS ONLY). [IF DR(DRUG)10a = No, DK/REF (i.e., did not
endorse feeling blue or down when they cut down or stopped using (DRUG) during the past
12 months)] This question is also about the times during the past 12 months after you cut
down or stopped [using DRUG].
During any of those times, did you use [DRUG] again, methamphetamine, prescription
stimulants, or any illegal substance to avoid feeling blue or down?
28
DR(DRUG)X1 and DR(DRUG)X2
DR(DRUG)X1 English-Language Findings (Stimulants and Nonstimulants)
When respondents answered “yes” to this question, most appeared to answer the question
correctly. They used another substance to avoid or get over the withdrawal symptoms they
indicated having, and the substance used was pharmacologically similar. One exception to the
pharmacologically similar rule is that one respondent who reported “trouble sleeping” as an
alcohol withdrawal symptom reported using marijuana/hashish to help him sleep. Although these
substances are not pharmacologically similar, trouble sleeping is a withdrawal symptom for both,
so it seems reasonable that one would use either substance to get over or avoid that symptom.
However, there were a few participants who answered “yes” for whom it was hard for
them to determine if they used another substance specifically to get over withdrawal symptoms
or simply to get high again. Often, it was for both reasons: when they were high, they did not
have withdrawal symptoms.
Participants who answered “no” appeared to understand the question. They noted that
their symptoms were not bad enough to use another substance or that they suffered through the
symptoms.
None of the participants who received this question pressed F2 to see the symptoms.
When asked what symptoms they were thinking of, most participants responded with the specific
symptoms they had indicated having or indicated that they were thinking of “general withdrawal
symptoms.” A couple of participants mentioned symptoms that were not specifically listed for
the substance or that were general feelings, such as “feeling sideways,” “feeling heavy,” or “flulike symptoms.” Some participants who used multiple substances seemed to think of all the
withdrawal symptoms they might have experienced and not just ones associated with the specific
substances being mentioned.
DR(DRUG)X2 English-Language Findings (Stimulants and Nonstimulants)
One participant answered “yes” but clarified that he was on marijuana/hashish or opiates
every day, so he would not know whether he had symptoms. Therefore, this response seems to
be a false positive because he did not take other substances specifically to avoid withdrawal,
although that might have been an outcome of continual substance use.
The remaining participants answered “no” to this question, but some appeared to
misunderstand the question. For example, they based their answers on whether they used the
substances mentioned and not on the use of these substances to avoid symptoms.
None of the participants pressed F2 when answering the question.
Two versions of this question were tested in Round 2: one for stimulants, and one for
nonstimulants. The stimulants version includes the extra sentence, “This question is also about
the times during the past 12 months after you cut down or stopped using [substance].” There did
not appear to be a difference in understanding between these two versions.
29
DR(DRUG)10b English-Language Findings (Stimulants Only)
Only four participants answered this question about four total substances. Three
participants answered “yes,” and one answered “no.”
All participants who answered “yes” answered incorrectly, according to the DSM-5
criteria for this question. Mostly, participants indicated taking additional drugs but not
specifically doing so to prevent withdrawal.
None of the participants pressed F2 when answering the question.
DR(DRUG)X1, DR(DRUG)X2, and DR(DRUG)10b Spanish-Language Findings
None of the Spanish-language participants had difficulty with this question. However,
some participants received the question in error because they indicated that they had alcohol
withdrawal symptoms when actually the symptoms were not due to withdrawal but were just a
side effect of drinking (e.g., hangover feelings).
DR(DRUG)23a and DR(DRUG)23b
DR(DRUG)23a. During the past 12 months, was there ever a time when you wanted to use
[DRUG] so much that you couldn’t think of anything else?
DR(DRUG)23b. [IF DR(DRUG)23a = No, DK/REF (i.e., did not endorse there being a time
during the past 12 months when they wanted to use (DRUG) so much that they couldn’t think
of anything else)] During the past 12 months, was there ever a time when you had a strong
desire or urge to use [DRUG]?
DR(DRUG)23a and DR(DRUG)23b English-Language Findings
Overall, participants appeared to understand question 23a without a problem. In Round 1,
there was some concern that participants interpreted the question slightly more severely than
intended. In Round 2, cognitive interviewers were instructed to probe on these comments further.
Further probing revealed that participants understood the question as intended. For example, one
participant said that the question meant, “you couldn’t think about nothing else or do nothing
else besides getting drunk.” The interviewer probed on this response, and the respondent said, “I
think people can have alcohol on their mind and still do stuff.” The participant understood that
the question was asking about both (or either) of those situations (cannot think of anything else
or cannot do anything else).
For question 23b, participants seemed to differ in their view of the intensity of the
question. When participants answered “yes,” they tended to indicate that it was because they
“really wanted to do it,” “look forward to it,” or “really enjoyed it.” When participants answered
“no,” they tended to indicate that they did not use the substance that much, were not an addict, or
were not obsessed. One participant said “no,” meaning that the question was asking about
needing to use the drug “right away.”
30
Interviewers asked participants what they thought about the phrase “very strong desire or
urge” to drink alcohol. Regardless of how they answered question 23b, about half of the
participants indicated that this wording was more or less the same as “strong desire or urge” and
would not change their answer. Other participants said that it sounded stronger.
DR(DRUG)23a and DR(DRUG)23b Spanish-Language Findings
All six participants received question 23a for alcohol, and three participants received it
for marijuana/hashish. All participants appeared to understand question 23a without difficulty.
Five participants received question 23b for alcohol, and two received it for
marijuana/hashish. None of the participants who received the question understood “deseo
apremiante” ("pressing desire"), which was the translation recommended for “urge.” Participants
recommended alternate wording such as “necesidad urgente” ("urgent need"), “deseo immediate”
("immediate desire"), “deseo intense” ("intense desire"), and “deseo urgent” ("urgent desire").
All participants understood “deseo fuerte” ("strong desire") as intended.
Final Revisions Made for Round 3
DR(DRUG)10: No changes to the question were made for Round 3.
DRMJ11a and DRMJ11b: No changes to the question were made for Round 3.
DR(DRUG)X1 and DR(DRUG)X2 and DR(DRUG)10b: All three questions were revised
for Round 3 by removing the clause “during the past 12 months” to make the question shorter
and easier for respondents to understand. In DR(DRUG)X2 and DR(DRUG)10b, the word
“avoid” was replaced with “prevent” to increase clarity. Spanish-language versions were
similarly revised.
DR(DRUG)23a and DR(DRUG)23b: In Round 3, the English version of DR(DRUG)23b
was revised to ask about a “strong urge” instead of a “strong desire or urge.” This change was
made because participants’ understanding of the word “desire” did not appear to match the
DSM-5 criteria for craving. The Spanish version was revised from “deseo apremiante” ("pressing
desire") to “deseo fuerte or la necesidad” ("strong desire or the need to").
4.6
Round 3 Findings
A summary of the Round 3 cognitive interview findings is presented below. More
detailed findings and recommendations are provided in the Appendix F Round 3 memo.
DR(DRUG)10
DR(DRUG)10. [IF DRMJ08 = No, DK/REF (i.e., did not endorse wanting to or trying to cut
down or stop using marijuana or hashish during the past 12 months) or DRMJ09 = No,
DK/REF (i.e., did not endorse being able to cut down or stop using marijuana or hashish every
time they wanted to or tried to during the past 12 months)] During the past 12 months, did you
cut down or stop [using DRUG] at least one time?
31
DR(DRUG)10 English-Language Findings
There were no changes to the wording of this question between Rounds 2 and 3, and
participants’ comprehension was similar to that in Round 2.
The primary concern with this question is that respondents tend to understand the
questions as asking about intentional times they cut down, such as when the participants thought
their usage was getting out of control, when they wanted to save money, or when they had to get
schoolwork done. When the participants stopped using for other reasons, such as running out of
money or because a family member made them go into treatment, they were less likely to include
those situations.
There were three instances of possible false negatives for withdrawal in Round 3.
DR(DRUG)10 Spanish-Language Findings
Most Spanish-language participants appeared to understand this question, and there was
no evidence of any false negatives.
DRMJ11a. [IF DRMJ09 = Yes (i.e., endorsed being able to cut down or stop using marijuana
or hashish every time they wanted to or tried to during the past 12 months) or DRMJ10 = Yes
(i.e., endorsed cutting down or stopping use of marijuana or hashish at least one time during
the past 12 months)] Please look at the symptoms listed below. During the past 12 months, did
you have any of these symptoms after you cut down or stopped using marijuana or hashish?
Stomach ache
Shaking or tremors
Sweating
Fever
Chills
Headache
1 Yes
2 No
DK/REF
DRMJ11b. [IF DRMJ09 = Yes or DRMJ10 = Yes] During the past 12 months, did you have
[IF DRMJ11a = Yes (i.e., endorsed experiencing 1 or more of the listed symptoms after
cutting down or stopping use of marijuana or hashish in the past 12 months), then fill 2; IF
DRMJ11a = No, DK/REF (i.e., did not endorse that they experienced any of the listed
symptoms after cutting down or stopping use of marijuana or hashish in the past 12 months),
then fill 3] or more of these symptoms after you cut down or stopped using marijuana or
hashish?
Feeling irritable or angry
Feeling anxious or nervous
Having trouble sleeping
Losing your appetite or losing weight without trying to
32
Feeling like you couldn’t sit still
Feeling depressed
1 Yes
2 No
DK/REF
DRMJ11a and DRMJ11b
DRMJ11a and DRMJ11b English-Language Findings
There was no wording change between Rounds 2 and 3 for either question. These
questions were generally well understood in both rounds of cognitive interviewing.
One participant reported a false positive for question DRMJ11b because he had only two
of the psychological symptoms and needed three to correctly answer “yes” to this question.
Those who said “yes” to question DRMJ11a were easily able to recognize these as
withdrawal symptoms, and all of the participants answering “yes” agreed that “withdrawal” was
the correct term for these feelings or experiences. The respondents who indicated “yes” for
question DRMJ11b all also agreed that the psychological symptoms are withdrawal symptoms.
There were no recommendations on what else these could be called in either question.
DRMJ11a and DRMJ11b Spanish-Language Findings
Overall, Spanish-language participants appeared to understand the question.
DR(DRUG)X1. [IF DR(DRUG)11a = Yes (i.e., endorsed experiencing some of the listed
symptoms after cutting down or stopping use of (DRUG) in the past 12 months)] You just
mentioned that you had symptoms after you cut down or stopped [using DRUG]. Did you use
[DRUG] again, methamphetamine, prescription stimulants, or any illegal substance to avoid or
get over these symptoms?
DR(DRUG)X2. [IF (DR(DRUG)11a = No, DK/REF (i.e., did not endorse experiencing
some of the listed symptoms after cutting down or stopping use of (DRUG) in the past
12 months)) AND (DR(DRUG)11b = No, DK/REF (i.e., did not endorse at least 3 of the
listed symptoms from 11a and 11b after cutting down or stopping use of (DRUG) during the
past 12 months))] After you cut down or stopped [using DRUG], did you use [DRUG] again
or any illegal substance to prevent these symptoms?
DR(DRUG)10b. [IF DR(DRUG)10a = No, DK/REF (i.e., did not endorse feeling blue or
down when they cut down or stopped using (DRUG) during the past 12 months)] This
question is also about the times after you cut down or stopped [using DRUG].
During any of those times, did you use [DRUG] again, methamphetamine, prescription
stimulants, or any illegal substance to prevent feeling blue or down?
33
DR(DRUG)X1 and DR(DRUG)X2
DR(DRUG)X1 English-Language Findings
This question was problematic for four respondents because it was not specifically clear
that they used a substance to “get over or avoid” withdrawal symptoms. Participants did not
consciously decide to use again to get over or avoid a symptom, but this may have contributed to
their wanting to get high or use the substance again.
For Round 3, this question was revised so that the reference period was removed to make
the question shorter. We probed participants on what time period they were thinking about. One
participant indicated a time period that started over 12 months ago but continued into the
reference period of the past 12 months. All of the other participants provided a specific period
within the past 12 months, but none specifically said that he or she was thinking about the full
12 months. However, this did not appear to affect how the participants would answer because
they were thinking about the times they experienced withdrawal, which were usually brief
periods of time.
Participants did appear to notice the instruction to press F2. Participants were split about
whether it would be better for the symptoms to appear on the screen or not.
DR(DRUG)X2 and DR(DRUG)10b English-Language Findings
Most participants answered “no” to this question. Yet the two participants who answered
“yes” answered incorrectly, leading to false positives for withdrawal. One participant thought the
question was asking if he had experienced any of the symptoms listed. Another participant
answered “yes” because he had used the substance again.
Similar to DR(DRUG)X1, participants were asked what time period they were thinking
of when they answered. Participants answered “the past 12 months” in six instances. For the
remaining cases, participants provided a specific period that was within the past 12 months, such
as “summertime” or “past 3 months.”
All but one participant indicated that he or she saw the F2 instruction, but only one
participant pressed it. Most participants said that providing the instruction on-screen was fine,
but some thought it would be better if the symptoms appeared on-screen. However, the one
participant (1000438) who did press F2 incorrectly answered the question because he thought it
was asking if he had those symptoms.
DR(DRUG)X1, DR(DRUG)X2, and DR(DRUG)10b Spanish-Language Findings
Spanish-language participants appeared to have some difficulty with these questions,
finding them confusing.
All participants said the instruction on the screen to see the symptoms was fine, despite
sometimes mentioning the wrong symptoms (e.g., alcohol symptoms when on the
marijuana/hashish question). However, these participants did not actually experience any
withdrawal symptoms.
34
All participants who received these questions said they were thinking about the past
12 months.
DR(DRUG)23a and DR(DRUG)23b
DR(DRUG)23a. During the past 12 months, was there ever a time when you wanted to use
[DRUG] so much that you couldn’t think of anything else?
DR(DRUG)23b. [IF DR(DRUG)23a = No, DK/REF (i.e., did not endorse there being a time
during the past 12 months when they wanted to use (DRUG) so much that they couldn’t think
of anything else)] During the past 12 months, was there ever a time when you had a strong
urge to use [DRUG]?
DR(DRUG)23a and DR(DRUG)23b English-Language Findings
The revised language “strong urge” improved the reporting on this question. When
participants explained why they answered “yes,” it appeared to fit the definition of craving.
When participants answered “no,” their responses seemed consistent with having a desire
but not a strong desire or strong urge.
We also asked participants if they would have answered differently if we asked about a
“strong desire or urge.” Only one participant who answered “no” said he would have answered
“yes.” Two other participants struggled somewhat with the question by saying they had a desire
to use but not a strong desire to do so. None of the participants who answered “yes” said it would
have changed their answer.
Overall, the findings suggest that “strong urge” was clearer to respondents than “strong
desire or urge” and did not appear to lead to any false positives.
DR(DRUG)23a and DR(DRUG)23b Spanish-Language Findings
All but one participant appeared to understand DR(DRUG)23a correctly. One participant
answered “yes” to alcohol, indicating that he had an urge to drink. His response did not indicate
that he wanted to drink so much he could not think of anything else. However, his indication that
he had an urge to drink is consistent with the criteria for DR(DRUG)23b. As such, it should
probably not be considered a false negative.
Five participants received DR(DRUG)23b for at least one substance, and all appeared to
correctly understand the phrase “deseo fuerte or la necesidad” ("strong desire or the need to") in
DR(DRUG)23b.
Participants were then asked about the difference between “ganas fuertes” ("strong
cravings") and “deseo fuerte” ("strong desire"). Three participants thought that “ganas fuertes”
meant the same thing as “deseo fuerte.” Two participants thought that the terms were different.
One participant could not elaborate on the difference but said that “ganas fuertes” meant having
less desire than “deseo fuerte.”
35
Participants were also asked about the difference between “deseo intenso” ("intense
desire") and “deseo fuerte.” All four participants who answered “no” to DR(DRUG)23b thought
the two terms were the same and would not have changed their answer. The one participant who
answered “yes” thought that “deseo intenso” was stronger than “deseo fuerte.” This participant
said he would have answered “no” for marijuana/hashish if the question said “deseo intenso.”
4.7
Conclusions
The revised SUD survey questions were reviewed by survey methodologists, substantive
experts, and language methodologists. Following this review, the survey questions were
cognitively tested with a total of 42 English-language participants (including 13 adolescents) and
12 Spanish-language participants over three rounds. Based on these findings, SAMHSA decided
that the survey questions tested in Round 3 were the most effective versions. However, due to
continuing problems with these questions, SAMHSA decided to delay instrumentation of a new
SUD module until additional research and testing can be completed. A copy of the full proposed
SUD module in English is provided in Appendix G. The Spanish-language version is provided in
Appendix H.
36
References
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders
(4th ed.). Washington, DC: Author.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: Author.
Sommer, W. H. (2013). Pathophysiology of alcohol addiction. In P. Boyle, P. Boffetta, A. B.
Lowenfels, H. Burns, O. Brawley, W. Zatonski, & J. Rehm (Eds.), Alcohol: Science, pathology
and public health (pp. 85–96). Oxford: Oxford University Press.
Substance Abuse and Mental Health Services Administration (SAMHSA). (In press). Impact of
the DSM-IV to DSM-5 changes on the National Survey on Drug Use and Health. Rockville, MD:
Office of Applied Studies, SAMHSA.
SurveyGizmo [Computer software]. (2015). Retrieved from https://www.surveygizmo.com/
Tourangeau, R., Rips, L. J., & Rasinksi, K. (2000). The psychology of survey response.
Cambridge: Cambridge University Press.
37
38
Appendix A: Substantive Reviewer Feedback
Substantive Reviewer Feedback
Marijuana/Hashish Use Disorder Assessment
DRMJ Think about your use of marijuana or hashish during the past 12 months as you
answer these next questions.
DRMJ01 During the past 12 months, was there a month or more when you spent a lot
of your time getting or using marijuana or hashish? [DSM-5 Criterion 3]
Dr. Compton: Why specify a “month or more”? The DSM does not specify this
timeframe. Change this item to “…was there a period when you spent…” or “…did you
spend….”
DRMJ02 [IF DRMJ01 = No OR DK/REF] During the past 12 months, was there a
month or more when you spent a lot of your time getting over the effects of the
marijuana or hashish you used? [DSM-5 Criterion 3]
Dr. Compton: Same comment as DRMJ01, why specify a “month or more”? The DSM
does not specify this timeframe. Change this item to “…was there a period when you
spent…” or “…did you spend….”
DRMJ04 During the past 12 months, did you try to set limits on how often or how much
marijuana or hashish you would use? [DSM-5 Criterion 1]
DRMJ05 [IF DRMJ04 = Yes] Were you able to keep to the limits you set, or did you
often use marijuana or hashish more than you intended to? [DSM-5 Criterion 1]
Dr. Compton: DRMJ05 is impossible to answer. It has two questions that are phrased in
opposite directions. Also, the phrasing is not consistent with the DSM criterion which
specifies “often taken in larger amounts or over a longer period than was intended”. As
an alternative, I suggest a single combined question for DRMJ04 and DRMJ05: “During
the past 12 months, did you often use marijuana or hashish in larger amounts or over a
much longer period of time than you planned?”
DRMJ06 During the past 12 months, did you need to use much more marijuana or
hashish than you once did in order to get the effect you wanted? [DSM-5 Criterion 10a]
Dr. Compton: The DSM specifies a “markedly increased” use.
DRMJ07 [IF DRMJ06 = No OR DK/REF] During the past 12 months, did you notice that
using the same amount of marijuana or hashish had much less effect on you than it
once did? [DSM-5 Criterion 10b]
Dr. Compton: Similarly, the DSM specifies a “markedly decreased” use.
A-1
DRMJ08 During the past 12 months, did you more than once want to or try to cut down
or stop using marijuana or hashish? [DSM-5 Criterion 2]
Dr. Compton: The DSM specifies “persistent” attempts to cut down or stop use.
DRMJ09 [IF DRMJ08 = Yes] During the past 12 months, were you able to cut down or
stop using marijuana or hashish every time you wanted to or tried to? [DSM-5 Criterion
2]
Dr. Compton: The DSM specifies a “persistent desire or unsuccessful efforts”.
Persistent desire is covered in DRMJ08, but unsuccessful efforts needs revision. I
suggest: “During the past 12 months, did you more than once want to or try to cut down
or stop using marijuana or hashish but found you couldn’t?”
DSM-5 Withdrawal Criteria Part 1: Criteria A & B
DRMJ10 [if DRMJ08 = No, DK/RF or DRMJ09 = No, DK/RF] During the past 12
months, did you cut down or stop using marijuana or hashish at least one time?
Dr. Compton: This question isn’t needed. This can be incorporated into the questions
below.
Reviewer Question 1: DSM-5 specifies that withdrawal occur after ceasing heavy and
prolonged cannabis use. The current question does not specify heavy or prolonged
use. Is this a substantial oversight? If so, how might we incorporate this information
into the question (keeping in mind that the population covered is aged 12 or older)?
Dr. Budney: This could be a skip out item based on previous responses to frequency of
cannabis use; you could only ask if they state that they used at least 15 days per month
for at least 6 months.
I think it is important if you are trying to capture prevalence of withdrawal. If someone
was using only once or twice per week, but was trying not to use at all, they would be
included, and not likely show withdrawal….this would underestimate the prevalence of
withdrawal among those who are heavy users by lumping them in with all users who
tried to cut down.
Dr. Compton: Could only ask withdrawal in persons who use cannabis on a daily or near
daily basis—i.e. 20 or more days per month or 180 or more days out of the previous
365.
Additional feedback from experts at NIDA: ICD-10-CM code indicates that the cannabis
withdrawal could be present only in the presence of a moderate and severe cannabis
use disorder. After collecting the NSDUH data, if collecting withdrawal questions for all
substance users, it will be possible to assess if this statement is correct. If it is, then the
A-2
following iteration of NSDUH could change and assess for withdrawal only those
participants, that will have moderate or severe cannabis use disorder (or whatever other
outcomes the data shows) based on the previous SUD questions or other
frequency/amount of marijuana use.
Question 2: DSM-5 text for withdrawal criterion A differs for several of the substances
regarding heavy and prolonged use. Specifically:
Alcohol – Heavy and prolonged use is undefined.
Opioids – Heavy use is undefined, prolonged use is defined as several weeks or
longer.
Sedatives/Hypnotics/Anxiolytics – Criterion A only mandates prolonged, not heavy,
use. Prolonged use is undefined.
Stimulants – Criterion A only mandates prolonged, not heavy, use. Prolonged use is
undefined.
None of the NSDUH questions (for any substance) specify heavy or prolonged use.
Similar to the prior question, is this a substantial oversight for any of these
substances? If so, do you have any suggestions for incorporating this information?
Dr. Budney: No, it is a limitation of the science that we do not know precisely how to
define in relation to probability of developing dependence that would be followed by
withdrawal. My previous comment would hold for all substances, experts from the other
substance areas might have an idea for a cut off?
Dr. Compton: Yes. Require daily or near daily use at some point during the year to
qualify.
Other NIDA comments: This should be incorporated into the questions for other
substances as well. I believe that several weeks were indicated specifically for the
withdrawal from opioids to emphasize that the withdrawal could happen even after a
short period of time after using opioids, compared to other substances, where it is
usually necessary to use a substance longer than few weeks in order to have a
withdrawal after its cessation of use. But, it is possible to look at the data from previous
NSDUH and see, if it is possible to establish some “cut off” of amount/frequency or
length of use for each substance in order to go forward with the withdrawal questions. I
am little skeptical here as I would expect high inter-individual variability (but I could be
wrong).
Question 3: DSM-5 wording does not specify that cessation after heavy/prolonged
use has to be intentional (e.g. an individual may be unable to obtain the substance or
be in a situation where use is restricted). Does the phrase “cut down or stop using”
imply intent? Consider that this question occurs immediately after questions about
“trying to cut down”. This consideration would apply to all substances.
A-3
Dr. Budney: [Going without] does not have to be intentional. Perhaps reword, and add:
either because you wanted to or because it wasn’t available.
Other NIDA comments: No [the phrase does not imply intent] and I think that’s fine. This
could be one of the questions asked during cognitive interviewing with substance using
respondents.
Question 4: Two alternate wording options have been considered for question 10:
• During the past 12 months, whether you wanted to or not, did you cut back or
stop using marijuana or hashish at least one time?
• During the past 12 months, did you go without using marijuana or hashish for
any period of time”
Are either of these (or combination of these) preferable to the current wording? Or is
there another option that we should consider?
Dr. Budney: Option one would seem preferable, as indicated above….substantial
reductions can produce withdrawal for many substances.
Other NIDA feedback: Option 1 wording seems clear to me. It distinguishes that we are
not asking about “control”, we are asking about the pharmacological criteria.
Additionally, how consistent is this with how the questions have been asked in the past?
[I’m] Ok with the wording of question 10 if consistent with prior iterations.
DRMJ11a [IF DRMJ09 = Yes or DRMJ10 = Yes] Please look at the symptoms listed
below. During the past 12 months, did you have any of these symptoms in the first day
or two after you cut back or stopped using marijuana or hashish?
• Abdominal pain
• Shakiness or tremors
• Sweating
• Fever
• Chills
• Headache
Other NIDA feedback: Could change “in the first day or two” to “in the first few days”
Question 5: DRMJ09 or DRMJ10 act as a gate question for the rest of the withdrawal
items. Given the considerations about intent and that withdrawal can occur after any
period of non-use (e.g. Alcoholics can awaken from a long sleep experiencing
withdrawal); is it appropriate to have a gate question of nonuse in order to ask about
withdrawal questions or should all respondents with past year use be asked the 11a
question? If all respondents with past year use should be asked the 11a question, do
you have a suggestion for how the wording should be altered to reflect those who had
not cut down or stopped? Please consider this question for all substances.
A-4
Dr. Budney: This is a doozy! You could state have not used for 24 hours or more (but
your alcohol example worries me; caffeine withdrawal onset also can occur more
quickly). Doesn’t this go back to how you are going to ask #10….that would seem to be
the decision point for moving to 11. If you were to ask of all heavy users, then you don’t
need item 10. Most people have probably stopped for some period where withdrawal
could possibly occur, but did not because of individual differences in time of onset.
Could you just add an alternative response to #11: (I did not cut back or stop) …which
would loop them out of the rest of the symptom questions?
Dr. Compton: ALL RESPONDENTS WHO USE MJ REGULARLY SHOULD BE ASKED.
Other NIDA feedback: For most of the substances, these questions were asked in the
previous years (for example for alcohol: DRALC 09, DRALC 10). Is it possible to look at
the previous data to answer this question?
Question 6: Do you have any concerns about the wording/interpretation of this item of
the marijuana withdrawal assessment?
Dr. Budney: These seem OK, [but it would be] preferable to ask each item [separately];
we simply “guessed” at how many items to require for this criterion, so more data on
symptom count would be nice. FYI this comment refers to 11b
Other NIDA Feedback: No. But, I understand that this question will go through a
cognitive interviewing with substance-using respondents that could compare the
wording from the DSMV with the suggested wording for the NSDUH
DRMJ11b Please look at the list below, during the past 12 months, have any of these
symptoms started in the first day or two after you stopped or cut down using marijuana
or hashish?
• Feeling irritable or angry Yes/No
• Feeling anxious Yes/No
• Having trouble sleeping Yes/No
• Having a smaller appetite than usual or losing weight without trying to Yes/No
• Feeling like you couldn’t sit still Yes/No
• Feeling depressed Yes/No
Question 7: Do you have any concerns about the wording/interpretation of this item of
the marijuana withdrawal assessment?
Other NIDA Feedback: As noted in the comments above
Question 8: Items 11a and 11b do not specify that the marijuana withdrawal
symptoms develop within a week of cessation. Is this a substantial oversight? If so,
how might we incorporate this into the question given our audience of children and
adults aged 12 or older?
A-5
Dr. Budney: I think you should put this qualifier in somehow: “within the first week that
you cut down or stopped”
Other NIDA Feedback: I think it is most important that the participant understand that
these symptoms are withdrawal symptoms and they developed after he/she stopped
using marijuana. What terms are substance-using respondents using when they talk
about “withdrawal”. This could be a part of the planned formative research.
Question 9: DSM-5 text for withdrawal criterion B differs for several of the substances
regarding the time of onset for withdrawal symptoms. Specifically:
Alcohol – Symptoms develop within several hours to a few days.
Opioids – Symptoms develop within minutes to several days.
Sedatives/Hypnotics/Anxiolytics – Symptoms develop within several hours to a few
days.
Stimulants – Symptoms develop within a few hours to several days.
None of the NSDUH withdrawal questions (for any substance) specify the time of
onset for withdrawal symptoms. Similar to the prior question, is this a substantial
oversight for any of these substances? If so, do you have any suggestions for
incorporating this information?
Dr. Budney: As in comment 9, I think it is good to put it in.
Other NIDA Feedback: Potentially, if you get too many false positives, piloting it both
ways would be helpful if possible. It’s not a major oversight but consider adding the
phrase “within the first day or two after you stopped or cut down using.”
Question 10: Does the series of questions 10 through 11b adequately capture the
concept of DSM-5 Cannabis Withdrawal Part 1 Criteria A and B?
Dr. Budney: Yes, but see my comment above.
Other NIDA Feedback: No, recommend adding a question like “have you used
marijuana or hashish to avoid these uncomfortable symptoms
Question 11: Do you have any additional concerns or suggestions regarding items 10
through 11b?
No additional feedback
A-6
DSM-5 Withdrawal Criteria Part 2:
Cannabis (or a closely related substance) is taken to relieve or avoid withdrawal
symptoms
Question 12: NSDUH does not currently assess this part of the withdrawal criteria for
any substances. Is this a substantial oversight?
Dr. Budney: This question is part of use disorder criteria, not withdrawal disorder? It
should be asked as part of use disorder diagnosis.
Dr. Compton: Yes, I would add.
DRMJXX: [IF DRMJ09 = Yes or DRMJ10 = Yes] During the past 12 months, when you
cut down or stopped using marijuana, did you start using marijuana again, drink alcohol,
take prescription drugs or any illegal substance to get rid of or prevent any of those
symptoms?
Alternate versions for other substances:
Alcohol: [IF DRALC09 = Yes or DRALC10 = Yes] During the past 12 months, when
you cut down or stopped drinking alcohol, did you start drinking alcohol again, use
marijuana, prescription drugs, or any illegal substance to get rid of or prevent any of
those symptoms?
Other Drugs: [IF DR(DRUG)09 = Yes or DR(DRUG)10 = Yes] During the past 12
months, when you cut down or stopped using X, did you use alcohol, marijuana,
prescription drugs, or any illegal substance to get rid of or prevent any of those
symptoms?
Question 13: DSM-5 specifically mentions use of the substance or a similar substance
to prevent or stop withdrawal symptoms. Is the proposed wording too broad? If so,
how much of a problem is it considering that we would need to tailor each question for
the substance being assessed?
Dr. Budney: I would think that you could mention the specific substance, then go broad
as stated above for all substances
Dr. Compton: The substances must be matched pharmacologically to the substance in
question. For alcohol, alcohol or prescription sedatives. For opioids or heroin,
prescription opioids or heroin. For marijuana, marijuana or hashish (including edible
forms of marijuana). Etc. Each should be tailored
Question 14: The wording of this question does not list the withdrawal symptoms
previously reported. Should it? How important is this (please consider this question for
all substances)?
Dr. Budney: Not necessary, but maybe state “those withdrawal symptoms.”
A-7
Dr. Compton: The phrasing could be: “You just mentioned that you experienced
symptoms after stopping or cutting down on marijuana or hashish. During the past year,
did you use marijuana or hashish or marijuana extracts to avoid or get over these
symptoms.” This question could be asked during the planned formative research with
substance-using respondents.
Question 15: Does this question adequately capture the DSM-5 concept of withdrawal
Part 2 (both for cannabis and other substances)?
Dr. Budney: Yes
Question 16: Do you have any other concerns or suggestions regarding this item (for
marijuana or any other substance)?
No additional feedback.
Question 17: Do you have any other comments or suggestions regarding the
assessment of withdrawal in general and cannabis withdrawal in particular?
Dr. Budney: No, just that if possible, asking each symptom separately would provide
great data for future analyses to determine reliability and validity of items
DRMJ13 During the past 12 months, did you have any problems with your emotions,
nerves, or mental health that were probably caused or made worse by your use of
marijuana or hashish? [DSM-5 Criterion 9]
DRMJ14 [IF DRMJ13 = Yes] Did you continue to use marijuana or hashish even though
you thought it was causing you to have problems with your emotions, nerves, or mental
health? [DSM-5 Criterion 9]
DRMJ15 [IF DRMJ13 = No OR DK/REF OR DRMJ14 = No OR DK/REF] During the
past 12 months, did you have any physical health problems that were probably caused
or made worse by your use of marijuana or hashish? [DSM-5 Criterion 9]
DRMJ16 [IF DRMJ15 = Yes] Did you continue to use marijuana or hashish even though
you thought it was causing you to have physical problems? [DSM-5 Criterion 9]
DRMJ17 This question is about important activities such as working, going to school,
taking care of children, doing fun things such as hobbies and sports, and spending time
with friends and family. During the past 12 months, did you give up or spend less time
doing these types of important activities in order to use marijuana or hashish? [DSM-5
Criterion 7]
A-8
DRMJ18 Sometimes people who use marijuana or hashish have serious problems at
home, work or school — such as:
• neglecting their children
• missing work or school
• doing a poor job at work or school
• losing a job or dropping out of school
During the past 12 months, did using marijuana or hashish cause you to have serious
problems like this either at home, work, or school? [DSM-5 Criterion 5]
DRMJ19 During the past 12 months, did you accidently injure yourself while under the
influence of marijuana or hashish, for example have a bad fall, cut yourself badly, get
hurt in a traffic accident, or anything like that? YES/NO
During the past 12 months, did you find yourself under the influence of marijuana or
hashish in situations that increased your chances of getting hurt, like swimming, using
machinery, walking in a dangerous area or driving a car, motorcycle, truck, boat or other
vehicle? YES/NO [DSM-5 Criterion 8]
DRMJ20 During the past 12 months, did using marijuana or hashish cause you to do
things that repeatedly got you in trouble with the law?
Note to Expert Reviewers: We recognize that this Criterion has been
removed from DSM-5
DRMJ21 During the past 12 months, did you have any problems with family or friends
that were probably caused by your use of marijuana or hashish? [DSM-5 Criterion 6]
DRMJ22 [IF DRMJ21 = Yes] Did you continue to use marijuana or hashish even though
you thought it caused problems with family or friends? [DSM-5 Criterion 6]
DRMJ23 Options for Craving [DSM-5 Criterion 4]
Below we present several options for assessing the new DSM-5 craving criterion. The
DSM-5 describes craving in two ways. In the criteria table, the DSM-5 defines craving
as “a strong desire or urge to use alcohol.” In the text description, the DSM-5 explains
craving as “indicated by a strong desire to [use substance] that makes it difficult to
think of anything else and that often results in the onset of [substance use]. These
items would be asked of all past year users for all substances.
Option A. During the past 12 months, did you ever have a strong desire or
overwhelming urge to use marijuana or hashish?
Question 18: How well does this question capture the definition of craving? Is “ever”
too inclusive?? FINE
Dr. Budney: Yes, it’s too inclusive. I would rather see some qualifier of
frequency...maybe “often” experience desires or urges...
A-9
Dr. Compton: Needs to be more severe.
Additional NIDA feedback: In structured interviews, the craving is usually measured by
two questions:
1. Wanted the substance so badly, couldn’t think of anything else
2. Strong desire or urge to use substance
Recommend testing these two options and the options in this document with the drugusing respondents and decide, which option captures craving the best way. Also, it is
possible to test the word “craving” by itself as well to see, what “word” are drug using
respondents using, when they talk about “craving”
Question 19: Can you foresee any confusion with regard to item wording??
No additional feedback.
Question 20: Do you have any other concerns regarding this option?
No additional feedback.
Option B. During the past 12 months, did you often have a strong desire or urge to use
marijuana or hashish?
Question 21: The word “often” has been added to this version because some of the
text in DSM-5 suggests a more stringent criterion (difficult to think of anything else)
than that presented in option A. Is this too stringent?
Dr. Budney: No, I like it.
Additional NIDA feedback: Yes, it may be too stringent
Question 22: Can you foresee any confusion with regard to item wording?
No additional feedback.
Question 23: Do you have any other concerns regarding this option?
No additional feedback.
Option C. During the past 12 months, after you didn’t use marijuana for a while, did you
start to crave it?
A-10
Question 24: This question takes a slightly different approach, indicating that craving
occurs after not having used for a while. What do you think about this variation?
Dr. Budney: I’m not sure I like it....cravings occur sometimes while using, which
contributes to meeting other criteria such as using more and longer than intended.
Additional NIDA feedback: Cutting back or quitting is not required for craving
Question 25: This version uses the actual word “crave” without defining it, is there any
concern about this? Please consider that the age range of the survey is 12 or older.
Dr. Budney: I don’t like it.
Additional NIDA feedback: This would need to go through a formative testing.
Question 26: Do you have any concerns about stipulating that craving occurs after a
period of non-use?
Additional NIDA feedback: Yes, because it is difficult to define what is non-use. Is it the
period of a time when the blood level of the drug decreases or is zero? How would the
drug user know?
Question 27: Do you have any other concerns regarding this option?
No additional feedback.
Option D. During the past 12 months, after you cut down or stopped using marijuana,
did you feel a strong urge to use it?
Question 28: This version specifies that craving occurs after the respondents has cut
down or stopped using. Do you have any concerns about the wording of “cut down or
stopped using”? For example, does that wording inadvertently imply an intentional
effort to cut down or stop?
Dr. Budney: See prior comments.
Additional NIDA feedback: This isn’t required in the DSM so wouldn’t include this
version.
Question 29: Options A through C are designed to be asked of all past year
substance users. In this option, we ask about times after a respondent cut down or
stopped using—if we were to go with this option would we only administer this
question if they had indicated an attempt to cut down or stop ([IF DRMJ09 = Yes or
DRMJ10 = Yes])?
Dr. Budney: yes, and this would be problematic
A-11
Question 30: Do you have any other concerns regarding this option?
No additional feedback.
Question 31: Which of these items or combination of items does the best job of
assessing craving as intended by the DSM-5 among our population of respondents
aged 12 or older?
Dr. Budney: I like B.
NIDA: A
Question 32: Do you have any other comments or suggestions regarding the
assessment of craving?
Additional NIDA feedback: Options should go through a formative testing with the target
population.
END
A-12
Methodologist Review Feedback
DRMJ Think about your use of marijuana or hashish during the past 12 months as you
answer these next questions.
DRMJ01 During the past 12 months, was there a month or more when you spent a lot
of your time getting or using marijuana or hashish?
DRMJ02 [IF DRMJ01 = No OR DK/REF] During the past 12 months, was there a
month or more when you spent a lot of your time getting over the effects of the
marijuana or hashish you used?
DRMJ04 During the past 12 months, did you try to set limits on how often or how much
marijuana or hashish you would use?
DRMJ05 [IF DRMJ04 = Yes] Were you able to keep to the limits you set, or did you
often use marijuana or hashish more than you intended to?
(1) Usually kept to the limits set
(2) Often used more than intended
DRMJ06 During the past 12 months, did you need to use more marijuana or hashish
than you used to in order to get the effect you wanted?
DRMJ07 [IF DRMJ06 = No OR DK/REF] During the past 12 months, did you notice that
using the same amount of marijuana or hashish had less effect on you than it used to?
DRMJ08 During the past 12 months, did you want to or try to cut down or stop using
marijuana or hashish?
DRMJ09 [IF DRMJ08 = Yes] During the past 12 months, were you able to cut down or
stop using marijuana or hashish every time you wanted to or tried to?
A-13
DSM‐5 Review Packet
The following set of items (DRMJ10 – DRMJXX) assesses the DSM-5 criteria for
withdrawal, some of the questions have been revised and some are new. We
would appreciate your feedback regarding these items.
The DSM-5 defines cannabis withdrawal as a person who endorses either Part 1
(both A and B) or Part 2 of the following:
Part 1. (assessed by items DRMJ10 – DRMJ11b)
• Criterion A: Cessation of cannabis use that has been heavy and prolonged
(i.e., usually daily or almost daily use of a period of at least a few months)
• Criterion B: 3 or more of the physical symptoms develop within approximately
1 week after Criterion A
1. Irritability, anger, or aggression
2. Nervousness or anxiety
3. Sleep difficulty (e.g. insomnia or disturbing dreams)
4. Decreased appetite or weight loss
5. Restlessness
6. Depressed mood
7. At least one of the following physical symptoms causing significant
discomfort: abdominal pain, shakiness/tremors, sweating, fever, chills, or
headache
Part 2. (assessed by DRMJXX)
Cannabis (or a closely related substance) is taken to relieve or avoid withdrawal
symptoms.
DSM-5 Withdrawal Criteria Part 1:
DRMJ10 [if DRMJ08 = No, DK/RF or DRMJ09 = No, DK/RF] During the past 12
months, whether you wanted to or not, did you cut down or stop using marijuana or
hashish at least one time?
Question 1: The intent of DRMJ10 is to identify those who ceased using cannabis (a
component of Part 1, Criterion A). Cessation of a substance is required for the
development of withdrawal symptoms; therefore individuals who never went without
the substance would not be at risk for developing withdrawal and are skipped out of
the next few questions. This item, while not new to NSDUH for other substances, is
being revised.
The DSM-5 does not specify that going without a substance has to be intentional (e.g.
an individual may be unable to obtain the substance, they may be in a situation where
use is restricted, or they may simply awaken from a long sleep and experience
withdrawal symptoms). To address this, we have added the phrase “whether you
wanted to or not” to the original item. Is this sufficient? This change would apply to all
substances asked about in the substance dependence and abuse section that have
withdrawal criteria: alcohol, marijuana/hashish, cocaine/crack, heroin,
A-14
DSM‐5 Review Packet
methamphetamine, prescription pain relievers, prescription tranquilizers, prescription
stimulants, and prescription sedatives.
Dr. Beatty: I think there is potential for confusion with the proposed approach—not
entirely because of the phrase “whether you wanted to or not,” but due to how this could
build upon other ambiguities. One general problem is uncertainty regarding the meaning
of “cut down or stop… at least one time.” Is the expectation that a respondent should
answer yes if literally on one occasion, they decided to use less than usual? It’s unclear
what the threshold for deciding yes should be for cutting down at least one time. I think
that ambiguity makes it harder to understand the intent of “whether you wanted to or
not.” I wonder if a better approach would be to ask first whether the respondent had
reduced usage for any reason, rather than trying to separate “intended to cut down” (08)
from “cut down regardless of whether you intended to” (10). If that’s not possible, since
they’re already addressed the issue of intentionally cutting back, could you limit this
question to asking about times that they unintentionally cut back?
Dr. Willis: Reference period: I find it strange that the DSM-5 criteria don’t include a
reference period for the activity (are they including events of 20 years ago…?). So, use
of a 12-month reference period for NSDUH seems like a good idea. ‘Whether you
wanted to or not.’ I like the wording (although with the caveat that any change would
benefit from cognitive testing). The alternative I grappled with is breaking up the
question to first ask if they cut down or stopped, and then following up with whether it
was voluntary. But, I doubt that would work, as I think the ‘cut down’ item without
‘whether you wanted to or not’ wouldn’t be very well understood, so you need that
element in the question.
DRMJ11a [IF DRMJ09 = Yes or DRMJ10 = Yes] Please look at the symptoms listed
below. During the past 12 months, did you have 1 or more of these symptoms after you
cut down or stopped using marijuana or hashish?
• Abdominal pain
• Shakiness or tremors
• Sweating
• Fever
• Chills
• Headache
Dr. Willis: I think that referring to the DRMJ11a adverse health effects as ‘symptoms’
may be excess baggage that is unnecessary. Also, a few of the symptoms can be
simplified (e.g., many people don’t know where their abdomen is; consider ‘shaking’
rather than ‘shakiness’).
I suggest: During the past 12 months, did ANY of the following happen to you after you
cut down or stopped using marijuana or hashish?
A-15
DSM‐5 Review Packet
•
•
•
•
•
•
Pain in the stomach or chest areas
Shaking or tremors
Sweating
Fever
Chills
Headaches
If the question is simplified as above, then it may be ok to add the one-week element
‘happen to you within a week after you cut down…” However, as you note below this
period isn’t consistent across substances, and given that it’s classically a bad idea to
constantly change reference periods, I would opt for simplicity and go with the prior
reviewers’ recommendation to forego this element.
DRMJ11b [IF DRMJ09 = Yes or DRMJ10 = Yes] During the past 12 months, did you
have [IF DRMJ11a = Yes then fill 2, IF DRMJ11a = No then say 3] or more of these
symptoms after you cut down or stopped using marijuana or hashish?
• Feeling irritable or angry
• Feeling anxious
• Having trouble sleeping
• Having a smaller appetite than usual or losing weight without trying to
• Feeling like you couldn’t sit still
• Feeling depressed
Dr. Willis:
1) Below I suggest a simpler approach involving getting Y or N to each, so you can just
count up and see if it’s 3 or more
2) Also, to adhere to the DSM, I added in a few more symptoms (‘nervous’; ‘bad
dreams’) and altered the appetite item:
During the past 12 months, did you have experience the following after you cut down or
stopped using marijuana or hashish?
Yes No
[ ] [ ] Feeling irritable or angry
[ ] [ ] Feeling nervous or anxious
[ ] [ ] Having trouble sleeping or bad dreams
[ ] [ ] Losing your appetite, or losing weight without trying to
[ ] [ ] Feeling like you couldn’t sit still
[ ] [ ] Feeling depressed
A-16
DSM‐5 Review Packet
Question 2: DSM-5 specifies that withdrawal symptoms occur after ceasing heavy
and prolonged substance use. The current questions (for each substance module,
11a and 11b above) do not specify heavy or prolonged use. Moreover, the DSM-5
text for withdrawal criterion A differs for several of the substances regarding heavy
and prolonged use. Specifically:
Alcohol – Heavy and prolonged use is undefined.
Marijuana - Heavy and prolonged use is undefined.
Opioids – Heavy use is undefined, prolonged use is defined as several weeks or
longer.
Sedatives/Hypnotics/Anxiolytics – Criterion A only mandates prolonged, not heavy,
use. Prolonged use is undefined.
Stimulants – Criterion A only mandates prolonged, not heavy, use. Prolonged use is
undefined
Do you have any suggestions for incorporating these criteria into questions 11a and
11b, given the NSDUH target population of respondents aged 12 or older?
Dr. Beatty: It would be quite awkward to try to assess intensity and longevity of use at
the same time as trying to determine symptoms. You really need to ascertain the extent
and duration of use in prior, separate questions.
Dr. Willis:
“Heavy and prolonged use.” As noted below, the DSM-5 criteria include ‘heavy and
prolonged use’ of cannabis, which is an element not included in DRMJ10. But, I can see
why you would choose to omit this from the question itself, as it (a) adds yet another
conceptual element to the question; and (b) is vague if undefined, and too long/complex
if it IS defined. Will there be a way to satisfy the ‘heavy and prolonged’ element, such as
by making use of other items that measure use over the past 12 months (that is, to set a
criterion for ‘heavy and prolonged use’ that can be used to subset cases for analysis)?
Or, perhaps another way of looking at this is that IF, in the end, the respondent satisfies
Criterion B (3 or more symptoms), then the analyst can assume that the use reported in
DRMJ10 must have been heavy and prolonged (if one assumes that it is unlikely that
use that was not heavy/prolonged would have produced such symptoms). Bottom line:
Assuming my logic above is reasonable, it seems ok to word as is (i.e., without
heavy/prolonged).
A-17
DSM‐5 Review Packet
Question 3: Items 11a and 11b do not specify that the marijuana withdrawal
symptoms develop within a week of cessation. The substantive reviewers indicated
that the main consideration is that the symptoms are linked to the cutting down or
stopping the use of the substance rather than the specific time period. Does the
current question adequately capture this intent?
If not, consider that the DSM-5 text for withdrawal criterion B differs for several of the
substances regarding the time of onset for withdrawal symptoms.
Specifically:
Alcohol – Symptoms develop within several hours to a few days.
Marijuana – Symptoms develop within one week.
Opioids – Symptoms develop within minutes to several days.
Sedatives/Hypnotics/Anxiolytics – Symptoms develop within several hours to a few
days.
Stimulants – Symptoms develop within a few hours to several days.
Since none of the NSDUH withdrawal questions (for any substance) specify the time
of onset for withdrawal symptoms, any changes would need to be made across all the
modules. Do you have any suggestions for incorporating this information into the
items?
Dr. Beatty: In most cases, it seems likely that respondents would answer based on
symptoms that they directly attributed to cutting down or stopping. It’s possible that
someone taking the questions very literally could report that they had these symptoms
“after” cutting back, even though there was no clear relationship (e.g. “after I cut back I
came down with the flu”). But on the whole, it seems dicey to ask directly about whether
respondents attribute symptoms to cutting back, and asking about whether the
symptoms simply followed is probably a safer approach. However, I don’t see a down
side to being more specific about time frame (e.g. “within a week”).
There are a lot of fairly complicated and subjective ideas in these questions, and
potential for interpretations of questions to be influenced by context of previous ones. I’d
think that the best way to evaluate your concerns would be through cognitive testing of
the whole module.
Question 4: Do you have any additional concerns or suggestions regarding items
DRMJ10 through 11b?
Dr. Willis: See above comments.
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DSM‐5 Review Packet
DSM-5 Withdrawal Criteria Part 2:
Version 1: DRMJXX: Marijuana: [IF DRALC09 = Yes or DRALC10 = Yes] During the
past 12 months, when you cut down or stopped using [marijuana or hashish], did you
start using [marijuana or hashish again] or use any illegal substance to get rid of or
prevent any of these symptoms?
Version 1 for other substances:
Alcohol: [IF DRALC09 = Yes or DRALC10 = Yes] During the past 12 months, when
you cut down or stopped [drinking alcohol], did you start using [alcohol again, or use
sedatives or tranquilizers,] or any other illegal substance to get rid of or prevent any of
these symptoms?
Prescription Sedatives: [IF DR(DRUG)09 = Yes or DR(DRUG)10 = Yes] During the
past 12 months, when you cut down or stopped using [sedatives], did you start using
[sedatives again, drink alcohol, use tranquilizers,] or use any other illegal substance
to get rid of or prevent any of these symptoms?
Prescription Tranquilizers: [IF DR(DRUG)09 = Yes or DR(DRUG)10 = Yes] During
the past 12 months, when you cut down or stopped using [tranquilizers], did you start
using [tranquilizers again, drink alcohol, use sedatives,] or use any other illegal
substance to get rid of or prevent any of these symptoms?
Prescription Stimulants: [IF DR(DRUG)09 = Yes or DR(DRUG)10 = Yes] During the
past 12 months, when you cut down or stopped using [stimulants], did you start using
[stimulants again, use methamphetamines or, cocaine or crack,] or use any other
illegal substance to get rid of or prevent any of these symptoms?
Methamphetamines: [IF DRME11 is Yes] During the past 12 months, when you cut
down or stopped using [methamphetamines], did you start using [methamphetamines
again, use stimulants, or cocaine or crack,] or use any other illegal substance to get
rid of or prevent any of these symptoms?
Cocaine: [IF DR(DRUG)09 = Yes or DR(DRUG)10 = Yes] During the past 12 months,
when you cut down or stopped using [cocaine or crack], did you start using [cocaine
or crack again, use stimulants or methamphetamines,] or use any other illegal
substance to get rid of or prevent any of these symptoms?
Heroin: [IF DR(DRUG)09 = Yes or DR(DRUG)10 = Yes] During the past 12 months,
when you cut down or stopped using [heroin], did you start using [heroin again, or use
prescription pain relievers,] or any other illegal substance to get rid of or prevent any
of these symptoms?
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DSM‐5 Review Packet
Prescription Pain Relievers: [IF DR(DRUG)09 = Yes or DR(DRUG)10 = Yes] During
the past 12 months, when you cut down or stopped using [prescription pain relievers],
did you start using [prescription pain relievers again, or use heroin, or any other illegal
substance] to get rid of or prevent any of these symptoms?
Dr. Willis: Yuck, confusing
Version 2:
DRMJXX: Marijuana [IF DRMJ09 = Yes or DRMJ10 = Yes] [Fill if 11a or 11b =
Yes: You just mentioned that you experienced symptoms after cutting down or stopping
marijuana or hashish.] During the past 12 months, did you use [marijuana or hashish] or
any illegal substance to avoid or get over these symptoms?
Version 2 for other substances:
Alcohol: [IF DRALC09 = Yes or DRALC10 = Yes] [Fill if 11a or 11b = Yes: You just
mentioned that you experienced symptoms after cutting down or stopping alcohol.
During the past 12 months, did you use [alcohol, or use sedatives or tranquilizers,] or
any other illegal substance to avoid or get over these symptoms?
Prescription Sedatives: [IF DR(DRUG)09 = Yes or DR(DRUG)10 = Yes] [Fill if 11a
or 11b = Yes: You just mentioned that you experienced symptoms after cutting down
or stopping sedatives.] During the past 12 months, did you use [sedatives, drink
alcohol, use tranquilizers,] or use any other illegal substance to avoid or get over
these symptoms?
Prescription Tranquilizers: [IF DR(DRUG)09 = Yes or DR(DRUG)10 = Yes] [Fill if
11a or 11b = Yes: You just mentioned that you experienced symptoms after cutting
down or stopping tranquilizers.] During the past 12 months, did you use [tranquilizers,
drink alcohol, use sedatives,] or use any other illegal substance to avoid or get over
these symptoms?
Prescription Stimulants: [IF DR(DRUG)09 = Yes or DR(DRUG)10 = Yes] [Fill if 11a
or 11b = Yes: You just mentioned that you experienced symptoms after cutting down
or stopping stimulants.] During the past 12 months, did you use [stimulants,
methamphetamine, cocaine or crack,] or use any other illegal substance to avoid or
get over these symptoms?
Cocaine: [IF DR(DRUG)09 = Yes or DR(DRUG)10 = Yes] [Fill if 11a or 11b = Yes:
You just mentioned that you experienced symptoms after cutting down or stopping
cocaine or crack.] During the past 12 months, did you use [cocaine or crack,
methamphetamine, stimulants], or use any other illegal substance to avoid or get over
these symptoms?
Methamphetamine: [IF DR(DRUG)09 = Yes or DR(DRUG)10 = Yes] [Fill if 11a or
11b = Yes: You just mentioned that you experienced symptoms after cutting down or
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stopping methamphetamine.] During the past 12 months, did you use
[methamphetamine, cocaine or crack, stimulants], or use any other illegal substance
to avoid or get over these symptoms?
Heroin: [IF DR(DRUG)09 = Yes or DR(DRUG)10 = Yes] [Fill if 11a or 11b = Yes: You
just mentioned that you experienced symptoms after cutting down or stopping heroin].
During the past 12 months, did you use [heroin, prescription pain relievers,] or any
other illegal substance to avoid or get over these symptoms?
Prescription Pain Relievers: [IF DR(DRUG)09 = Yes or DR(DRUG)10 = Yes] [Fill if
11a or 11b = Yes: You just mentioned that you experienced symptoms after cutting
down or stopping prescription pain relievers]. During the past 12 months, did you use
[prescription pain relievers, use heroin,] or any other illegal substance to avoid or get
over these symptoms?
Question 5: What do you think about the phrasing “to get rid of or prevent” and “to
avoid or get over”? Is there a better way to phrase this?
Dr. Beatty: Both wordings seem clear to me, and get at similar ideas. I think they work.
Dr. Willis: See my comments above: I think ‘to get rid of or prevent’ sounds ok, but ‘to
avoid or get over’ also seems ok. No strong preference.
Question 6: Which of the two version sets above (or combination thereof) do you
prefer (and why)?
Dr. Beatty: I might slightly prefer “get rid of or prevent” rather than “to avoid or get over”
because it seems slightly more straightforward. I think the optimal structure of the
question would be “During the past 12 months, did you start using [ ] again, or use any
other illegal substance, to get rid of or prevent these symptoms?” If the question
immediately follows the item on symptoms, I’m not sure it’s necessary to refer back to
the fact that they experienced symptoms after cutting back. The introductory sentence
in Version 2 seems particularly repetitive, although cognitive testing might indicate
whether it’s really needed.
Dr. Willis:
1) I vote for some variant of Version 2, which I believe is much clearer than Version 1
above.
2) Concerning wording, instead of referring to ‘symptoms’, if you went with my
suggestion above to ‘mark all that apply’, would there be a way to have the system list
those the respondent has just marked YES to, and then ask “During the past 12
months, did you use ‘marijuana or hashish] or any illegal substance to avoid or get over
[any of] these?”
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Question 7: Do you have any concerns or suggestions regarding the preferred
version (for marijuana or any other substance)?
No further feedback.
Question 8: Do you have any other comments or suggestions regarding the
assessment of withdrawal in general and cannabis withdrawal in particular?
Dr. Beatty: If there were multiple instances of withdrawal, would you want the
respondent to say “yes” if it they ever used substances to escape symptoms (but not
always)?
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DRMJ13 During the past 12 months, did you have any problems with your emotions,
nerves, or mental health that were probably caused or made worse by your use of
marijuana or hashish?
DRMJ14 [IF DRMJ13 = Yes] Did you continue to use marijuana or hashish even though
you thought it was causing you to have problems with your emotions, nerves, or mental
health?
DRMJ15 [IF DRMJ13 = No OR DK/REF OR DRMJ14 = No OR DK/REF] During the
past 12 months, did you have any physical health problems that were probably caused
or made worse by your use of marijuana or hashish?
DRMJ16 [IF DRMJ15 = Yes] Did you continue to use marijuana or hashish even though
you thought it was causing you to have physical problems?
DRMJ17 This question is about important activities such as working, going to school,
taking care of children, doing fun things such as hobbies and sports, and spending time
with friends and family. During the past 12 months, did using marijuana or hashish
cause you to give up or spend less time doing these types of important activities?
DRMJ18 Sometimes people who use marijuana or hashish have serious problems at
home, work or school — such as:
• neglecting their children
• missing work or school
• doing a poor job at work or school
• losing a job or dropping out of school
During the past 12 months, did using marijuana or hashish cause you to have serious
problems like this either at home, work, or school?
DRMJ19 During the past 12 months, did you regularly use marijuana or hashish and
then do something where using marijuana or hashish might have put you in physical
danger?
DRMJ20 During the past 12 months, did using marijuana or hashish cause you to do
things that repeatedly got you in trouble with the law?
Note to Expert Reviewers: The criterion seen in DRMJ20, legal issues, has
been removed from DSM-5 but will be retained for historical purposes.
DRMJ21 During the past 12 months, did you have any problems with family or friends
that were probably caused by your use of marijuana or hashish?
DRMJ22 [IF DRMJ21 = Yes] Did you continue to use marijuana or hashish even though
you thought it caused problems with family or friends?
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DSM‐5 Review Packet
Craving
The DSM-5 has added an additional criterion for substance use disorder diagnosis,
called “craving”. Three options (the third option contains two parts) are presented
below for assessing the new DSM-5 craving criterion. The DSM-5 describes craving
in two ways. First, the DSM-5 defines craving as “a strong desire or urge to use
alcohol.” Additionally, the DSM-5 explains craving as “indicated by a strong desire to
[use substance] that makes it difficult to think of anything else and that often results in
the onset of [substance use]. This is a new criterion applicable to all substances,
therefore these items would be asked of all past year users for all substances.
DRMJ23 Option A. During the past 12 months, did you often have a strong desire or
urge to use marijuana or hashish?
Question 9: How well does this question capture the general definition of craving and
its severity? Is the word “often” too stringent?
Dr. Willis: Seems to me that this doesn’t match the DSM5, as ‘often’ is not a criterion.
Question 10: Do you have any concerns regarding this option?
Dr. Beatty: One issue is that “often” is quite subjective. If it happened once a month for
12 months, would that be often? Also, I’m not sure the wording captures the full intensity
of craving if you are really trying to capture urges so strong that they “make it difficult to
think of anything else.” You could consider something like “have an urge to use [ ] that
was so strong, it was difficult for you to think of anything else?” On the other hand, such
wording is more complicated, and might be setting the threshold higher than is needed.
Dr. Willis: The DSM appears to be concerned with intensity, rather than frequency, of the
use of ‘often’ doesn’t seem right, so I don’t favor Option A.
DRMJ23 Option B.
During the past 12 months, did you often have a strong desire or overwhelming urge to
use marijuana or hashish?
Question 11: How well does this capture the general definition of craving? Given the
addition of the word “overwhelming,” does the word “often” make this option too
stringent? If so, would you suggest dropping the word “often” altogether, or replacing
it with “ever”?
Dr. Beatty: Again, I’m concerned about the inherent subjectivity of “often.” The word
“overwhelming” seems to get at the intensity reasonably well, although it would
be useful to test it.
Dr. Willis: Again, as the DSM doesn’t include ‘often’, or frequency generally, I would
delete ‘often.’
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Question 12: Do you have any concerns or suggestions regarding this option?
Dr. Willis: The inclusion of strong design matches the DSM—the addition of ‘desire’
makes sense, but is described in DSM as ‘strong’ rather than ‘overwhelming’—so
Option B still doesn’t seem too good a match.
DRMJ23 Option C. This would be two-part question. If A is yes, B is not asked. If the
respondent answers yes to A or B, then the withdrawal criterion is met:
A. During the past 12 months, did you want marijuana or hashish so badly you
couldn't think of anything else?
B. During the past 12 months, did you have a strong desire or overwhelming urge to
use marijuana or hashish?
Question13: This question takes a slightly different approach, breaking the question
into two parts. If a respondent indicated yes to either option, then they would be
considered to have met the craving criteria. What do you think about this variation?
Dr. Beatty: I think the 2-pronged approach is interesting and might help to tease out the
level of intensity. However, if you only want to know whether either of these apply, then
it seems unnecessary—you could simply ask the “B” question. The only reason you
would ask them as presented is if you assumed a sort of “contrast effect,” i.e.
respondents are willing to endorse “B” after rejecting “A” as too strong. But as a general
principle of questionnaire design, I would probably put the questions in a different order:
first asking about a strong urge, and then asking the respondent whether it was
overwhelmingly strong. As currently presented, I’d be concerned that having answered
no to the first part, they would be unlikely to indicate that they had an “overwhelming”
urge, just not so overwhelming as in the previous question.
Dr. Willis: I like breaking up complex concepts, so this variation seems good.
Question 14: Do you have any other concerns or suggestions regarding this option?
Dr. Beatty: The absence of any guidance on frequency (often, ever?) could make this
difficult. It’s unclear whether you’re asking if this was a constant problem, or
whether this happened at least once.
Dr. Willis: The implied reference period still seems pretty unspecified – do we mean all
the time, just once…? I interpret the intention to mean something less than
continuously over the whole year – maybe better to specify this as a ‘time’ or
‘period.’ So, consider changes to wording:
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DSM‐5 Review Packet
A. During the past 12 months, was there ever a time when you wanted marijuana or
hashish so much that you couldn’t think of anything else?
IF YES -> SKIP B
IF NO, ASK B
B. During the past 12 months, was there ever a time when you had a strong desire or
strong urge to use marijuana or hashish?
Finally, another way to think about this is to conclude that the DSM-5 is itself
inconsistent, in having two definitions having different intensity criteria. It might make
sense to go with the more stringent one, and rely only on Part A—that is, to retain the
‘couldn’t think of anything else’ element as defining craving. Avoiding the definition
incorporated into Part B is attractive because that is such a vague metric (seems like
something intended for a therapist to make a judgment call on—not really amenable to
a self-report national survey).
Question 15: Which of these three options (or combination of options) does the best
job of assessing craving as intended by the DSM-5 among the NSDUH target
population of respondents aged 12 or older?
Dr. Beatty: A two-question approach would make it possible to distinguish between
strong and overwhelming cravings—if that’s a useful distinction, then two questions
would probably be the best way to go about it. If you’re really only concerned about
capturing “strong desire” then I think you could probably just ask that in a
straightforward way.
Dr. Willis: C, in some form.
Question 16: Do you have any other comments or suggestions regarding the
assessment of craving?
Dr. Beatty: As with other comments, my reactions are pretty speculative. It would be
really useful to test alternate versions and evaluate how people actually interpret and
answer them.
END
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DSM‐5 Review Packet
Spanish Language Review
Cannabis Use Disorder Assessment
DRMJ [IF MAR12MON = 1 - 3] Piense en su uso de marihuana o hachís en los últimos
12 meses, al responder las siguientes preguntas.
DRMJ01
[IF MAR12MON = 1 - 3] En los últimos 12 meses, ¿hubo un mes o más en
que usted dedicó mucho tiempo para conseguir o usar marihuana o hachís?
DRMJ02
[IF DRMJ01 = 2 OR DK/REF] En los últimos 12 meses, ¿hubo un mes o
más en que usted pasó mucho tiempo recuperándose de los efectos de la marihuana o
hachís que había usado?
DRMJ04
[IF MAR12MON = 1 - 3] En los últimos 12 meses, ¿trató de ponerse
límites en la frecuencia o cantidad de marihuana o hachís que usaría?
DRMJ05
[IF DRMJ04 = 1] ¿Logró mantener los límites que estableció, o usó con
frecuencia más marihuana o hachís de lo que había planeado?
1
Por lo general mantuvo los límites establecidos
2
Por lo general usó más de lo planeado
DRMJ06
[IF MAR12MON = 1 - 3] En los últimos 12 meses, ¿tuvo que usar más
marihuana o hachís de lo que acostumbraba usar, para poder conseguir el efecto que
deseaba?
DRMJ07
[IF DRMJ06 = 2 OR DK/REF] En los últimos 12 meses, ¿notó que usar la
misma cantidad de marihuana o hachís le causaba menos efecto que antes?
DRMJ08
[IF MAR12MON = 1 - 3] En los últimos 12 meses, ¿quiso o trató de usar
menos marihuana o hachís o de dejar de usarlo?
Dr. Canino: , ¿ quiso o trató de usar menos o dejó de usar marihuana o hachís?
This is a better translation, easier to understand and is consistent with the translation
your people did for DRMJ10.
DRMJ09
[IF DRMJ08 = 1] En los últimos 12 meses, ¿logró usar menos marihuana
o hachís o dejar de usarlo todas las veces que quiso o trató de hacerlo?
Dr. Canino: I know this is not one of the items you wanted me to review. However, if you
notice, the next question is worded the same way I changed this one which is a better
translation and more easily understood. I suggest you change it.
En los últimos 12 meses, ¿logró usar menos o dejó de usar marihuana o hachís todas
las veces que quiso o trató de hacerlo?
DRMJ10
[IF DRMJC08 = 2 OR DK/REF OR DRMJC09 = 2 OR DK/REF] En los
últimos 12 meses, ¿usó menos o dejó de usar marihuana o hachís por lo menos una
vez?
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DSM‐5 Review Packet
The following set of items (DRMJ10 – DRMJXX) assesses the DSM-5 criteria for
withdrawal, some of the questions have been revised and some are new. We
would appreciate your feedback regarding these items.
The DSM-5 defines cannabis withdrawal as a person who endorses either Part 1
(both A and B) or Part 2 of the following:
Part 1. (assessed by items DRMJ10 – DRMJ11b)
• Criterion A: Cessation of cannabis use that has been heavy and prolonged
(i.e., usually daily or almost daily use of a period of at least a few months)
• Criterion B: 3 or more of the physical symptoms develop within approximately
1 week after Criterion A
1. Irritability, anger, or aggression
2. Nervousness or anxiety
3. Sleep difficulty (e.g. insomnia or disturbing dreams)
4. Decreased appetite or weight loss
5. Restlessness
6. Depressed mood
7. At least one of the following physical symptoms causing significant discomfort:
abdominal pain, shakiness/tremors, sweating, fever, chills, or headache
Part 2. (assessed by DRMJXX)
Cannabis (or a closely related substance) is taken to relieve or avoid withdrawal
symptoms.
DSM-5 Withdrawal Criteria Part 1:
DRMJ11a
[IF DRMJ09 = 1 OR DRMJ10 = 1] Por favor mire la siguiente lista de síntomas. En los
últimos 12 meses, ¿tuvo alguno de estos síntomas después de usar menos o dejar de usar
marihuana o hachís?
• Dolor de estómago
• Agitación o temblores en el cuerpo
• Sudor
• Fiebre
• Escalofríos
• Dolor de cabeza
1
Sí
2
No
DK/REF
DRMJ11b
[IF DRMJ0 = 1 OR DRMJ10 = 1] En los últimos 12 meses, ¿tuvo [IF DRMJ11a = 1 then
fill 2, IF DRMJ11a = 2, DK/REF then fill 3] o más de estos síntomas después que usó
menos o dejó de usar marihuana o hachís?
• Se sintió irritable o molesto
• Se sintió ansioso
• Tuvo problemas para dormir
• Perdió el apetito o bajó de peso sin tratar de hacerlo
• Se sintió inquieto
• Se sintió deprimido
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DSM‐5 Review Packet
1
Sí
2
No
DK/REF
English Versions
DRMJ11a
[IF DRMJ09 = 1 OR DRMJ10 = 1] Please look at the symptoms listed below. During the
past 12 months, did you have any of these symptoms after you cut down or stopped using
marijuana or hashish?
• Stomach ache
• Shaking or tremors
• Sweating
• Fever
• Chills
• Headache
1
Yes
2
No
DK/REF
DRMJ11b
[IF DRMJ09 = 1 OR DRMJ10 = 1] During the past 12 months, did you have [IF
DRMJ11a = 1 then fill 2, IF DRMJ11a = 2, DK/REF then fill 3] or more of these
symptoms after you cut down or stopped using marijuana or hashish?
• Feeling irritable or angry
• Feeling anxious
• Having trouble sleeping
• Losing your appetite or losing weight without trying to
• Feeling like you couldn’t sit still
• Feeling depressed
1
Yes
2
No
DK/REF
Question 1: Items 11a and 11b do not specify that the marijuana withdrawal
symptoms develop within a week of cessation. The main consideration is that the
symptoms are linked to the cutting down or stopping the use of the substance rather
than the specific time period. Does the current question adequately capture this
intent?
If not, consider that the DSM-5 text for withdrawal criterion B differs for several of the
substances regarding the time of onset for withdrawal symptoms.
Specifically:
Alcohol – Symptoms develop within several hours to a few days.
Marijuana – Symptoms develop within one week.
Opioids – Symptoms develop within minutes to several days.
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DSM‐5 Review Packet
Sedatives/Hypnotics/Anxiolytics – Symptoms develop within several hours to a few
days.
Stimulants – Symptoms develop within a few hours to several days.
Since none of the NSDUH withdrawal questions (for any substance) specify the time
of onset for withdrawal symptoms, any changes would need to be made across all the
modules. Do you have any suggestions for incorporating this information into the
items?
Dr. Algeria: See the following changes also consider asking age of first symptoms.
DRMJ11a
[IF DRMJ09 = 1 OR DRMJ10 = 1] Por favor mire la siguiente lista de
síntomas. Quisiera que pensara ahora en los últimos doce meses. ¿Tuvo
alguno de estos síntomas a la semana de dejar de usar o reducir el uso
de marihuana o hachís?
• Dolor de estómago
• Agitación o temblores en el cuerpo
• Sudor
• Fiebre
• Escalofríos
• Dolor de cabeza
1
Sí
2
No
DK/REF
DRMJ11b
[IF DRMJ09 = 1 OR DRMJ10 = 1] Volvamos hablar sobre los últimos 12
meses. ¿Tuvo [IF DRMJ11a = 1 then fill 2, IF DRMJ11a = 2, DK/REF then
fill 3] o más de estos síntomas a la semana de dejar de usar o reducir su
uso de marihuana o hachís?
• Se sintió irritable o molesto
• Se sintió ansioso
• Tuvo problemas para dormir
• Perdió el apetito o bajó de peso cuando no trataba de hacerlo
• Se sintió inquieto
• Se sintió deprimido
1
Sí
2
No
DK/REF
Dr. Canino: The questions certainly address the main consideration of the symptoms
occurring after cutting down or stopping use of the drug. However, if you want to add
the time element, the alternative you have is to have another question asked to those
who said yes to question 11 a and 11 b. The question would inquire whether the
symptoms endorsed occurred within approximately one week (this would have to
change according to the drug) after cessation or cutting down of the drug. I do not think
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you need age of onset since criterion B states that the symptoms should start (one
week, or whatever time frame depending on drug) after cessation or cutting down of the
drug independent on when was the first time they tried to stop or diminish the use of the
drug.
Question 2: Does the current wording of 11a and 11b adequately capture the
symptoms described in the DSM-5?
Dr. Algeria: Yes, with the added modifications.
Dr. Canino: Almost all, nervousness and aggression were left out.
DRMJ11b [IF DRMJ09 = 1 OR DRMJ10 = 1] En los últimos 12 meses, ¿tuvo [IF
DRMJ11a = 1 then fill 2, IF DRMJ11a = 2, DK/REF then fill 3] o más de
estos síntomas después que usó menos o dejó de usar marihuana o
hachís?
• Se sintió irritable o molesto/a (enojado/a)
• Se sintió ansioso/a o nervioso/a
• Tuvo problemas para dormir
• Perdió el apetito o bajó de peso sin tratar de hacerlo
• Se sintió inquieto/a
• Se sintió deprimido/a
1
Sí
2
No
DK/REF
Also Molesto is usually used for upset, but not for angry. A better translation for angry
would be enojado/a which would be understood for most Latino groups. In Spanish you
have masculine (o) and feminine (a) so every time you use an adjective referring to a
person you have to put a slash and an “a” or an “o” if the word before was feminine.
Question 3: Do you have any additional concerns or suggestions regarding items
DRMJ11a and11b?
No additional feedback
DSM-5 Withdrawal Criteria Part 2:
[Cannabis or a closely related substance is taken to relieve or avoid withdrawal
symptoms]
Note: This is a new item for almost all substances and there is variation in the wording
based upon prior survey skip pattern responses, therefore we have provided two sets
of the questions.
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DSM‐5 Review Packet
For alcohol, marijuana, heroin, prescription sedatives and tranquilizers, and
prescription pain relievers, there are two versions of this question. We present
the marijuana version as an example. The ‘similar substance’ list is customized
for each question but always ends with ‘or any illegal substance.’
DRMJXXa: [This version is asked if respondents endorsed withdrawal symptoms]
[IF DRMJ11a = 1 OR DRMJ11b = 1] Usted acaba de mencionar que tuvo síntomas después de usar
menos o dejar de usar marihuana o hachís. En los últimos 12 meses, ¿usó marihuana
o hachís otra vez, o alguna sustancia ilícita para evitar o superar estos síntomas?
1
Sí
2
No
DK/REF
Presione F2 para ver estos síntomas otra vez
English version
DRMJXXa
[IF DRMJ11a = 1 OR DRMJ11b = 1] You just mentioned that you had symptoms after
you cut down or stopped using marijuana or hashish. During the past 12 months, did
you use marijuana or hashish again, or any illegal substance to avoid or get over these
symptoms?
DRMJXXb: [This version is asked if the respondents does not report withdrawal
symptoms]
DRMJXXb: [IF (DRMJ11a = 2 OR DK/REF) AND (DRMJ11b = 2 OR DK/REF)] Después que usted
usó menos o dejó de usar marihuana o hachís en los últimos 12 meses, ¿usó
marihuana o hachís otra vez, o alguna sustancia ilícita para evitar estos síntomas?
1
Sí
2
No
DK/REF
Presione F2 para ver estos síntomas otra vez
English version
DRMJXXb: [IF (DRMJ11a = 2 OR DK/REF) AND (DRMJ11b = 2 OR DK/REF)] After you cut
down or stopped using marijuana or hashish during the past 12 months, did you use
marijuana or hashish again, or any illegal substance to avoid these symptoms?
For stimulant-type substances, respondents are asked if they experienced
dysphoric mood symptoms, which are a required part of stimulant withdrawal.
If they say no to this criterion then they are skipped out of the other withdrawal
questions. Therefore, there are 3 versions for stimulant-type substances.
Cocaine/Crack version A: [This version is asked if the respondents reports
dysphoric mood and other withdrawal symptoms]
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DSM‐5 Review Packet
DRCCXXa
[IF DRCC11 = 1] Usted acaba de mencionar que tuvo síntomas después de usar menos
o dejar de usar [COKEFILL]*. En los últimos 12 meses, ¿usó usted cocaína o
“crack”, metanfetamina, estimulantes que normalmente se venden con una receta
médica o alguna sustancia ilícita para evitar o superar estos síntomas?
1
Sí
2
No
DK/REF
Presione F2 para ver los síntomas otra vez
* [COKEFILL] is placeholder for the form of cocaine a respondent reported using earlier in the survey.
English version:
DRCCXXa
[IF DRCC11 = 1] You just mentioned that you had symptoms after you cut down or
stopped using [COKEFILL]. During the past 12 months, did you use cocaine or crack
again, methamphetamine, prescription stimulants, or any illegal substance to avoid or
get over these symptoms?
Cocaine/Crack version B: [This version is asked if the respondent reports dysphoric
mood but no other withdrawal symptoms]
DRCCXXb: [IF DRCC11 = 2 OR DK/REF] Esta pregunta es también acerca de las
ocasiones en los últimos 12 meses después que usted usó menos o dejó de usar
[COKEFILL].
Durante alguna de esas ocasiones, ¿usó [COKEFILL] otra vez, metanfetamina,
estimulantes que normalmente se venden con una receta médica o alguna sustancia
ilícita para evitar esos síntomas?
1
Sí
2
No
DK/REF
Presione F2 para ver estos síntomas otra vez
English version:
DRCCXXb:
[IF DRCC11 = 2 OR DK/REF] This question is also about the times during the past 12
months after you cut down or stopped using [COKEFILL].
During any of those times, did you use [COKEFILL] again, methamphetamine,
prescription stimulants, or any illegal substance to avoid these symptoms?
Cocaine/Crack version C: [This version is asked if the respondent does not report
dysphoric mood symptoms]
DRCCXXc: [IF DRCC10a = 2] Esta pregunta es también acerca de las ocasiones en los últimos 12 meses
después que usted usó menos o dejó de usar [COKEFILL].
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DSM‐5 Review Packet
Durante alguna de esas ocasiones, ¿usó [COKEFILL] otra vez, metanfetamina, estimulantes que
normalmente se venden con una receta médica o alguna sustancia ilícita para evitar sentirse
deprimido o decaído?
1
Sí
2
No
DK/REF
English version:
DRCCXXc:
[IF DRCC10a = 2] This question is also about the times during the past 12 months after
you cut down or stopped using [COKEFILL].
During any of those times, did you use [COKEFILL] again, methamphetamine,
prescription stimulants, or any illegal substance to avoid feeling blue or down?
Question 4: How well do you think these items capture the intent of DSM-5
withdrawal criteria, part 2?
Dr. Algeria: Well, with the following modifications:
DRMJXXa:
[IF DRMJ11a = 1 OR DRMJ11b = 1] Usted acaba de mencionar que tuvo síntomas
después de dejar de usar o reducir el uso de marihuana o hachís. En los
últimos 12 meses, ¿volvió a usar marihuana o hachís o alguna sustancia
ilícita para no tener estos síntomas?
1
Sí
2
No
DK/REF
Presione F2 para ver estos síntomas otra vez
DRMJXXb: [IF (DRMJ11a = 2 OR DK/REF) AND (DRMJ11b = 2 OR DK/REF)]
Volvamos hablar sobre los últimos doce meses. Después que dejó de
usar o redujo el uso de marihuana o hachís, usó marihuana o hachís
otra vez, o alguna sustancia ilícita para no tener estos síntomas?
1
Sí
2
No
DK/REF
Presione F2 para ver estos síntomas otra vez
Question 5: Do you have any concerns about how Spanish-speaking respondents
will interpret any of these items?
Dr. Algeria: No, but you have to separate the time frames so that respondents can focus
on the questions. Remind them of the time frame and then ask the question.
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DSM‐5 Review Packet
Dr. Canino: If you want a translation of “”get over”” superar is not the best one, it would
be “recuperarse de””. However, I think that the criterion is to relieve not get over, in
which case the translation would be “”mejorarse de””
Question 6: Do you have any other comments or suggestions regarding the
assessment of withdrawal in general and cannabis withdrawal in particular?
No additional feedback.
DRMJ13
[IF MAR12MON = 1 - 3] En los últimos 12 meses, ¿tuvo algún problema
emocional, de nervios o de la salud mental que quizá haya sido causado o empeorado
por usar marihuana o hachís?
Dr. Canino: En los últimos 12 meses, ¿tuvo algún problema emocional, de nervios o de
salud mental que pudo haber sido causado o empeorado por usar marihuana o hachís?
DRMJ14
[IF DRMJ13 = 1] ¿Continuó usando marihuana o hachís aún cuando
pensaba que le estaba causando problemas emocionales, de nervios o de la salud
mental?
Dr. Canino: ¿Continuó usando marihuana o hachís aún cuando pensaba que le estaba
causando problemas emocionales, de nervios o de salud mental?
DRMJ15
[IF DRMJ13 = 2 OR DK/REF OR DRMJ14 = 2 OR DK/REF] En los últimos
12 meses, ¿tuvo algún problema de salud física que quizá haya sido causado o
empeorado por usar marihuana o hachís?
Dr. Canino: En los últimos 12 meses, ¿tuvo algún problema de salud física que pudo
haber sido causado o empeorado por usar marihuana o hachís?
DRMJ16
[IF DRMJ15 = 1] ¿Continuó usando marihuana o hachís aún cuando
pensaba que le estaba causando problemas de salud física?
DRMJ17
[IF MAR12MON = 1 - 3] Esta pregunta se trata de actividades importantes
como trabajar, ir a estudiar, cuidar niños o hacer cosas divertidas como pasatiempos,
jugar deportes y pasar tiempo con los amigos y la familia.
En los últimos 12 meses, ¿el usar marihuana o hachís le hizo abandonar o
dedicar menos tiempo a hacer estos tipos de actividades importantes?.
Dr. Canino: Esta pregunta se trata de actividades importantes como trabajar, estudiar,
cuidar niños o hacer cosas divertidas como pasatiempos, jugar deportes y pasar tiempo
con los amigos y la familia.
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DSM‐5 Review Packet
DRMJ18
[IF MAR12MON = 1 - 3] A veces las personas que usan marihuana o
hachís tienen problemas serios en su hogar, en el trabajo o en la escuela, como:
- descuidar de sus hijos
- faltar al trabajo o a la escuela
- desempeñarse mal en el trabajo o en los estudios
- perder su trabajo o abandonar los estudios
En los últimos 12 meses, ¿su uso de marihuana o hachís le causó problemas serios
como esos en su hogar, en el trabajo o en la escuela?
Dr. Canino: A veces las personas que usan marihuana o hachís tienen problemas
serios en su hogar, en el trabajo o en la escuela, tales como:
- descuidar de sus hijos
- faltar al trabajo o a la escuela
- desempeñarse mal en el trabajo o en los estudios
- perder su trabajo o abandonar los estudios
En los últimos 12 meses, ¿su uso de marihuana o hachís, ¿ le causó problemas
serios como esos en su hogar, en el trabajo o en la escuela?
DRMJ19
[IF MAR12MON = 1 - 3] En los últimos 12 meses, ¿usaba marihuana o
hachís en forma regular y luego hacía algo que lo hubiera expuesto al peligro físico
porque estaba usando marihuana o hachís?
Dr. Canino: En los últimos 12 meses, ¿usaba marihuana o hachís en forma regular y
luego hacía algo que lo hubiera expuesto a algún peligro físico porque estaba usando
marihuana o hachís?
DRMJ20
[IF MAR12MON = 1 - 3] En los últimos 12 meses, ¿el usar marihuana o
hachís le causó hacer cosas que lo metieron en problemas con la ley una y otra vez?
DRMJ21
[IF MAR12MON = 1 - 3] En los últimos 12 meses, ¿tuvo algún problema
con la familia o los amigos que probablemente fue causado por su uso de marihuana o
hachís?
DRMJ22
[IF DRMJ21 = 1] ¿Continuó usando marihuana o hachís aún cuando
usted pensaba que le causaba problemas con la familia o los amigos?
Craving
The DSM-5 has added an additional criterion for substance use disorder diagnosis,
called “craving”. Three options (the third option contains two parts) are presented
below for assessing the new DSM-5 craving criterion. The DSM-5 describes craving
in two ways. First, the DSM-5 defines craving as “a strong desire or urge to use
A-36
DSM‐5 Review Packet
alcohol.” Additionally, the DSM-5 explains craving as “indicated by a strong desire to
[use substance] that makes it difficult to think of anything else and that often results in
the onset of [substance use]. This is a new criterion applicable to all substances,
therefore these items would be asked of all past year users for all substances.
DRMJ23. This is a two-part question. If A is yes, B is not asked. If the respondent
answers yes to A or B, then the withdrawal criterion is met:
DRMJ23a En los últimos 12 meses, ¿hubo alguna ocasión cuando usted tenía tantas ganas de usar
marihuana o hachís que no podía pensar en nada más?
1
Sí
2
No
DK/REF
Dr. Canino: It is more colloquial to say “” hubo alguna vez instead of ocasion
DRMJ23b [IF DRMJ23a = 2, DK/REF] En los últimos 12 meses, ¿hubo alguna ocasión cuando usted
tuvo un fuerte deseo o urgencia de usar marihuana o hachís?
1
Sí
2
No
DK/REF
Dr. Canino: Could also be: ¿hubo alguna ocasión cuando usted tuvo un deseo fuerte o
un deseo apremiante de usar marihuana o hachis?
English versions:
DRMJ23a During the past 12 months, was there ever a time when you wanted to use marijuana or
hashish so much that you couldn’t think of anything else?
DRMJ23b [IF DRMJ23a = 2, DK/REF] During the past 12 months, was there ever a time when you had
a strong desire or urge to use marijuana or hashish?
Question 7: Prior cognitive testing of the English language versions of these items
noted that craving assessment is very sensitive to wording (i.e. individuals may
change their endorsement of these questions when the question has only slight
wording differences). Do you have any concerns regarding the wording or
interpretation of these questions for Spanish speaking respondents?
Dr. Algeria: See the following modifications
DRMJ23a Alguna vez eEn los últimos 12 meses, ¿hubo alguna ocasión cuando usted
tuvoenía tantas ganas de usar marihuana o hachís que no podía pensar en nada más?
1
Sí
2
No
DK/REF
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DSM‐5 Review Packet
DRMJ23b [IF DRMJ23a = 2, DK/REF] Alguna vez eEn los últimos 12 meses, ¿hubo
alguna ocasión cuando usted tuvo un fuerte deseo o necesidad urgencia de usar
marihuana o hachís?
1
Sí
2
No
DK/REF
Dr. Canino: I think these are good translations. However, the ideal would be that you
pilot these two items. I thought a lot about the translation of the word urge which was
translated as “”urgencia””. I thought about “deseo apremiante”” which is a better
translation but I truly think you should try this item out and the other translation I offered
which captures better the intent of the question. A proper translation of the word urge is
crucial for this item because it is the translation of the crux of the criterion. Given the
importance of this item, I would try both translations with some subjects, do cognitive
debriefing.
Question 8: How well do these questions assess craving as intended by the DSM-5,
considering the NSDUH target population of respondents aged 12 or older?
Dr. Canino: The English items do measure the criterion of craving. Not sure about the
Spanish translation
Question 9: Do you have any other comments or suggestions regarding the
assessment of craving?
No further feedback.
END
A-38
Appendix B: DSM-5 Cognitive Testing R3 Protocol
National Survey on Drug Use and Health:
DSM-5 Cognitive Testing Round 3 Protocol
CASEID
__ ‐ __ __ __ ‐ __ __ __
DATE: __ __ / __ __ / __ __ __ __
INTERVIEWER: ______________________________________
Introduction
[PROVIDE INFORMED CONSENT TO PARTICIPANTS AND TO PARENTS OR
GUARDIANS, IF APPLICABLE]
[IF OBSERVERS ARE PRESENT, MENTION HOW MANY OBSERVERS AND
WHETHER THEY ARE FROM RTI OR SAMHSA]
Thank you for participating in our study. In the first half of the interview, I will show you
how to use our project laptop and you will enter your answers to questions about use of
alcohol and certain drugs into the computer. Although normally you would listen to the
questions privately using headphones, for the purpose of this study the questions will be
read out loud by the computer. Before you enter your response into the computer, please
tell me your answer out loud so that I can follow along.
After you complete the first half of the interview, you will receive a notice asking you to
enter a 3-letter code, which I will give you, to continue.
The second half of the interview will work a little differently. After some of the survey
questions, I will ask you follow-up questions about the question. For example, I might
ask “Can you tell me in your own words what this question is asking” or “How did you
come up with your answer to that question?” There are no right or wrong answers to the
questions I ask. My main goal is to make sure that the questions make sense and that
people can answer them easily. You can help me by pointing out anything you find
confusing or unclear. If something doesn’t make sense, tell me that. Or if you’re not sure
about your response, tell me that too. When we’re done you’ll receive $40 as a token of
our appreciation.
I’ll provide reminders about this, but as you answer the rest of the questions, please do
not mention your name, anyone else's name, or anything that might identify another
person. If you do talk about another person, you can say things like “somebody I know,”
or “this person.” Do not say things like, “my mom,” or “my friend Joe.”
READ FOR ADOLESCENTS ONLY: If you name an adult that has provided you with
any drugs or non-prescribed medications, I, or my supervisors may need to report it to the
B-1
agency in this state that investigates abuse. Once we make a report, we have no control
over what will be done with the information.
Do you have any questions? ANSWER ANY QUESTIONS. HAVE R COMPLETE THE
DRUG SCREENING MODULES
Substance Dependence and Abuse
THE RESPONDENT SHOULD ALERT YOU WHEN HE OR SHE HAS COMPLETED
THE DRUG SCREENING MODULES. AT THIS POINT READ THIS
INTRODUCION:
As I mentioned before, this next section will work a little differently. After some of the
survey questions, I will ask you follow-up questions. For this section, you can either read
the questions out loud or let the computer read them for you. Either choice is fine. Would
you rather read the questions out loud yourself or listen to the computer voice?
[IF R WANTS TO READ: For each of the questions, please read the question aloud and
then tell me your answer. You do not have to read all of the answer categories aloud.]
[IF SPEAKERS: Just as a reminder, before entering your response into the computer, tell
me your answer out loud so that I can follow along.]
As you are answering this next set of questions, feel free to think aloud and tell me
anything that comes to mind as you answer these questions. This helps us determine if
everyone understands our questions in the same way. After some of the questions, I will
stop you and ask you some follow up questions such as “Can you tell me in your own
words what this question is asking?” You don’t have to repeat the question word for
word, I just want to know what it meant to you.
There are no right or wrong answers to the questions I ask. Our main goal is to make
sure that the questions make sense and that people can answer them easily. My job is to
take a lot of notes and to figure out how potential respondents think about these
questions.
GIVE R 3-DIGIT CODE TO CONTINUE.
B-2
ALCOHOL
DRALC10
[IF DRALC08 = 2 OR DK/REF OR DRALC09 = 2 OR DK/REF] During
the past 12 months, did you cut down or stop drinking at least one time?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
P_AL01
You answered [Yes/No]. How did you come up with your answer to this
question? [IF ANSWERED YES, PROBE FOR HOW LONG THEY CUT
DOWN IF NOT MENTIONED]
P_AL02
What does “cut down or stop drinking” mean to you as it’s used in this
question? [IF NEEDED: What came to mind?]
P_AL03
[IF ANSWERED NO] Was there at least one time in the past 12 months
that you cut down or stopped because you had to work, could not get a
hold of any, were in rehab or some other reason? [IF YES TO PROBE:
Can you tell me why you didn’t consider that to be cutting down or
stopping when you answered this question?]
P_AL04
[NOTE WHETHER R DID GO WITHOUT SUBSTANCE. IF SO,
INSTRUCT R TO RESPOND ‘YES’ TO THIS QUESTION.]
B-3
DRALC11
[IF DRALC09 = 1 OR DRALC10 = 1] Please look at the symptoms listed
below. During the past 12 months, did you have 2 or more of these
symptoms after you cut down or stopped drinking alcohol?
•
•
•
•
•
•
•
•
Sweating or feeling that your heart was beating fast
Having your hands tremble
Having trouble sleeping
Vomiting or feeling nauseous
Seeing, hearing, or feeling things that weren’t really there
Feeling like you couldn’t sit still
Feeling anxious
Having seizures or fits
1
Yes
2
No
DK/REF
DRALCX1
[IF DRALC11=1] You just mentioned that you had symptoms after you
cut down or stopped drinking alcohol. Did you drink alcohol again, use
prescription sedatives or tranquilizers, or any illegal substance to avoid or
get over these symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Press F2 to see these symptoms again
P_AL13
You answered [yes/no]. How did you come up with your answer to this
question? [IF YES: In what way did drinking again or using another drug
help you avoid or get over your symptoms?]
P_AL14
IF YES: What did you use to avoid or get over these symptoms? [IF
NEEDED: Was it alcohol, prescription sedatives, tranquilizers, or
something else? PROBE FOR SPECIFIC SUBSTANCE.]
B-4
P_AL15
What time period were you thinking about when you answered this
question? [IF NOT 12 MONTHS: If this question had said, “During the
past 12 months,” would you have answered differently? How so?]
P_AL16
What symptoms were you thinking of when you read (or heard) this
question? [IF F2 NOT PRESSED: ] Did you notice the instruction to Press
F2 to see the symptoms? Is that instruction ok or would you prefer to see
the symptoms listed on the screen?
DRALCX2
[IF DRALC11=2 OR DK/REF] After you cut down or stopped drinking
alcohol, did you drink alcohol again, use prescription sedatives or
tranquilizers, or any illegal substance to prevent these symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Press F2 to see these symptoms again
P_AL17
In your own words, what is this question asking?
P_AL18
IF YES: How did you come up with your answer to this question? In what
way did drinking again or using another drug help you prevent these
symptoms?
B-5
P_AL19
IF YES: What did you use to prevent these symptoms? [IF NEEDED: Was
it alcohol, sedatives, tranquilizers, or something else? PROBE FOR
SPECIFIC SUBSTANCE.]
P_AL20
What time period were you thinking about when you answered this
question? [IF NOT 12 MONTHS: If this question had said, “During the
past 12 months,” would you have answered differently? How so?]
P_ AL21
What symptoms were you thinking of when you read (or heard) this
question? [IF F2 NOT PRESSED: ] Did you notice the instruction to Press
F2 to see the symptoms? Is that instruction ok or would you prefer to see
the symptoms listed on the screen?
DRALC23a During the past 12 months, was there ever a time when you wanted to drink
alcohol so much that you couldn’t think of anything else?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
P_AL22
Can you tell me in your own words what this question is asking?
P_AL23
You answered [Yes/No]. How did you come up with your answer to this
question?
B-6
DRALC23b [If DRALC23a=2, DK/REF] During the past 12 months, was there ever a
time when you had a strong urge to drink alcohol?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
P_AL24
You answered [Yes/No]. How did you come up with your answer to this
question?
P_AL25
What does the phrase “strong urge to drink alcohol” mean to you as it’s
used in this question?
P_AL26
If I asked, “During the past 12 months, was there ever a time when you
had a strong desire or urge to drink alcohol?” would you have answered
differently? How so?
MARIJUANA
DRMJ10
[IF DRMJC08 = 2 OR DK/REF OR DRMJC09 = 2 OR DK/REF] During
the past 12 months, did you cut down or stop using marijuana or hashish
at least one time?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
P_MJ01
You answered [Yes/No]. How did you come up with your answer to this
question? [IF ANSWERED YES, PROBE FOR HOW LONG THEY CUT
DOWN IF NOT MENTIONED]
B-7
P_MJ02
What does “cut down or stop using” mean to you as it’s used in this
question? [IF NEEDED: What came to mind?]
P_MJ03
[IF ANSWERED NO] Was there at least one time in the past 12 months
that you cut down or stopped because you had to work, could not get a
hold of any, were in rehab or some other reason? [IF YES TO PROBE:
Can you tell me why you didn’t consider that to be cutting down or
stopping when you answered this question?]
P_MJ04
[NOTE WHETHER R DID GO WITOUT SUBSTANCE. IF SO,
INSTRUCT R TO RESPOND ‘YES’ TO THIS QUESTION]
DRMJ11a
[IF DRMJ09=1 OR DRMJ10=1] Please look at the symptoms listed
below. During the past 12 months, did you have any of these symptoms
after you cut down or stopped using marijuana or hashish?
Stomach ache
Shaking or tremors
Sweating
Fever
Chills
Headache
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
P_MJ05
You answered [Yes/No]. How did you come up with your answer to this
question?
B-8
P_MJ06
[IF YES:] Did you get these symptoms as a result of cutting down or
stopping or do you think it was unrelated?
P_MJ07
[IF YES] How soon after stopping or cutting back did you get these
symptoms? [Within a day, a week, a month?]
P_MJ08
Do you consider these symptoms to be withdrawal symptoms or
something else? How so?
DRMJ11b
[IF DRMJ09=1 OR DRMJ10=1] During the past 12 months, did you have
[IF DRMJ11a=1 then fill 2, IF DRMJ11a=2, DK/REF then fill 3] or more
of these symptoms after you cut down or stopped using marijuana or
hashish?
Feeling irritable or angry
Feeling anxious or nervous
Having trouble sleeping
Losing your appetite or losing weight without trying to
Feeling like you couldn’t sit still
Feeling depressed
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
P_MJ09
You answered [Yes/No]. How did you come up with your answer to this
question? [VERIFY NUMBER OF SYMPTOMS.]
B-9
P_MJ10
[IF YES:] Did you get these symptoms as a result of cutting down or
stopping or do you think it was unrelated?
P_MJ11
[IF YES] How soon after stopping or cutting back did you get these
symptoms? [Within a day, a week, a month?]
P_MJ12
And for these symptoms, do you consider these symptoms to be
withdrawal symptoms or something else?
DRMJX1
[IF DRMJ11a=1 OR DRMJ11b=1] You just mentioned that you had
symptoms after you cut down or stopped using marijuana or hashish.
Did you use marijuana or hashish again, or any illegal substance to avoid
or get over these symptoms?
1
Yes
2
No
DK/REF
Press F2 to see these symptoms again.
P_MJ13
You answered [yes/no]. How did you come up with your answer to this
question? [IF YES: In what way did using marijuana/hashish again or
using another drug help you avoid or get over your symptoms?]
P_ MJ14
IF YES: What did you use to avoid or get over these symptoms? [IF
NEEDED: Was it marijuana or something else? PROBE FOR SPECIFIC
SUBSTANCE.]
B-10
P_MJ15
What time period were you thinking about when you answered this
question? [IF NOT 12 MONTHS: If this question had said, “During the
past 12 months,” would you have answered differently? How so?]
P_ MJ16
What symptoms were you thinking of when you read (or heard) this
question? [IF F2 NOT PRESSED: ] Did you notice the instruction to Press
F2 to see the symptoms? Is that instruction ok or would you prefer to see
the symptoms listed on the screen?
DRMJX2
[IF (DRMJ11a=2 OR DK/REF) AND (DRMJ11b=2 OR DK/REF)] After
you cut down or stopped using marijuana or hashish, did you use
marijuana or hashish again, or any illegal substance to prevent these
symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Press F2 to see these symptoms again.
P_MJ17
In your own words, what is this question asking?
P_MJ18
IFYES: How did you come up with your answer to this question? In what
way did using marijuana/hashish again or using another drug help you
prevent these symptoms?
B-11
P_MJ19
IF YES: What did you use to prevent these symptoms? [IF NEEDED: Was
it marijuana or something else? PROBE FOR SPECIFIC SUBSTANCE.]
P_MJ20
What time period were you thinking about when you answered this
question? [IF NOT 12 MONTHS: If this question had said, “During the
past 12 months,” would you have answered differently? How so?]
P_MJ21
What symptoms were you thinking of when you read (or heard) this
question? [IF F2 NOT PRESSED: ] Did you notice the instruction to Press
F2 to see the symptoms? Is that instruction ok or would you prefer to see
the symptoms listed on the screen?
DRMJ23a During the past 12 months, was there ever a time when you wanted to use
marijuana or hashish so much that you couldn’t think of anything else?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
P_MJ22
Can you tell me in your own words what this question is asking?
P_MJ23
You answered [Yes/No]. How did you come up with your answer to this
question?
B-12
DRMJ23b [IF DRMJ23a=2, DK/REF] During the past 12 months, was there ever a time
when you had a strong urge to use marijuana or hashish?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
P_MJ24
You answered [Yes/No]. How did you come up with your answer to this
question?
P_MJ25
What does the phrase “strong urge to use marijuana or hashish” mean to
you as it’s used in this question?
P_MJ26
If I asked, “During the past 12 months, was there ever a time when you
had a strong desire or urge to use marijuana or hashish?” would you have
answered differently? How so?
COCAINE
DRCC10 [IF DRCC8 = 2 OR DK/REF OR DRCC9 = 2 OR DK/REF] During the past
12 months, did you cut down or stop using [COKEFILL] at least one time?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
P_CC01
You answered [Yes/No]. How did you come up with your answer to this
question? [IF ANSWERED YES, PROBE FOR HOW LONG THEY CUT
DOWN IF NOT MENTIONED]
B-13
P_CC02
IF FIRST DRUG: What does “cut down or stop using” mean to you as it’s
used in this question? [IF NEEDED: What came to mind?]
P_CC03
[IF ANSWERED NO] Was there at least one time in the past 12 months
that you cut down or stopped because you had to work, could not get a
hold of any, were in rehab or some other reason? [IF YES TO PROBE:
Can you tell me why you didn’t consider that to be cutting down or
stopping when you answered this question?]
P_CC04
[IF R DID GO WITHOUT SUBSTANCE, INSTRUCT R TO RESPOND
‘YES’ TO THIS QUESTION]
DRCC10a [IF DRCC09 = 1 OR DRCC10 = 1] During the past 12 months, have you felt
kind of blue or down when you cut down or stopped using [COKEFILL]?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC10b:
[IF DRCC10a=2] This question is also about the times after you cut down
or stopped using [COKEFILL].
During any of those times, did you use cocaine or ‘crack’ again,
methamphetamine, prescription stimulants, or any illegal substance to
prevent feeling blue or down?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
B-14
P_CC17
In your own words, what is this question asking?
P_CC18
IF YES: How did you come up with your answer to this question? In what
way did using cocaine again or using another drug help you prevent these
symptoms?
P_CC19
IF YES: What did you use to prevent these symptoms? [IF NEEDED: Was
it ‘crack,’ methamphetamine, stimulants, or something else? PROBE FOR
SPECIFIC SUBSTANCE.]
P_CC20
What time period were you thinking about when you answered this
question? [IF NOT 12 MONTHS: If this question had said, “During the
past 12 months,” would you have answered differently? How so?]
DRCC11 [IF DRCC10a = 1] Please look at the symptoms listed below. During the past
12 months, did you have 2 or more of these symptoms after you cut down or
stopped using [COKEFILL]?
•
•
•
•
•
Feeling tired or exhausted
Having bad dreams
Having trouble sleeping or sleeping more than you normally do
Feeling hungry more often
Feeling either very slowed down or like you couldn’t sit still
1
Yes
2
No
DK/REF
B-15
DRCCX1
[IF DRCC11=1] You just mentioned that you had symptoms after you cut
down or stopped using [COKEFILL]. Did you use cocaine or ‘crack’
again, methamphetamine, prescription stimulants, or any illegal substance
to avoid or get over these symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Press F2 to see these symptoms again
P_CC13
You answered [yes/no]. How did you come up with your answer to this
question? [IF YES: In what way did using cocaine again or using another
drug help you avoid or get over your symptoms?]
P_ CC14
IF YES: What did you use to avoid or get over these symptoms? [IF
NEEDED: Was it [COKEFILL] or something else? PROBE FOR
SPECIFIC SUBSTANCE.]
P_ CC15
What time period were you thinking about when you answered this
question? [IF NOT 12 MONTHS: If this question had said, “During the
past 12 months,” would you have answered differently? How so?]
P_ CC16
What symptoms were you thinking of when you read (or heard) this
question? [IF F2 NOT PRESSED: ] Did you notice the instruction to Press
F2 to see the symptoms? Is that instruction ok or would you prefer to see
the symptoms listed on the screen?
B-16
DRCCX2
[IF DRCC11=2 OR DK/REF] After you cut down or stopped using
[COKEFILL], did you use cocaine or ‘crack’ again, methamphetamine,
prescription stimulants, or any illegal substance to prevent these
symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Press F2 to see these symptoms again
P_CC17
IF FIRST DRUG: In your own words, what is this question asking?
P_CC18
IF YES: How did you come up with your answer to this question? In what
way did using cocaine again or using another drug help you prevent these
symptoms?
P_CC19
IF YES: What did you use to prevent these symptoms? [IF NEEDED: Was
it ‘crack,’ methamphetamine, stimulants, or something else? PROBE FOR
SPECIFIC SUBSTANCE.]
P_CC20
What time period were you thinking about when you answered this
question? [IF NOT 12 MONTHS: If this question had said, “During the
past 12 months,” would you have answered differently? How so?]
P_CC21
What symptoms were you thinking of when you read (or heard) this
question? [IF F2 NOT PRESSED: ] Did you notice the instruction to Press
F2 to see the symptoms? Is that instruction ok or would you prefer to see
the symptoms listed on the screen?
B-17
DRCC23a
During the past 12 months, was there ever a time when you wanted to use
[COKEFILL] so much that you couldn’t think of anything else?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
P_CC22
[IF FIRST DRUG] Can you tell me in your own words what this question
is asking?
P_CC23
You answered [Yes/No]. How did you come up with your answer to this
question?
DRCC23b
[IF DRCC23a = 2, DK/REF] During the past 12 months, was there ever a
time when you had a strong urge to use [COKEFILL]?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
P_CC24
You answered [Yes/No]. How did you come up with your answer to this
question?
P_CC25
What does the phrase “strong urge to use [COKEFILL]” mean to you as
it’s used in this question?
B-18
P_CC26
If I asked, “During the past 12 months, was there ever a time when you
had a strong desire or urge to use [COKEFILL]?” would you have
answered differently? How so?
HEROIN
DRHE10 [IF DRHE08 = 2 OR DK/REF OR DRHE09 = 2 OR DK/REF] During the
past 12 months, did you cut down or stop using heroin at least one time?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
P_HE01
You answered [Yes/No]. How did you come up with your answer to this
question? [IF ANSWERED YES, PROBE FOR HOW LONG THEY CUT
DOWN IF NOT MENTIONED]
P_HE02
IF FIRST DRUG: What does “cut down or stop using” mean to you as it’s
used in this question? [IF NEEDED: What came to mind?]
P_HE03
[IF ANSWERED NO] Was there at least one time in the past 12 months
that you cut down or stopped because you had to work, could not get a
hold of any, were in rehab or some other reason? [IF YES TO PROBE:
Can you tell me why you didn’t consider that to be cutting down or
stopping when you answered this question?]
B-19
P_HE04
[IF R DID GO WITOUT SUBSTANCE, INSTRUCT R TO RESPOND
‘YES’ TO THIS QUESTION]
DRHE11 [IF DRHE09 = 1 OR DRHE10 = 1] Please look at the symptoms listed
below. During the past 12 months, did you have 3 or more of these
symptoms after you cut down or stopped using heroin?
•
•
•
•
•
•
•
•
•
Feeling kind of blue or down
Vomiting or feeling nauseous
Having cramps or muscle aches
Having teary eyes or a runny nose
Feeling sweaty, having enlarged eye pupils, or having body hair
standing up on your skin
Having diarrhea
Yawning
Having a fever
Having trouble sleeping
1
Yes
2
No
DK/REF
DRHEX1
[IF DRHE11=1] You just mentioned that you had symptoms after you cut
down or stopped using heroin. Did you use heroin again, prescription
pain relievers, or any illegal substance to avoid or get over these
symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Press F2 to see these symptoms again
P_HE13
You answered [yes/no]. How did you come up with your answer to this
question? [IF YES: In what way did using heroin again or using another
drug help you avoid or get over your symptoms?]
B-20
P_ HE14
IF YES: What did you use to avoid or get over these symptoms? [IF
NEEDED: Was it heroin or something else? PROBE FOR SPECIFIC
SUBSTANCE.]
P_ HE15
What time period were you thinking about when you answered this
question? [IF NOT 12 MONTHS: If this question had said, “During the
past 12 months,” would you have answered differently? How so?]
P_ HE16
What symptoms were you thinking of when you read (or heard) this
question? [IF F2 NOT PRESSED:] Did you notice the instruction to Press
F2 to see the symptoms? Is that instruction ok or would you prefer to see
the symptoms listed on the screen?
DRHEX2
[IF DRHE11=2 OR DK/REF] After you cut down or stopped using
heroin, did you use heroin again, prescription pain relievers, or any illegal
substance to prevent these symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Press F2 to see these symptoms again
P_HE17
IF FIRST DRUG: In your own words, what is this question asking?
P_HE18
IF YES: How did you come up with your answer to this question? In what
way did using heroin again or another drug help you prevent these
symptoms?
B-21
P_HE19
IF YES: What did you use to prevent these symptoms? [IF NEEDED: Was
it heroin or something else? PROBE FOR SPECIFIC SUBSTANCE.]
P_HE20
What time period were you thinking about when you answered this
question? [IF NOT 12 MONTHS: If this question had said, “During the
past 12 months,” would you have answered differently? How so?]
P_HE21
What symptoms were you thinking of when you read (or heard) this
question? [IF F2 NOT PRESSED:] Did you notice the instruction to Press
F2 to see the symptoms? Is that instruction ok or would you prefer to see
the symptoms listed on the screen?
DRHE23a
During the past 12 months, was there ever a time when you wanted to use
heroin so much that you couldn’t think of anything else?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
P_HE22
[IF FIRST DRUG] Can you tell me in your own words what this question
is asking?
P_HE23
You answered [Yes/No]. How did you come up with your answer to this
question?
B-22
DRHE23b [If DRHE23a = 2, DK/REF] During the past 12 months, was there ever a time
when you had a strong urge to use heroin?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
P_HE24
You answered [Yes/No]. How did you come up with your answer to this
question?
P_HE25
What does the phrase “strong urge to use heroin” mean to you as it’s used
in this question?
P_HE26
If I asked, “During the past 12 months, was there ever a time when you
had a strong desire or urge to use heroin?” would you have answered
differently? How so?
METHAMPHETAMINE
DRME10 [IF DRME08 = 2 OR DK/REF OR DRME09 = 2 OR DK/REF] During the
past 12 months, did you cut down or stop using methamphetamine at least
one time?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
P_ME01
You answered [Yes/No]. How did you come up with your answer to this
question? [IF ANSWERED YES, PROBE FOR HOW LONG THEY CUT
DOWN IF NOT MENTIONED]
B-23
P_ME02
IF FIRST DRUG: What does “cut down or stopped using” mean to you as
it’s used in this question? [IF NEEDED: What came to mind?]
P_ME03
[IF ANSWERED NO] Was there at least one time in the past 12 months
that you cut down or stopped because you had to work, could not get a
hold of any, were in rehab or some other reason? [IF YES TO PROBE:
Can you tell me why you didn’t consider that to be cutting down or
stopping when you answered this question?]
P_ME04
[IF R DID GO WITOUT SUBSTANCE, INSTRUCT R TO RESPOND
‘YES’ TO THIS QUESTION]
DRME10a [IF DRME09 = 1 OR DRME10 = 1] During the past 12 months, have you
felt kind of blue or down when you cut down or stopped using
methamphetamine?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME10b:
[IF DRME10a=2] This question is also about the times after you cut
down or stopped using methamphetamine.
During any of those times, did you use methamphetamine again, cocaine
or ‘crack,’ prescription stimulants, or any illegal substance to prevent
feeling blue or down?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
B-24
P_ME17
In your own words, what is this question asking?
P_ME18
IF YES: How did you come up with your answer to this question? In what
way did using methamphetamine again or using another drug help you
prevent these symptoms?
P_ME19
IF YES: What did you use to prevent these symptoms? [IF NEEDED: Was
it methamphetamine, cocaine or ‘crack,’ stimulants or something else?
PROBE FOR SPECIFIC SUBSTANCE.]
P_ME20
What time period were you thinking about when you answered this
question? [IF NOT 12 MONTHS: If this question had said, “During the
past 12 months,” would you have answered differently? How so?]
DRME11 [IF DRME10a = 1] Please look at the symptoms listed below. During the
past 12 months, did you have 2 or more of these symptoms after you cut
down or stopped using methamphetamine?
•
•
•
•
•
Feeling tired or exhausted
Having bad dreams
Having trouble sleeping or sleeping more than you normally do
Feeling hungry more often
Feeling either very slowed down or like you couldn’t sit still
1
Yes
2
No
DK/REF
B-25
DRMEX1
[IF DRME11=1] You just mentioned that you had symptoms after you cut
down or stopped using methamphetamine. Did you use
methamphetamine again, cocaine or ‘crack,’ prescription stimulants, or
any illegal substance to avoid or get over these symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Press F2 to see these symptoms again.
P_ME13
You answered [yes/no]. How did you come up with your answer to this
question? [IF YES: In what way did using methamphetamine or using
another drug help you avoid or get over your symptoms?]
P_ ME14
What did you use to avoid or get over these symptoms? [IF NEEDED:
Was it methamphetamine or something else? PROBE FOR SPECIFIC
SUBSTANCE.]
P_ ME15
What time period were you thinking about when you answered this
question? [IF NOT 12 MONTHS: If this question had said, “During the
past 12 months,” would you have answered differently? How so?]
P_ ME16
What symptoms were you thinking of when you read (or heard) this
question? [IF F2 NOT PRESSED: Did you notice the instruction to Press
F2 to see the symptoms? Is that instruction ok or would you prefer to see
the symptoms listed on the screen?
B-26
DRMEX2
[If DRME11=2 OR DK/REF] After you cut down or stopped using
methamphetamine did you use methamphetamine again, cocaine or
‘crack,’ prescription stimulants, or any illegal substance to prevent these
symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Press F2 to see these symptoms again
P_ME17
IF FIRST DRUG: In your own words, what is this question asking?
P_ME18
IF YES: How did you come up with your answer to this question? In what
way did using methamphetamine again or using another drug help you
prevent these symptoms?
P_ME19
IF YES: What did you use to prevent these symptoms? [IF NEEDED: Was
it methamphetamine, cocaine or ‘crack,’ stimulants or something else?
PROBE FOR SPECIFIC SUBSTANCE.]
P_ME20
What time period were you thinking about when you answered this
question? [IF NOT 12 MONTHS: If this question had said, “During the
past 12 months,” would you have answered differently? How so?]
B-27
P_ME21
DRME23a
What symptoms were you thinking of when you read (or heard) this
questions? [IF F2 NOT PRESSED:] Did you notice the instructions to
Press F2 to see the symptoms? Is that instruction ok or would you prefer to
see the symptoms listed on the screen?
During the past 12 months, was there ever a time when you wanted to use
methamphetamine so much that you couldn’t think of anything else?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
P_ME22
[IF FIRST DRUG] Can you tell me in your own words what this question
is asking?
P_ME23
You answered [Yes/No]. How did you come up with your answer to this
question?
DRME23b
[IF DRME23a = 2, DK/REF] During the past 12 months, was there ever a
time when you had a strong urge to use methamphetamine?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
P_ME24
You answered [Yes/No]. How did you come up with your answer to this
question?
B-28
P_ME25
What does the phrase “strong urge to use methamphetamine” mean to you
as it’s used in this question?
P_ME26
If I asked, “During the past 12 months, was there ever a time when you
had a strong desire or urge to use methamphetamine?” would you have
answered differently? How so?
B-29
PRESCRIPTION PAIN RELIEVERS
DRPR10 [IF DRPR08 = 2 OR DK/REF OR DRPR09 = 2 OR DK/REF] During the past
12 months, did you cut down or stop using prescription pain relievers at
least one time?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
P_ PR01
You answered [Yes/No]. How did you come up with your answer to this
question? [IF ANSWERED YES, PROBE FOR HOW LONG THEY CUT
DOWN IF NOT MENTIONED]
P_PR02
What does “cut down or stop using” mean to you as it’s used in this
question? [IF NEEDED: What came to mind?]
P_ PR03
[IF ANSWERED NO] Was there at least one time in the past 12 months
that you cut down or stopped because you had to work, could not get a
hold of any, were in rehab or some other reason? [IF YES TO PROBE:
Can you tell me why you didn’t consider that to be cutting down or
stopping when you answered this question?]
P_ PR04
[IF R DID GO WITOUT SUBSTANCE, INSTRUCT R TO RESPOND
‘YES’ TO THIS QUESTION]
B-30
DRPR11 [IF DRPR09 = 1 OR DRPR10 = 1] Please look at the symptoms listed
below. During the past 12 months, did you have 3 or more of these
symptoms after you cut down or stopped using prescription pain relievers?
•
•
•
•
•
•
•
•
•
Feeling kind of blue or down
Vomiting or feeling nauseous
Having cramps or muscle aches
Having teary eyes or a runny nose
Feeling sweaty, having enlarged eye pupils, or having body hair
standing up on your skin
Having diarrhea
Yawning
Having a fever
Having trouble sleeping
1
Yes
2
No
DK/REF
DRPRX1
[IF DRPR11=1] You just mentioned that you had symptoms after you cut
down or stopped using prescription pain relievers. Did you use
prescription pain relievers, heroin, or any illegal substance to avoid or get
over these symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Press F2 to see these symptoms again
P_PR13
You answered [yes/no]. How did you come up with your answer to this
question? [IF YES: In what way did using prescription pain relievers again
or using another drug help you avoid or get over your symptoms?]
P_PR14
IF YES: What did you use to avoid or get over these symptoms? [IF
NEEDED: Was it a prescription pain reliever or something else? PROBE
FOR SPECIFIC SUBSTANCE.]
B-31
P_PR15
What time period were you thinking about when you answered this
question? [IF NOT 12 MONTHS: If this question had said, “During the
past 12 months,” would you have answered differently? How so?]
P_PR16
What symptoms were you thinking of when you read (or heard) this
question? [IF F2 NOT PRESSED:] Did you notice the instruction to Press
F2 to see the symptoms? Is that instruction ok or would you prefer to see
the symptoms listed on the screen?
DRPRX2
[IF DRPR11=2 OR DK/REF] After you cut down or stopped using
prescription pain relievers, did you use prescription pain relievers again,
heroin, or any illegal substance to prevent these symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Press F2 to see these symptoms again
P_PR17
In your own words, what is this question asking?
P_PR18
IF YES: How did you come up with your answer to this question? In what
way did using prescription pain relievers again or using another drug help
you prevent these symptoms?
P_PR19
IF YES: What did you use to prevent these symptoms? [IF NEEDED: Was
it prescription pain relievers, heroin, or something else? PROBE FOR
SPECIFIC SUBSTANCE.]
B-32
P_PR20
What time period were you thinking about when you answered this
question? [IF NOT 12 MONTHS: If this question had said, “During the
past 12 months,” would you have answered differently? How so?]
P_PR21
What symptoms were you thinking of when you read (or heard) this
question? [IF F2 NOT PRESSED:] Did you notice the instruction to Press
F2 to see the symptoms? Is that instruction ok or would you prefer to see
the symptoms listed on the screen?
DRPR23a
During the past 12 months, was there ever a time when you wanted to use
prescription pain relievers so much that you couldn’t think of anything
else?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
P_PR22
[IF FIRST DRUG] Can you tell me in your own words what this question
is asking?
P_PR23
You answered [Yes/No]. How did you come up with your answer to this
question?
B-33
DRPR23b
[IF DRPR23a = 2, DK/REF] During the past 12 months, was there ever a
time when you had a strong urge to use prescription pain relievers?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
P_PR24
You answered [Yes/No]. How did you come up with your answer to this
question?
P_PR25
What does the phrase “strong urge to use prescription pain relievers” mean
to you as it’s used in this question?
P_PR26
If I asked, “During the past 12 months, was there ever a time when you
had a strong desire or urge to use prescription pain relievers?” would you
have answered differently? How so?
PRESCRIPTION TRANQUILIZERS
DRTR10 [IF DRTR08 = 2 OR DK/REF OR DRTR09 = 2 OR DK/REF] During the past
12 months, did you cut down or stop using prescription tranquilizers at
least one time?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
P_TR01
[IF FIRST DRUG] You answered [Yes/No]. How did you come up with
your answer to this question? [IF ANSWERED YES, PROBE FOR HOW
LONG THEY CUT DOWN IF NOT MENTIONED]
B-34
P_TR02
What does “cut down or stop using” mean to you as it’s used in this
question? [IF NEEDED: What came to mind?]
P_TR03
[IF ANSWERED NO] Was there at least one time in the past 12 months
that you cut down or stopped because you had to work, could not get a
hold of any, were in rehab or some other reason? [IF YES TO PROBE:
Can you tell me why you didn’t consider that to be cutting down or
stopping when you answered this question?]
P_TR04
[IF R DID GO WITOUT SUBSTANCE, INSTRUCT R TO RESPOND
‘YES’ TO THIS QUESTION]
DRTR11 [IF DRTR09 = 1 OR DRTR10 = 1] Please look at the symptoms listed below.
During the past 12 months, did you have 2 or more of these symptoms after
you cut down or stopped using prescription tranquilizers?
•
•
•
•
•
•
•
•
Sweating or feeling that your heart was beating fast
Having your hands tremble
Having trouble sleeping
Vomiting or feeling nauseous
Seeing, hearing, or feeling things that weren’t really there
Feeling like you couldn’t sit still
Feeling anxious
Having seizures or fits
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
B-35
DRTRX1
[IF DRTR11=1] You just mentioned that you had symptoms after you cut
down or stopped using prescription tranquilizers. Did you use
prescription tranquilizers again, drink alcohol, use prescription sedatives,
or any illegal substance to avoid or get over these symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Press F2 to see these symptoms again
P_TR13
You answered [yes/no]. How did you come up with your answer to this
question? [IF YES: In what way did using prescription tranquilizers again
or using another drug help you avoid or get over your symptoms?
P_TR14
IF YES: What did you use to avoid or get over these symptoms? [IF
NEEDED: Was it a prescription tranquilizer or something else? PROBE
FOR SPECIFIC SUBSTANCE.]
P_TR15
What time period were you thinking about when you answered this
question? [IF NOT 12 MONTHS: If this question had said, “During the
past 12 months,” would you have answered differently? How so?]
P_TR16
What symptoms were you thinking of when you read (or heard) this
question? [IF F2 NOT PRESSED:] Did you notice the instruction to Press
F2 to see the symptoms? Is that instruction ok or would you prefer to see
the symptoms listed on the screen?
B-36
DRTRX2
[IF DRTR11=2 OR DK/REF] After you cut down or stopped using
prescription tranquilizers, did you use prescription tranquilizers again,
drink alcohol, use prescription sedatives, or any illegal substance to
prevent these symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALEDAR
Press F2 to see these symptoms again
P_TR17
In your own words, what is this question asking?
P_TR18
IF YES: How did you come up with your answer to this question? In what
way did using prescription tranquilizers again or using another drug help
you prevent these symptoms?
P_TR19
IF YES: What did you use to prevent these symptoms? [IF NEEDED: Was
it a prescription tranquilizer or something else? PROBE FOR SPECIFIC
SUBSTANCE.]
P_TR20
What time period were you thinking about when you answered this
question? [IF NOT 12 MONTHS: If this question had said, “During the
past 12 months,” would you have answered differently? How so?]
P_TR21
What symptoms were you thinking of when you read (or heard) this
question? [IF F2 NOT PRESSED:] Did you notice the instruction to Press
F2 to see the symptoms? Is that instruction ok or would you prefer to see
the symptoms listed on the screen?
B-37
DRTR23a
During the past 12 months, was there ever a time when you wanted to use
prescription tranquilizers so much that you couldn’t think of anything
else?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALEDAR
P_TR22
[IF FIRST DRUG] Can you tell me in your own words what this question
is asking?
P_TR23
You answered [Yes/No]. How did you come up with your answer to this
question?
DRTR23b
[IF DRTR23a = 2, DK/REF] During the past 12 months, was there ever a
time when you had a strong urge to use prescription tranquilizers?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALEDAR
P_TR24
[IF FIRST DRUG] You answered [Yes/No]. How did you come up with
your answer to this question?
P_TR25
What does the phrase “strong urge to use prescription tranquilizers” mean
to you as it’s used in this question?
B-38
P_TR26
If I asked, “During the past 12 months, was there ever a time when you
had a strong desire or urge to use prescription tranquilizers?” would you
have answered differently? How so?
PRESCRIPTION STIMULANTS
DRST10 [IF DRST08 = 2 OR DK/REF OR DRST09 = 2 OR DK/REF] During the past
12 months, did you cut down or stop using prescription stimulants at least
one time?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
P_ST01
You answered [Yes/No]. How did you come up with your answer to this
question? [IF ANSWERED YES, PROBE FOR HOW LONG THEY CUT
DOWN IF NOT MENTIONED]
P_ST02
What does “cut down or stop using” mean to you as it’s used in this
question? [IF NEEDED: What came to mind?]
P_ST03
[IF ANSWERED NO] Was there at least one time in the past 12 months
that you cut down or stopped because you had to work, could not get a
hold of any, were in rehab or some other reason? [IF YES TO PROBE:
Can you tell me why you didn’t consider that to be cutting down or
stopping when you answered this question?]
P_ST04
[IF R DID GO WITOUT SUBSTANCE, INSTRUCT R TO RESPOND
‘YES’ TO THIS QUESTION]
B-39
DRST10a [IF DRST09 = 1 OR DRST10 = 1] During the past 12 months, have you felt
kind of blue or down when you cut down or stopped using prescription
stimulants?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST10b:
[IF DRST10a=2] This question is also about the times after you cut down
or stopped using prescription stimulants.
During any of those times, did you use prescription stimulants again,
methamphetamine, cocaine or ‘crack,’ or any illegal substance to prevent
feeling blue or down?
P_ST17
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
In your own words, what is this question asking?
P_ST18
IF YES: How did you come up with your answer to this question? In what
way did using prescription tranquilizers again or using another drug help
you prevent these symptoms?
P_ST19
IF YES: What did you use to prevent these symptoms? [IF NEEDED: Was
it a prescription stimulant or something else? PROBE FOR SPECIFIC
SUBSTANCE.]
P_ST20
What time period were you thinking about when you answered this
question? [IF NOT 12 MONTHS: If this question had said, “During the
past 12 months,” would you have answered differently? How so?]
B-40
DRST11 [IF DRST10a = 1] Please look at the symptoms listed below. During the past
12 months, did you have 2 or more of these symptoms after you cut down or
stopped using prescription stimulants?
•
•
•
•
•
Feeling tired or exhausted
Having bad dreams
Having trouble sleeping or sleeping more than you normally do
Feeling hungry more often
Feeling either very slowed down or like you couldn’t sit still
1
Yes
2
No
DK/REF
DRSTX1
[IF DRST11=1] You just mentioned that you had symptoms after you cut
down or stopped using prescription stimulants. Did you use prescription
stimulants again, methamphetamine, cocaine or ‘crack,’ or any illegal
substance to avoid or get over these symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Press F2 to see these symptoms again
P_ST13
You answered [yes/no]. How did you come up with your answer to this
question? [IF YES: In what way did using prescription stimulants again or
using another drug help you avoid or get over your symptoms?]
P_ST14
IF YES: What did you use to avoid or get over these symptoms? [IF
NEEDED: Was it a prescription stimulant or something else? PROBE
FOR SPECIFIC SUBSTANCE.]
P_ST15
What time period were you thinking about when you answered this
question? [IF NOT 12 MONTHS: If this question had asked “During the
past 12 months,” would you have answered differently? How so?]
B-41
P_ST16
What symptoms were you thinking of when you read (or heard) this
question? [IF F2 NOT PRESSED:] Did you notice the instruction to Press
F2 to see the symptoms? Is that instruction ok or would you prefer to see
the symptoms listed on the screen?
DRSTX2
[IF DRST11=2 OR DK/REF] After you cut down or stopped using
prescription stimulants, did you use prescription stimulants again,
methamphetamine, cocaine or ‘crack,’ or any illegal substance to prevent
these symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Press F2 to see these symptoms again
P_ST17
IF FIRST DRUG: In your own words, what is this question asking?
P_ST18
IF YES: How did you come up with your answer to this question? In what
way did using prescription stimulants again or using another drug help you
prevent these symptoms?
P_ST19
IF YES: What did you use to prevent these symptoms? [IF NEEDED: Was
it a prescription stimulant or something else? PROBE FOR SPECIFIC
SUBSTANCE.]
B-42
P_ST20
What time period were you thinking about when you answered this
question? [IF NOT 12 MONTHS: If this question had said, “During the
past 12 months,” would you have answered differently? How so?]
P_ST21
What symptoms were you thinking of when you read (or heard) this
question? [IF F2 NOT PRESSED:] Did you notice the instruction to Press
F2 to see the symptoms? Is that instruction ok or would you prefer to see
the symptoms listed on the screen?
DRST23a During the past 12 months, was there ever a time when you wanted to use
prescription stimulants so much that you couldn’t think of anything else?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
P_ST22
Can you tell me in your own words what this question is asking?
P_ST23
You answered [Yes/No]. How did you come up with your answer to this
question?
DRST23b
[IF DRST23a = 2, DK/REF] During the past 12 months, was there ever a
time when you had a strong urge to use prescription stimulants?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
B-43
P_ST24
You answered [Yes/No]. How did you come up with your answer to this
question?
P_ST25
What does the phrase “strong urge to use prescription stimulants” mean to
you as it’s used in this question?
P_ST26
If I asked, “During the past 12 months, was there ever a time when you
had a strong desire or urge to use prescription stimulants?” would you
have answered differently? How so?
PRESCRIPTION SEDATIVES
DRSV10 [IF DRSV08 = 2 OR DK/REF OR DRSV09 = 2 OR DK/REF] During the past
12 months, did you cut down or stop using prescription sedatives at least
one time?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
P_SV01
[IF FIRST DRUG] You answered [Yes/No]. How did you come up with
your answer to this question? [IF ANSWERED YES, PROBE FOR HOW
LONG THEY CUT DOWN IF NOT MENTIONED]
P_SV02
What does “cut down or stop using” mean to you as it’s used in this
question? [IF NEEDED: What came to mind?]
B-44
P_SV03
[IF ANSWERED NO] Was there at least one time in the past 12 months
that you cut down or stopped because you had to work, could not get a
hold of any, were in rehab or some other reason? [IF YES TO PROBE:
Can you tell me why you didn’t consider that to be cutting down or
stopping when you answered this question?]
P_SV04
[IF R DID GO WITOUT SUBSTANCE, INSTRUCT R TO RESPOND
‘YES’ TO THIS QUESTION]
DRSV11 [IF DRSV09 = 1 OR DRSV10 = 1] Please look at the symptoms listed below.
During the past 12 months, did you have 2 or more of these symptoms after
you cut down or stopped using prescription sedatives?
•
•
•
•
•
•
•
•
Sweating or feeling that your heart was beating fast
Having your hands tremble
Having trouble sleeping
Vomiting or feeling nauseous
Seeing, hearing, or feeling things that weren’t really there
Feeling like you couldn’t sit still
Feeling anxious
Having seizures or fits
1
Yes
2
No
DK/REF
DRSVX1
[IF DRSV11=1] You just mentioned that you had symptoms after you cut
down or stopped using prescription sedatives. Did you use prescription
sedatives again, drink alcohol, use prescription tranquilizers, or any illegal
substance to avoid or get over these symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Press F2 to see these symptoms again
B-45
P_SV13
You answered [yes/no]. How did you come up with your answer to this
question? [IF YES: In what way did using prescription sedatives again or
using another drug help you avoid or get over these symptoms?]
P_SV14
IF YES: What did you use to avoid or get over these symptoms? [IF
NEEDED: Was it a prescription sedative or something else? PROBE FOR
SPECIFIC SUBSTANCE.]
P_SV15
What time period were you thinking about when you answered this
question? [IF NOT 12 MONTHS: If this question had said, “During the
past 12 months,” would you have answered differently? How so?]
P_SV16
What symptoms were you thinking of when you read (or heard) this
question? [IF F2 NOT PRESSED:] Did you notice the instruction to Press
F2 to see the symptoms? Is that instruction ok or would you prefer to see
the symptoms listed on the screen?
DRSVX2
[IF DRSV11=2 OR DK/REF] After you cut down or stopped using
prescription sedatives, did you use prescription sedatives again, drink
alcohol, use prescription tranquilizers, or any illegal substance to prevent
these symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Press F2 to see these symptoms again
B-46
P_SV17
In your own words, what is this question asking?
P_SV18
IF YES: How did you come up with your answer to this question? In what
way did using prescription stimulants again or using another drug help you
prevent these symptoms?
P_SV19
IF YES: What did you use to prevent these symptoms? [IF NEEDED: Was
it a prescription sedative or something else? PROBE FOR SPECIFIC
SUBSTANCE.]
P_SV20
What time period were you thinking about when you answered this
question? [IF NOT 12 MONTHS: If this question had said, “During the
past 12 months,” would you have answered differently? How so?]
P_SV21
What symptoms were you thinking of when you read (or heard) this
question? [IF F2 NOT PRESSED:] Did you notice the instruction to Press
F2 to see the symptoms? Is that instruction ok or would you prefer to see
the symptoms listed on the screen?
DRSV23a
During the past 12 months, was there ever a time when you wanted to use
prescription sedatives so much that you couldn’t think of anything else?
1 Yes
2 No
DK/REF, PROGRAMMER: SHOW 12 MONTH CALENDAR
B-47
P_SV22
[IF FIRST DRUG] Can you tell me in your own words what this question
is asking?
P_SV23
You answered [Yes/No]. How did you come up with your answer to this
question?
DRSV23b
[IF DRSV23a = 2, DK/REF] During the past 12 months, was there ever a
time when you had a strong desire or urge to use prescription sedatives?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
P_SV24
[IF FIRST DRUG] You answered [Yes/No]. How did you come up with
your answer to this question?
P_SV25
What does the phrase “strong urge to use prescription sedatives” mean to
you as it’s used in this question?
P_SV26
If I asked, “During the past 12 months, was there ever a time when you
had a strong desire or urge to use prescription sedatives?” would you have
answered differently? How so?
B-48
END
Those are all of the questions that I have. Do you have any additional thoughts
or comments on these survey questions that you would like to share?
THANKR2
Thank you for your time.
[ALL CASES] BE SURE YOU HAVE YOUR SHOWCARD BOOKLET,
QC ENVELOPE W/ FORM AND INCENTIVE RECEIPT COPIES.
[ALL CASES] PRESS [ENTER] TO CONTINUE.
FIEXIT
End of interview reached.
PRESS 1 TO EXIT.
B-49
Appendix C: DSM-5 Testing Adult Cognitive Interview
Participant Informed Consent Form and Parental
Permission and Informed Consent Form
DSM-5 Testing
Adult Cognitive Interview Participant Informed Consent Form
National Survey on Drug Use and Health (NSDUH)
Introduction
I am going to explain this study to you. You can stop me at any time if you have questions about anything I tell
you.
The purpose of this study is to test some questions that will be used in the National Survey on Drug Use and
Health, or NSDUH. The NSDUH is a large survey given to about 70,000 people across the country each year. It
collects information on many health-related issues. Right now, we're interested in evaluating some questions
about your experience with past drug and alcohol use. We want to see how well people understand these
questions and how they might go about answering them. RTI is carrying out this research study for the
Substance Abuse and Mental Health Services Administration, or SAMHSA, which is part of the US
Department of Health and Human Services. You are one of 51 participants at least 12 years old (including about
39 adults) who will review the survey questions for this study.
Description of the Interview
Your participation in this interview will involve answering questions about your experiences with past drug and
alcohol use. In addition to answering these questions, I will ask you follow up questions to determine how you
decided on an answer for these survey questions and if they were clear and easy for you to understand. For
some questions, I may ask you to put the questions in your own words. The interview will last approximately 60
minutes. Your participation in this study will end after you finish the interview.
We also would like to audio record what you say during the interview. Only the people who work on this study
will hear the recording. It will help us make sure we have understood your answers. If you don't want us to
audio record you, that's okay.
Confidentiality/Your Rights
Taking part in the interview is completely voluntary. You can skip any interview questions you do not wish to
answer. Your personal information will not be connected to your answers in any way. Federal law requires us to
keep your answers confidential and to use these answers only for statistical purposes (the Confidential
Information Protection and Statistical Efficiency Act of 2002).
With your agreement, we will audio record your interview. You can ask us to pause or stop the recording at any
time. Only RTI and SAMHSA research team members will be able to listen to the recordings. The recordings
will be destroyed within 60 days of the end of this study. Comments from all interviews will be combined in a
report that will not identify who made the comments.
[Read only if observer is present: Member of the RTI research team or representatives of SAMHSA are here
with us today and would like to observe this interview from a separate observation room. If you do not want
anyone else to observe your interview, we will simply ask these people to leave the observation room and then
do the interview.]
Possible Risks and Benefits
You can ask me to stop the interview at any time. If you want to take a break at any time during the interview,
please tell me. It is possible some of the survey questions may make you feel uncomfortable or upset. If this
happens, I can tell you how to contact a counselor.
C-1
There are no direct benefits to you from participating in this interview. However, the answers you give will help
us to improve the quality of questions for the NSDUH.
Payment for Participation
You will be given $40 in cash for completing the interview.
Your Questions
If you have any other questions about the study, you can call Ms. Emily Geisen at 1-800-334-8571 ext. 26566.
If you have any questions about your rights as a study participant, you can call RTI's Office of Research
Protection at 1-866-214-2043 (a toll-free number).
I will sign my name here to indicate that I have explained this information to you and that you have agreed to be
interviewed.
___________________________
Signature of Interviewer
_________________________
Date
Read only if observer is present: I also will sign my name here to indicate that you have given your consent for
members of the RTI research team or representatives of SAMHSA to observe the interview. [INTERVIEWER,
PLEASE WRITE "NA" ON THE SIGNATURE LINE IF THE INTERVIEW IS NOT BEING OBSERVED.]
___________________________
Signature of Interviewer
_________________________
Date
Finally, I will sign my name here to indicate that you have agreed for the interview to be audio recorded.
___________________________
Signature of Interviewer
_________________________
Date
NOTICE: Public reporting burden for this collection of information is estimated to average 60 minutes per response, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or
any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, Paperwork Reduction Project (09300290); Room 2-1057; 1 Choke Cherry Road, Rockville, MD 20857. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information
unless it displays a currently valid OMB control number. The OMB control number for this project is 0930-0290, expiration date 5/31/17.
C-2
Parental Permission and Informed Consent
Introduction
The National Survey on Drug Use and Health (NSDUH) is a large survey given to about 70,000 people across
the country every year. RTI International conducts the NSDUH. It collects information on many health-related
issues. Right now we’re testing some new questions about past drug and alcohol use to learn how well people
understand these questions and how they might go about answering them. We are under contract with the
Substance Abuse and Mental Health Services Administration to carry out this survey. You or your child
responded to an advertisement that we placed for research subjects. At present, we are seeking the help of
young people like your child to see how our new questions work.
Confidentiality
Your child is one of 12 adolescent respondents in Washington, DC, Chicago, IL, Portland, OR, and Research
Triangle Park, NC who are participating in this study. Taking part in the interview is strictly voluntary. Your
child can skip any portion of the interview he/she does not wish to be involved with. There is no penalty if
he/she chooses to skip any part of the interview. The interview will be conducted in private to ensure nobody
else overhears his/her answers. All answers will be kept private and confidential. We will not share the
information given to us with any person outside the project staff, and your child's name will never be connected
to the answers he/she provides. Federal law requires us to keep your child’s answers confidential and to use
his/her answers only for statistical purposes (the Confidential Information Protection and Statistical Efficiency
Act of 2002). The only exception to this promise of confidentiality is if your child tells me that (he/she) intends
to seriously harm him/herself or someone else or if (he/she) tells me (he/she) has been abused, or if your child
identifies a person who has given (him/her) drugs. In this situation I may need to notify a mental health
professional or other authorities.
Possible Risks and Benefits
Some of the questions we ask may make your child feel uncomfortable or upset. If this happens, we can either
take a break or I can give your child information about talking with a counselor.
There are no direct benefits to you or your child from doing this interview. Your child’s involvement in this
study will help us improve the questions for the NSDUH.
Description of the Interview
The interview will take about one hour. During the interview, your child will be asked survey questions about
past drug and alcohol use. The survey includes questions about the use of alcohol and drugs such as marijuana.
In addition to these questions, we will ask follow up items about the survey questions to determine how your
child decided on an answer for these questions and if they were clear and easy for your child to understand. For
example, we may ask your child to repeat the question in his or her own words.
(He/She) will receive $40 in cash in appreciation for the interview.
We would like to audio record the interactions between your child and the interviewer. The recording will be
heard only by members of the research team to help us make sure we have all the information from your child
about how these questions work. To protect (his/her) privacy, the recording will remain on the laptop computer,
which will be protected by a password. The recording will be destroyed soon after the study ends. However,
having the interactions recorded is voluntary and you can decline for your child.
[Read only if observer is present: Members of the RTI research team or representatives of SAMHSA are here
with us today and would like to observe this interview from a separate observation room. If you do not want
anyone else to observe your interview, we will simply ask these people to leave the observation room and then
do the interview.]
C-3
If you have any questions about this study, you can contact Emily Geisen at RTI at 1-800-334-8571 X. 26566).
If you have any questions about your rights as a parent or legal guardian or your child's rights as a study
participant, you can call RTI's Office of Research Protection at 1-866-214-2043 (a toll-free number).
Do we have your permission for [CHILD’S NAME] to participate?
As Parent/Guardian, I give my permission for my child to participate in this interview.
____Yes
____No
As Parent/Guardian, I give my permission for my child’s interview to be audio recorded:
____Yes
____No
As Parent/Guardian, I give my permission for members of the RTI research team or representative of SAMHSA
to observe the interview:
____Yes
____No
Signature of Interviewer: ______________________________
Date: __________________
NOTICE: Public reporting burden for this collection of information is estimated to average 60 minutes per response, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or
any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, Paperwork Reduction Project (09300290); Room 2-1057; 1 Choke Cherry Road, Rockville, MD 20857. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information
unless it displays a currently valid OMB control number. The OMB control number for this project is 0930-0290, expiration date 5/31/17.
C-4
Participant Informed Assent (ADOLESCENT)
Introduction
I am going to explain this study to you. You can stop me at any time if you have questions about anything I tell
you.
The purpose of this study is to test some questions that will be used in the National Survey on Drug Use and
Health, or NSDUH. The NSDUH is a large survey given to about 70,000 people across the country each year. It
collects information on many health-related issues. We're interested in evaluating some questions about your
experience with past drug and alcohol use. We want to see how well people understand these questions. We also
want to know how people go about answering the questions. RTI is doing this study for the Substance Abuse
and Mental Health Services Administration, or SAMHSA. You are one of 12 participants between the ages of
12 to 17 who will help us test these questions.
Description of the Interview
Your participation in this interview will involve answering questions about your experiences with past drug and
alcohol use. In addition to answering these questions, I will ask you follow up questions to determine how you
decided on an answer for these survey questions and if they were clear and easy for you to understand. For
some questions, I may ask you to put the questions in your own words. The interview will last approximately 60
minutes. Your participation in this study will end after you finish the interview.
We also would like to audio record what you say during the interview. Only the people who work on this study
will hear the recording. It will help us make sure we have understood your answers. If you don't want us to
audio record you, that's okay.
Confidentiality/Your Rights
You don't have to answer a question if you don't want to. If you want to take a break at any time, just tell me.
Your name will be kept private. Only people working on or with the study will see your answers to these
questions. Your parents will not find out about your answers to questions. The only exceptions to this promise
of confidentiality are if you tell me that you intend to seriously harm yourself or someone else or if you have
been abused or if you identify an adult who has given you drugs; in these situations I may need to notify a
mental health professional or other authorities.
Possible Risks and Benefits
Some of the questions we ask may make you feel uncomfortable or upset. If this happens, let me know right
away, and we can either take a break or I can give you information about talking with a counselor.
We are required by law to keep your answers private. The law also requires the study to use your answers only
to learn how the questions work. The name of this law is the Confidential Information Protection and Statistical
Efficiency Act of 2002.
There are no direct benefits to you from doing this interview. Your involvement in this study will help us
improve the questions for the NSDUH.
When we finish, I will give you $40 in cash to thank you for taking time to talk to me.
If you or your parent/guardian have any other questions about the study, you can call Ms. Emily Geisen at 1800-334-8571 ext. 26566. If you or your parent/guardian have any questions about your rights as a participant
in this study, you can call RTI's Office of Research Protection at 1-866-214-2043.
C-5
I will sign my name here to indicate that I have explained this information to you and that you have agreed to be
interviewed. You will be given a copy of this form.
___________________________
Signature of Interviewer
_________________________
Date
I will sign my name here to indicate that you have agreed for the interview to be audio recorded.
___________________________
Signature of Interviewer
_________________________
Date
NOTICE: Public reporting burden for this collection of information is estimated to average 60 minutes per response, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or
any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, Paperwork Reduction Project (09300290); Room 2-1057; 1 Choke Cherry Road, Rockville, MD 20857. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information
unless it displays a currently valid OMB control number. The OMB control number for this project is 0930-0290, expiration date 5/31/17.
C-6
Participant Assent to Be Observed (ADOLESCENT)
[Another person who works on the study/A person or people who work(s) with the sponsor of this study] also is
here with us today. This person (These people) would like to watch your interview in a separate observation
room. We have already talked with your parent or guardian about this, and they have said it is okay to have this
person (these people) watch the interview. What you say will still be kept private. It's okay if you don't want
this person (these people) to watch your interview. We will simply ask that person(them) to leave the
observation room.
Is it OK for this person (them) to watch your interview?
CHECK ONE OF THE BOXES BELOW. SIGN AND DATE FORM
____Other study team member or sponsor representative may observe the interview.
____Other study team member or sponsor representative may not observe the interview.
___________________________
Signature of Interviewer
_______________________
Date
NOTICE: Public reporting burden for this collection of information is estimated to average 60 minutes per response, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or
any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, Paperwork Reduction Project (09300290); Room 2-1057; 1 Choke Cherry Road, Rockville, MD 20857. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information
unless it displays a currently valid OMB control number. The OMB control number for this project is 0930-0290, expiration date 5/31/17.
C-7
Appendix D: DSM-5 R1 Memo
Memo
To:
Substance Abuse and Mental Health Services Administration, Center for Behavioral Health
and Statistics and Quality
From:
Emily Geisen, Cristie Glasheen, Gretchen McHenry, Patty LeBaron, Jeanne Snodgrass,
Mark Edlund, Rhonda Karg, Doug Currivan
Date:
May 6, 2015
Re:
DSM-5 Round 1 Cognitive Interviewing Summary and Recommendations
Purpose
The purpose of the DSM-5 project was to evaluate the diagnostic changes in the Diagnostic and
Statistical Manual of Mental Disorders (DSM) from the fourth edition (DSM-IV) to the fifth edition (DSM-5)
and to develop revisions to the substance abuse modules of the National Survey on Drug Use and Health
(NSDUH) to produce estimates of DSM-5-based substance use disorders (SUDs) (American
Psychological Association [APA], 1994, 2013).
After completing a review of diagnostic changes, the DSM-5 project revised and developed NSDUH items
to reflect DSM-5 criteria for SUDs. The revisions and new items were reviewed by substantive and
methodological experts and further changes were made. Following these changes, draft items were
tested in the first round of cognitive interviewing, which was completed on April 23, 2015. This memo
provides a summary of the findings of the first round of cognitive interviewing and recommendations for
item revision for the second round of cognitive interviewing, which will be conducted in English and
Spanish. The second round of cognitive interviewing is scheduled to occur after Spanish translation and
expert review.
SAMHSA Background
At the direction of Substance Abuse and Mental Health Services Administration (SAMHSA) management,
DSM-5 changes are limited to the addition of a craving question for all drugs and withdrawal questions for
marijuana. Final marijuana withdrawal symptom questions may require minor changes to symptom
questions for other substances for consistency. Any additional findings and recommendations should
continue to be included for documentation purposes. However, SAMHSA resolutions for Round 2 are
limited to these items.
Participants
Ten adult participants were recruited from advertisements placed on www.craigslist.com in three cities:
Chicago, Illinois; Washington, DC; and Portland, Oregon. Three adolescent participants were recruited
from treatment facilities in Durham, North Carolina. Participant characteristics are described below.
D-1
To be eligible, participants had to report using alcohol or marijuana at least six times in the past year, or
using cocaine, heroin, or methamphetamine at least once in the past year, or misusing prescription drugs
in the past year. To test new marijuana withdrawal questions as well as the other revised substance use
dependence questions, RTI selected a majority of marijuana users. Although participants self-reported
certain drug use during the screener, they may not have received the substance dependence module for
that substance if they did not use the substance frequently enough (alcohol or marijuana).
In Table 1, RTI provides a list of the cognitive interview participants by demographics and the substance
dependence modules received. Throughout the findings, participants are referred to by their CaseIDs to
provide a better understanding for how participants interpreted the questions.
Table 1. Participant Characteristics
CaseID
Age
Range
Sex
Race
1000030
35-54
Female
White
1000093
55 or
older
Female
Black or African
American
1000149
18-34
Male
White
2000042
35-54
Female
White
2000053
18-34
Female
White
Female
White
2000101
3000027
3000033
3000038
3000055
55 or
older
55 or
older
35-54
55 or
older
55 or
older
Female
Male
Female
Male
Black or African
American
Black or African
American
Black or African
American
Black or African
American
4000001
12-17
Male
White
4000015
12-17
Female
White
4000030
12-17
Male
White
Ethnicity
Education
Not
Hispanic
Not
Hispanic
Not
Hispanic
Not
Hispanic
Not
Hispanic
Not
Hispanic
Not
Hispanic
Not
Hispanic
Not
Hispanic
Not
Hispanic
Not
Hispanic
Not
Hispanic
Not
Hispanic
Some college, but
no degree
Some college, but
no degree
Some college, but
no degree
Bachelor's Degree
(B.A., B.S.)
Bachelor's Degree
(B.A., B.S.)
Some college, but
no degree
High school
diploma or GED
High school
diploma or GED
Some college, but
no degree
Some college, but
no degree
Less than High
School
Less than High
School
Less than High
School
Organization
The findings of the cognitive interviewing are organized as follows:
•
•
•
•
question text,
brief background of the revision/addition,
cognitive interview findings,
recommendations,
D-2
Received Substance
Dependence Modules for:
Alcohol, marijuana, cocaine
Alcohol
Alcohol, marijuana
Alcohol, marijuana,
methamphetamine
Alcohol, marijuana, cocaine
Alcohol, marijuana
Alcohol
Alcohol, marijuana, cocaine,
heroin
Alcohol
Alcohol, cocaine
Alcohol, marijuana, cocaine
Alcohol, marijuana
Alcohol, marijuana, cocaine,
methamphetamine
•
•
•
resolutions from SAMHSA,
Spanish-language expert review findings, and
recommendations.
Overall Changes for Round 2
The entire substance abuse module will be reproduced to facilitate observers following along with the
cognitive interviews without seeing all the questions. Similarly, headphones will not be used in the
cognitive testing. Participants will read the question aloud or listen to the computer audio and then say
their responses as they are entering them. Some participants in Round 1 apparently denied using
substances for which they were recruited and therefore did not get the appropriate follow-up questions.
Round 2 will include specific recruitment of a few prescription drug misusers.
DR(Drug)10
During the past 12 months, whether you wanted to or not, did you cut down or stop [using Drug] at
least one time?
History
This question is a revised version of the existing NSDUH question DR(DRUG)10: “During the past 12
months did you cut down or stop [using Drug] at least one time?” This item is used as part of the skip
pattern to determine who will receive the withdrawal symptom questions. During review of the NSDUH
items, concern was raised that the items immediately preceding this question may create a context effect
where people are only considering times that they intentionally cut down and not times that they went
without for other reasons (e.g., they ran out of money or they had to work). The phrase “whether you
wanted to or not” was added to try to prompt individuals to think about these other times.
Findings
Only one participant (3000038) did not receive this question for any substances due to the skip pattern of
previous questions.
Overall, this question did not work as intended, and participants were thinking primarily about intentionally
cutting down or stopping. This led to a high number of likely false negatives, based on cognitive testing.
Incorrectly answering “no” means that participants will not get following questions about experiencing
symptoms of substance withdrawal.
False negatives were probable in four cases for alcohol (1000149, 2000042, 3000027, and 4000015),
three cases for marijuana (1000149, 2000053, and 4000001), and two cases for cocaine (1000030 and
3000055). Participants answered “no” incorrectly for three main reasons as summarized below:
•
Participants were thinking only about intentionally stopping and not just periods of time when they
might have gone without the substance for other reasons:
D-3
○
○
○
○
•
Participants thought this question was asking about successfully cutting down or stopping:
○
○
○
•
1000149 on alcohol: “I am thinking about stopping drinking and not drinking for a given night
as two different things. I might not drink if I have to work in the morning, but I don’t consider
that cutting down or stopping.”
2000053 said that she cut down her marijuana use twice over the past year, for about a
month each, but she was not thinking of that when she answered. She said, “I didn’t not use
because I consciously chose not to, I just didn’t have it and didn’t care.”
When asked if he ever went without alcohol, 2000042 responded, “Not when I was younger,
but now, yes, because of work.”
4000001 said that he went without marijuana for a week because of a church trip. When
asked why he answered “no” even though he went without marijuana, he replied, “I didn’t not
want to go on the church retreat so I didn’t think it included that. I was fine with going on the
church retreat so not smoking didn’t really affect my decision.”
4000015 said that question was confusing. She thought the question was asking, “Am I able
to stop when I want to at least once?” She said she answered “no” because “It’s only been
recently that I have been trying not to but I haven’t been able to.”
3000055 said about alcohol that “It seems to me that they’re asking if you are attempting to
cut down or stop drinking at least once over the past year. I’m thinking it’s asking you to get
information about whether or not you were able to do it at least once.”
3000055 answered “no” for cocaine for similar reasons: “In the past 12 months, I’ve wanted
to not quite binge as much as I did but I wasn’t able. I wasn’t very successful at it.” She then
acknowledged that she had gone without cocaine for as long as a week due to unavailability.
Participants did not use the substance often enough to “cut down.” While this question should
have been answered “yes,” these participants’ infrequent use would likely not have prompted
withdrawal symptoms; therefore, no important diagnostic information on withdrawal would be
missed:
○
○
○
1000030 on cocaine: “This is not something I use regularly. Just did it not too much.”
1000149 noted that he used to use marijuana “extremely heavily” more than 12 months ago
but that now, “No, I just use at concerts.”
3000027 commented, “I am not an alcohol person,” and implied that she answered “no”
because she did not drink that much and did not want to cut down.
When the participants above answered “no,” they were asked if there was ever a time they went without
the substance for a while. Many of these participants indicated that they went without the substance for
periods of time because of work, because they could not get a hold of any, because they did not have any
money, or just because they did not do it very often.
The phrase “whether you wanted to or not” was added to encourage participants to think about both
intentional and intentional times that they might have cut down or stopped drinking. However, it does not
appear that participants understood this phrase as intended:
•
•
Several participants (2000053, 4000001, 4000015) said they found the phrase confusing.
As noted above, several participants interpreted it as asking about success in stopping.
D-4
•
Others thought it was asking about the times they cut back or stopped due to external forces. For
example, participant 1000149 said, “I’m thinking it means if you were compelled to by some
reason, perhaps your health or law enforcement has gotten involved and you’re taking some sort
of sobriety test that are necessary as opposed to wanting to do it, the word I want to use is ‘more
organically.’”
Three participants (4000030 for alcohol, 2000101 for marijuana, and 2000053 for cocaine) answered
“yes” to this question and reported thinking about times they unintentionally went without when they
answered this question (e.g., when they ran out or did not have money). However, 2000101’s and
2000053’s “yes” responses are likely due to the effect of cognitive probing because these participants
incorrectly answered “no” for previous substances.
Other participants answered “yes” correctly reported cutting back or stopping for the following reasons:
•
•
•
•
•
deliberately cutting back for a personal reason, such as to use a prescription medication
(1000093 for alcohol) or improve swimming performance (3000033 for marijuana);
not using the substance frequently, so that there were periods of time they went without (3000033
for cocaine and heroin, 4000001 for alcohol and cocaine, 4000030 for methamphetamine);
2000101 said there were times when she went without drinking for “a day or a week,” but she did
not explain why;
deliberately cutting back to fight addiction (3000055 for alcohol); and
entering of a rehab program (4000015 and 4000030 for marijuana) or desire to cut down
(3000055).
Possible Revisions
•
•
Remove item DR(Drug)10 from all modules and eliminate the skip pattern for withdrawal items so
all respondents in the substance abuse modules receive the withdrawal questions. This would
eliminate the possibility of people who should be answering the withdrawal question not receiving
them.
Test an alternate version:
○
○
○
○
○
○
○
During the past 12 months did you cut down or stop [using Drug] at least one time, for any
reason?
During the past 12 months did you cut down or stop [using Drug] for any reason?
During the past 12 months did you go without [using Drug] at least one time?
During the past 12 months did you go without [using Drug] at least one time, for any reason?
During the past 12 months did you go without [using Drug] at any time?
During the past 12 months did you go without [using Drug] for any reason?
During the past 12 months did you go without [using Drug] for at least [drug specific amount
of time]?
Recommendations
•
Our recommendation is to remove DR(Drug)10 and eliminate the skip pattern for withdrawal
items and to use cognitive interviewing in Round 2 to determine whether this results in an inflated
false-positive rate for withdrawal items. As evidenced in the cognitive interviewing, almost
everyone went without the substance at some point in the past year.
D-5
•
•
If an alternate version is preferred, then RTI recommends testing two versions of this question
simultaneously. This may provide valuable information because the answers could be contrasted
with each other. Based on the respondents who indicated they were specifically not thinking of
times they went without unintentionally, there is some indication that “cutting down or stopping” is
partially responsible for excluding those times, suggesting that a different wording, such as “going
without,” may be helpful. Adding a specific amount of time may also assist in reframing the
question away from intentional versus unintentional and avoiding judgments of “success,” but
because withdrawal can occur at varying times after stopping use, it would need to be tailored to
each substance or set to the minimum amount of time for any substance.
If this question is to be included, RTI recommends testing the following two versions in Round 2.
Use of these two questions will allow us to compare going without for any reason versus going
without for a specified period of time:
○
○
During the past 12 months did you go without [using Drug] at least one time, for any reason?
During the past 12 months did you go without [using Drug] for at least [drug specific amount
of time]?
Resolutions from SAMHSA
DR10 is an existing question and not included in the SAMHSA management directive, so we cannot
delete it. We agree that the phrase “whether you wanted to or not” should be dropped. Instead of
including the phrase “for any reason,” please use the existing (2015) question wording and routing in
Round 2, probing for the reason, intent, and length of time participants cut down or stopped using the
substance. Substituting the phrase “go without using” could result in even more false positives. We do not
agree with inserting the drug-specific amount of time in the questions because even the SUD experts
could not agree on this.
Spanish-Language Review Findings
There were no comments from the reviewers for this item.
Final Recommendation
Complete cognitive testing on the original NSDUH wording of DR10.
DRMJ11a
[IF DRMJ09 or DRMJ10 = 1] Please look at the symptoms listed below. During the
past 12 months, did you have any of these symptoms after you cut down or
stopped using marijuana or hashish?
•
•
•
•
•
•
Pain in the stomach area
Shaking or tremors
Sweating
Fever
Chills
Headache
1
Yes
2
No
DK/REF
D-6
DRMJ11b
[IF DRMJ09 or DRMJ10 = 1] During the past 12 months, did you have [IF DRMJ11a =
1 then fill 2, IF DRMJ11a = 2, DK/REF then fill 3] or more of these symptoms after
you cut down or stopped using marijuana or hashish?
•
•
•
•
•
•
Feeling irritable or angry
Feeling anxious
Having trouble sleeping
Losing your appetite or losing weight without trying to
Feeling like you couldn’t sit still
Feeling depressed
1
Yes
2
No
DK/REF
History
DSM-5 has added a withdrawal syndrome to the Marijuana Use Disorder criteria. Symptoms are broken
into two groups (physical and psychological). Respondents must have three or more symptoms, one of
which can be from the physical symptom list. Even if a respondent has all of the physical symptoms, it
only counts as one of the three needed to meet marijuana syndrome criteria. The complexity of this
required the use of two questions to assess this criteria. If they endorse 11a, then the fill for 11b is 2,
otherwise the 11b question requires 3.
DRMJ11a Findings
Six participants (1000030, 2000042, 2000101, 3000033, 4000015, and 4000030) received this question
based on their use of marijuana and their responses to prior questions.
In general, this question appeared to work well, although several participants did not think these
symptoms were likely to occur from marijuana withdrawal. Participants 2000042 and 3000033 specifically
commented that they had never heard of these symptoms occurring for marijuana. One of these
participants noted that she associated these symptoms with heroin withdrawal rather than marijuana
withdrawal. Participant 1000030 said that she did not think that people would have these symptoms
(except for headaches) and noted that people would have anxiety or depression. Participants would then
volunteer other symptoms that they thought more likely to occur for marijuana, like trouble sleeping or
anxiety, which were asked about in DRMJ11b.
Only one participant (4000015) answered “yes” to this question, reporting headaches. Another participant
(1000030) initially answered “no,” but then considered changing her answer to “yes” during cognitive
probing because she did have headaches. She did not report those initially because she was not sure if
the headaches “were connected,” that is, a result of cutting down marijuana use. However, this person
endorsed all of the symptoms in DRMJ11b, so she still would have met the criteria for withdrawal. Both of
these participants reported getting headaches within 1 or 2 days of stopping.
Although participants did not have many of the symptoms listed, they appeared to understand them for
the most part. One of the adolescent participants (4000015) was uncertain what “chills” meant but was
able to describe it as “when the hair on your arms are standing up.” Although this is not a precise
D-7
understanding of chills, it appears that she has a general understanding of the symptom. Participant
2000102 said that “pain in the stomach area” sounded archaic and would recommend “stomach ache”
instead.
DRMJ11b Findings
The symptoms in 11b resonated more with participants than the symptoms in 11a. However, for some
participants, it was difficult to tell if these symptoms were a result of withdrawal because they indicated
that they had some of these symptoms already and using marijuana helped alleviate those symptoms.
For example, participant 2000042 answered “yes” but said that it is “hard to tell because I have some of
these symptoms anyways—I always feel anxious.” Participant 2000101 noted that she was using
marijuana last year because of an illness that took away her appetite. So when she stopped using, she
would have loss of appetite. Participant 4000030 said that “I was definitely irritable and angry. Smoking
kind of calmed me down.” Therefore, it is possible that this will generate some false positives if
respondents endorse symptoms that were not actually a result of withdrawal.
All but one participant (2000101) answered “yes” to this question. Although she had some symptoms, she
noted that she did not have three and answered “no.” One of the participants who answered “yes”
(2000042) answered incorrectly because she only had one of the reported symptoms and did not notice
that it said “3 or more symptoms.” RTI recommends bolding the number of symptoms in the question to
make this clearer.
All participants seemed to understand the symptoms listed, although some participants had suggestions
for how some of the symptoms could be approved. One participant (2000042) suggested using “upset”
instead of “angry.” Instead of “trouble sleeping,” she recommended using “sleeping too much or sleeping
too little.” However, DSM criteria also include disturbing dreams, which would not be captured by that
change. That respondent also thought that gaining weight should be added; however, that is not a DSM
symptom. Another participant (4000015) suggested changing “feeling anxious” to “having anxiety.” None
of these suggestions seem to be an improvement over the original wording and may introduce other
concerns.
We also asked participants what they thought of the word “symptom” as it was used in these questions.
While some participants offered suggestions such as “consequences, feelings, or events,” only two
participants had particular concerns with the word “symptom.” Participant 2000042 said, “It sounds very
medical. Most people will probably go to any medical symptoms they are having.” However, none of the
participants appeared to include any symptoms that were not listed on this question. Participant 2000101
said, “I think of being sick. Feels like it could be a judgment. Something a little more neutral could be
used, like ‘characteristics,’ something less clinical.”
Recommendations
Overall, these questions appear to be working well for respondents who received them. However, based
on the responses from DR[DRUG]10, RTI is concerned that respondents associate “cutting down or
stopping” as intentional. Therefore RTI recommends revising “cut down or stopped” to “went without.” The
number of symptoms is bolded in the withdrawal questions for other substances, and RTI recommends
doing the same for the marijuana withdrawal questions to ensure that respondents notice them more
easily.
D-8
Although RTI does not recommend revising the word “symptom” in Round 2, RTI recommends probing
respondents further on the word symptoms and asking if they prefer alternatives such as “after you went
without . . . , did you have any of these feelings?” or “after you went without . . . , did you experience any
of the following?”
An example of the revised question for marijuana is shown below. If the option to use a specific amount of
time is chosen for DR(DRUG)10, then a similar clause can be added to the end of each question.
Otherwise, it can be excluded. If DR(Drug)10 is asked and the skip logic removed, it may be necessary to
add a third response option allowing the respondent to indicate that he or she never went without the
substance.
DRMJ11a
[IF DRMJ09 = 1 OR DRMJ10 = 1] Please look at the symptoms listed below. During the
past 12 months, after you went without using marijuana or hashish [for at least [drug
specific amount of time]], did you have any of these symptoms?
•
•
•
•
•
•
Pain in the stomach area
Shaking or tremors
Sweating
Fever
Chills
Headache
1
Yes
2
No
DK/REF
DRMJ11b
[IF DRMJ09 = 1 OR DRMJ10 = 1] During the past 12 months, after you went without using
marijuana or hashish [for at least [drug specific amount of time]], did you have [IF
DRMJ11a = 1 then fill 2, IF DRMJ11a = 2, DK/REF then fill 3] or more of these
symptoms?
•
•
•
•
•
•
Feeling irritable or angry
Feeling anxious
Having trouble sleeping
Losing your appetite or losing weight without trying to
Feeling like you couldn’t sit still
Feeling depressed
1
Yes
2
No
DK/REF
Resolutions from SAMHSA
Please keep these questions as they now exist for Round 2. While we understand that there were issues
with the phrase “cut down or stopped,” we are concerned that “went without” could create more false
positives (without the addition of a specific time, which is not a viable alternative). Again, probe for
misunderstanding of the questions to try and determine whether the symptoms actually resulted from
stopping or cutting down on the substance. Please bold the number of symptoms in DR11b so it is
consistent with other substance withdrawal questions and bold the word “after” in both DR11a and
DR11b.
D-9
There is no need to continue to probe on the word “symptom” because no clear alternative emerged in
Round 1.
While this was not one of the recommendations, please change “pain in the stomach area” to “stomach
ache” as recommended by one of the participants. This change will help to further simplify the DSM-5
symptom of “abdominal pain.”
Spanish-Language Review Findings
Dr. Canino had no comments on 11a and noted that 11b did not have nervousness or aggression in the
English or Spanish versions. She also recommends using the term “enojado” for “angry,” which she feels
is more applicable than “molesto.” She is also suggesting to add the translation “nervioso” for “nervous.”
Dr. Alegría recommends including additional text on both questions, as follows:
•
•
•
•
“Me gustaría que piense en los últimos 12 menses” (“I would like for you to think about the past
12 months”) for “During the past 12 months” on DRM11Ja, and “Volvamos hablar sobre los
últimos 12 meses” (“Let’s talk about the past 12 months again”) for “During the past 12 months”
on DRMJ11b. However, this change would affect the consistency of what is currently used
throughout the NSDUH.
“A la semana de dejar de usar o reducir” (“A week after stop using or reducing”) for “After you cut
down or stopped using,” which is also reversing the terms “cut down” and “stopped using.”
However, the added time period has not been approved by SAMHSA at this time.
She also recommends revising the translation “Perdió el apetito o bajó de peso sin tratar de
hacerlo” to “Perdió el apetito o bajó de peso cuando no trataba de hacerlo” for “Losing your
appetite or losing weight without trying to.” The phrase being changed is for “without trying to.” It
currently reads “sin tratar de hacerlo” (without trying to), and her recommendation reads “when
not trying to.” However, the message is conveyed accurately both ways; therefore, the current
translation is unaltered, but if cognitive interviewing suggests this is confusing, the alternate
translation can be tested in Round 3.
Finally, Dr. Algerίa indicated an alternate phrasing for “cut down.” This involves changing “usar
menos,” which means “using less” to “reducir el uso,” which means “reduce the use.” This
variation may have implications to interpretation and be closer to the DSM-5 definition of cutting
down; therefore, the question was modified to enable testing for the second round of cognitive
interviewing.
Final Recommendation
Although consistent with the DSM-5, the word “aggressive” has negative connotations and may reduce
endorsement of relevant symptoms. If this were added to 11b, it may need a separate bulleted line so that
the concept of aggressiveness does not prevent respondents from endorsing feeling irritable or angry.
However, this would negatively impact calculating the number of symptoms and would therefore require
an additional question just asking about irritability, anger, or aggression. There is likely overlap in the
concept of aggression with anger and irritability; therefore, this question may still capture the concept of
aggression. Cognitive probing may be beneficial to verify that there is not a high rate of false negatives
resulting from omitting aggression. Revising the second bullet to “feeling anxious or nervous” to address
the fact that nervousness is in the DSM-5 criteria is a minor change that would benefit from cognitive
testing in the second round.
D-10
Consider testing the following:
DRMJ11a
[IF DRMJ09 = 1 OR DRMJ10 = 1] Please look at the symptoms listed below. During the
past 12 months, did you have any of these symptoms after you cut down or stopped
using marijuana or hashish?
•
•
•
•
•
•
Stomach ache
Shaking or tremors
Sweating
Fever
Chills
Headache
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ11b [IF DRMJ09 = 1 OR DRMJ10 = 1] During the past 12 months, did you have [IF
DRMJ11a = 1 then fill 2, IF DRMJ11a = 2, DK/REF then fill 3] or more of these
symptoms after you cut down or stopped using marijuana or hashish?
•
•
•
•
•
•
Feeling irritable or angry
Feeling anxious or nervous
Having trouble sleeping
Losing your appetite or losing weight without trying to
Feeling like you couldn’t sit still
Feeling depressed
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ11a
[IF DRMJ09 = 1 OR DRMJ10 = 1] Por favor mire la siguiente lista de síntomas. En los
últimos 12 meses, ¿tuvo alguno de estos síntomas después de reducir el uso o dejar de
usar marihuana o hachís?
• Dolor de estómago
• Agitación o temblores en el cuerpo
• Sudor
• Fiebre
• Escalofríos
• Dolor de cabeza
1
Sí
2
No
DK/REF
D-11
DRMJ11b [IF DRMJ09 = 1 OR DRMJ10 = 1] En los últimos 12 meses, ¿tuvo [IF DRMJ11a = 1 then
fill 2, IF DRMJ11a = 2, DK/REF then fill 3] o más de estos síntomas después que reducir
el uso o dejó de usar marihuana o hachís?
• Se sintió irritable o enojado
• Se sintió ansioso o nervioso
• Tuvo problemas para dormir
• Perdió el apetito o bajó de peso sin tratar de hacerlo
• Se sintió inquieto
• Se sintió deprimido
1
Sí
2
No
DK/REF
DR(Drug)XXa [IF DR(Drug)11 = 1 OR DRMJ11b = 1] You just mentioned that you
experienced symptoms after you cut back or stopped using [Drug]. During
the past 12 months, did you use [Drug list], or any illegal substance to
avoid or get over these symptoms?
1
Yes
2
No
DK/REF
DR(Drug)XXb [IF (DR(Drug)11 = 2 OR DK/REF) During the past 12 months, did you use [Drug list],
or any illegal substance to avoid these symptoms?
1
Yes
2
No
DK/REF
History
DSM-5 criteria indicate that a person can meet criteria for withdrawal by either having the symptoms of
withdrawal syndrome (assessed in the DR(DRUG)11 questions) or using the substance or a
pharmacologically similar substance to avoid, prevent, or get over the symptoms of withdrawal syndrome.
This has never been assessed in NSDUH. Two versions were proposed: one for if they endorsed
symptoms (a), and one for if they did not (b). This question is vital to (1) identify people who never
experienced withdrawal because they prevented it by using a replacement substance, and (2) identify
people who may not have had enough symptoms to meet the criteria for withdrawal syndrome because
they went back to using the substance to avoid them (e.g., someone only has two of three required
symptoms because they started using again before they developed a third symptom).
DR(Drug)XXa Findings
Six participants (1000030, 3000033, 3000038, 4000001, 4000015, and 4000030) received these
questions based on their responses to prior questions. Some participants received this question for more
than one substance. Three participants answered about alcohol, four about marijuana, and one about
cocaine.
There was a high number for false positives for this item based on the intended DSM5 criteria. Four
participants (1000030, 3000033, 40000001, and 4000030) incorrectly answered “yes” for at least one
substance. The reasons for false positives are summarized below:
D-12
•
Participants used a substance that was not pharmacologically similar:
○
○
○
•
Participants used another substance to continue to get high as opposed to avoid or get over
symptoms:
○
○
•
Participant 1000030 reported using ecstasy to cope with marijuana withdrawal symptoms.
Participant 40000001 reported using marijuana to get over alcohol withdrawal symptoms as
well as cocaine withdrawal symptoms.
Participant 40000030 reported using alcohol to get over marijuana withdrawal.
Participant 40000001 said, “If I wasn’t drinking, I would probably smoke weed or smoke
[cigarettes]. My drug of choice is weed, not alcohol.” When answering for cocaine, he said, “If
I was doing a lot of coke in a night, a couple of grams with some friends, we would definitely
save some weed because when we got the blues, and you know you’re always going to get
the blues, we would either have some alcohol or weed, so that you could smoke and relax
yourself or drink and not feel the effects of the blues.”
Participant 4000030 said, “When I stopped smoking back in November, it was just a shift to
alcohol. . . . It was just something I could do that wouldn’t show up on a drug test.”
Participants were thinking of symptoms that were not a result of withdrawal:
○
○
Participant 3000033 said he used marijuana to “resolve” the symptoms he gets when he does
not smoke. However, he later implied that he uses marijuana to self-medicate for anxiety, “I’m
dealing with some other issues to help me get over that anxiety, but I was using marijuana,
too.”
Participant 40000001 reported using weed to get over the effects of hangover, “If I got pretty
drunk the night before I would get a hangover. I would then smoke a bowl to feel better.”
Only participant 4000015 correctly answered “yes” to this question. She commented, “Yeah, I would stop
[smoking weed], and I couldn’t sleep or I’d have trouble eating so I’d just smoke more [weed].”
Two participants (3000033, 3000038) correctly answered “no,” indicating that they did not use any other
substances to avoid or get over the symptoms. Participant 3000033 notes, “I did use [other substances],
but it wasn’t for alcohol symptoms. I would have to say no.” However, participant 3000033 appeared to
misunderstand the reference period and said, “It gives you a year time frame to avoid or get over.”
Instead of thinking of whether this occurred in the past year, he was thinking of a year time period to use
another substance to get over symptoms.
All participants but one thought that it might help to have the symptoms repeated on the screen.
Participant 3000030 said that she did not think it was necessary because “If they’ve had it, it will
immediately jump in their mind when they see it.” No participants mentioned the physical symptoms when
asked what symptoms they were thinking about when hearing this question, but most participants did not
experience physical symptoms. However, participant 4000015 specifically said that she did not think the
physical symptoms she had (headaches) were to be considered for this question.
We asked participants if they preferred “to get rid of or prevent” over “to avoid or get over.” Two preferred
“to get rid of prevent,” but four preferred “to avoid or get over.” Although one person thought “prevent or
get over” sounded even better.
D-13
DR(Drug)XXb Findings
All but one participant answered “no” to this question. Participant 2000101 answered “yes,” saying that
she used marijuana again to help with anxiety. However, based on her responses during the cognitive
interview, it is more likely that she used marijuana to self-medicate her anxiety rather than use it get over
a symptom of marijuana withdrawal because she did not note that she had anxiety as a result of stopping
or cutting down in DRMJ11b.
Two participants correctly answered No, but seemed to misunderstand the intent of the question:
•
•
Participant 1000093 misunderstood the question to be asking about combining drugs and
alcohol—“I didn’t mix alcohol with medication.”
Participant 2000053 said, “I don’t use sedatives or tranqs. If I have a headache, I’d use over the
counter Ibuprofen or Advil.”
Other participants (1000030, 2000101, 2000042, 30000033, 3000055, 4000015, and 4000030) answered
“no” for at least one substance and appeared to understand the question. For example, participant
1000030 reported, “I didn’t take these to get over or stop any symptoms of alcoholism.” Participant
2000042 commented, “symptoms weren’t intense enough to require me to fix it with anything else.”
For alcohol, though, some participants seemed to be thinking about hangover symptoms instead of
withdrawal symptoms. Participant 4000015 specifically asked if the symptom list was for “withdrawals or a
hangover.” She assumed withdrawal, but said it was not clear. Participant 3000055 said, “I’ve certainly
had periods where I’ve woken up shaky, woken up hung over, . . . and I’ve had those experiences, but
they haven’t been current.”
Participant 4000030 said, “It’s a little confusing on this one.” He wondered why someone would use
alcohol again if they were on a “period of cutting down.” This stems from confusion over item 10 and
indicates that he was thinking only about intentionally cutting down and not about other periods of time
when you might go without a substance.
We probed participants on what symptoms they were thinking of when they answered this question.
People tended to answer based on the symptoms they generally associated with the substances or
symptoms they had experienced before. For example, participant 1000030 said, “Having the shakes,
physical symptoms, anxiety, symptoms from being an alcoholic.” She acknowledged that she could not
remember all of the things on the list from the previous question. Participant 1000093 said she thought
the question was asking about “pain.” The participant did not realize it was about the symptoms listed on
the previous screen. Participant 3000033 had to go back to the previous screen to look at the symptoms.
He then verified that she did not use a substance to avoid or get over those symptoms.
Similar to DRMJX1, when asked, all but one participant thought it would be helpful to include the
symptoms on this screen. Participant 3000055 said, “I think it should. My attention span isn’t as great as it
should be. I was thinking about the actual directions and if there was a little guide to the side with the F
controls for people.” The respondent was referencing the F2 help command that was mentioned during
the tutorial. Only participant 4000015 said it should not be repeated in reference to alcohol. However,
when asked DRMJX1 for marijuana, she changed her mind and said she did think the symptoms should
be listed on the screen.
D-14
Recommendations
We recommend a number of changes to these two questions to address the issues described above. At a
minimum, RTI recommends that the question shows the symptoms on the screen to ensure that
respondents think about all of the symptoms from the previous one or two questions (depending on the
substance). Second, RTI recommends that the question more clearly indicate that a respondent might
use the same substance again or a substance with a similar effect—as opposed to any substance. RTI
also recommends specifically indicating that these symptoms occur as a result of not using the
substance. Third, RTI recommends indicating that use of a similar substance is a result of “going without”
as opposed to “cutting down or stopping” because many respondents were thinking only of intentionally
cutting down or stopping and not just any time they went without the substance.
DRMJX1
[IF DRMJ11a = 1 OR DRMJ11b = 1] During the past 12 months, did you use marijuana
or hashish again or a substance with a similar effect to avoid or get over any symptoms
that might happen as a result of going without using marijuana? These symptoms include:
•
•
•
•
Pain in the stomach area, shaking or tremors, sweating, fever, chills, headache
Feeling irritable or angry
Feeling anxious
…
1
Yes
2
No
DK/REF
DRMJX2
[IF DRMJ11a = 1 OR DRMJ11b = 1] During the past 12 months, did you use marijuana
or hashish again or a substance with a similar effect to avoid any symptoms that might
happen as a result of going without using marijuana? These symptoms include:
•
•
•
•
Pain in the stomach area, shaking or tremors, sweating, fever, chills, or headache
Feeling irritable or angry
Feeling anxious
…
1
Yes
2
No
DK/REF
During cognitive testing for Round 2, cognitive testing can evaluate the following:
1. Whether it is acceptable to group physical symptoms together in one bullet or whether the
symptoms should be listed individually.
2. Whether respondents are more likely to report using similar substances compared with Round 1.
3. Whether respondents are less likely to report using substances to “self-medicate” or to get high
rather than to avoid or get over withdrawal symptoms.
4. How respondents interpret “going without” the substance, and whether they are thinking of both
intentional and unintentional times. Also, whether they are thinking of going without the substance
for long enough periods to reasonably get withdrawal symptoms.
D-15
Resolutions from SAMHSA
We agree participants need to see the symptoms again. However, the symptom list is long, especially for
marijuana, so we would like to have the list(s) in a help (F2) screen with an instruction for respondents to
press F2 to see the symptoms again. Please keep the current wording for both questions (with the
exceptions noted), and for DRMJX1, the help screen should show the list or lists the participant endorsed
in 11a/b, and the lists should be separated visually by space so that it is clear that these are two different
sets of symptoms. For DRMJX2, the help screen should include both lists of symptoms.
While we understand there are additional issues with these questions, we are concerned that the
recommended changes will increase cognitive burden and reporting error. The only changes to the
question wording that should be made include changing “experience” to “had” in DRMJX1 and adding
“again” after the substance in question as suggested in the recommendations.
We agree with items 2 and 3 from the list of issues to evaluate in Round 2, that is,
probe for substances used and probe to learn if they are reporting use to “selfmedicate” or get high rather than to avoid or get over withdrawal symptoms.
Additional Follow-up
During cognitive testing, it was noted that there was a problem in the skip patterns of these questions for
the stimulant-type drugs, which have an additional withdrawal requirement of feeling sad, blue, or
depressed. Alternate versions of these questions, which involve three versions to address the skip pattern
have been developed.
Spanish-Language Review Findings
Dr. Canino noted several translational changes for these questions. First, that “get over” is better
translated with “recuperarse de” (recover from) instead of “superar” (to beat) as it is also more easily
understood by low-income people. She also noted that there are different ways of operationalizing relief
of symptoms (which is what the criterion is about), and it is better described with the wording “get over.” In
Spanish, the translation of “get over” versus “relieve” involves two different meanings. “Get over” is
associated with “getting rid of,” with “eliminating”; “relieve” is associated with “getting better,” with
“diminishing.”
Dr. Alegría recommends revising the translation for “avoid or get over” to read “para no tener . . .” (“in
order not to have . . .”). However, Dr. Canino’s suggestion is closer to the English version.
D-16
Final Recommendation
English
For marijuana and nonstimulant types, test the following:
DRMJX1
[IF DRMJ11a = 1 OR DRMJ11b = 1] You just mentioned that you had symptoms after you
cut down or stopped using marijuana or hashish. During the past 12 months, did you
use marijuana or hashish again, or any illegal substance to avoid or get over these
symptoms?
1
Yes
2
No
DK/REF
Press F2 to see these symptoms again
DRMJX2:
[IF (DRMJ11a = 2 OR DK/REF) AND (DRMJ11b = 2 OR DK/REF)] After you cut down or
stopped using marijuana or hashish during the past 12 months, did you use marijuana or
hashish again, or any illegal substance to avoid these symptoms?
1
Yes
2
No
DK/REF
Press F2 to see these symptoms again
For stimulant types:
DRCC10b: [IF DRCC10a = 2] This question is also about the times during the past 12 months after
you cut down or stopped using [COKEFILL].
During any of those times, did you use [COKEFILL] again, methamphetamine,
prescription stimulants, or any illegal substance to avoid feeling blue or down?
1
Yes
2
No
DK/REF
DRCCX1
[IF DRCC11 = 1] You just mentioned that you had symptoms after you cut down or
stopped using [COKEFILL]. During the past 12 months, did you use cocaine or crack
again, methamphetamine, prescription stimulants, or any illegal substance to avoid or get
over these symptoms?
1
Yes
2
No
DK/REF
Press F2 to see these symptoms again
DRCCX2:
[IF DRCC11 = 2 OR DK/REF] This question is also about the times during the past 12
months after you cut down or stopped using [COKEFILL].
During any of those times, did you use [COKEFILL] again, methamphetamine,
prescription stimulants, or any illegal substance to avoid these symptoms?
1
Yes
2
No
DK/REF
Press F2 to see these symptoms again
D-17
For Spanish
Regarding deciding between “to get over” versus to “relieve,” from a pharmacological perspective, the
DSM requirement that the substance be “similar” points toward using the Spanish wording for “get over”
rather than “relieve,” which could imply using nonsimilar substances to relieve a symptom. As Dr. Canino
notes, “get over” is associated with getting rid of or eliminating. Using the same or a similar substance
would stop withdrawal symptoms by filling the physiological deficit caused by not having that substance
rather than reduce them or improve them. For this reason, “get over” may be a more accurate
operationalization. Dr. Canino’s recommendation to change “superar” to “recuperarse de” is reasonable
for “get over.” Therefore, this change has been made on all pertinent questions.
Testing versions:
DRMJXXa
[IF DRMJ11a = 1 OR DRMJ11b = 1] Usted acaba de mencionar que tuvo síntomas
después de usar menos o dejar de usar marihuana o hachís. En los últimos 12 meses,
¿usó marihuana o hachís otra vez, o alguna sustancia ilícita para evitar o recuperarse
de estos síntomas?
1
Sí
2
No
DK/REF
Presione F2 para ver estos síntomas otra vez
DRMJXXb [IF (DRMJ11a = 2 OR DK/REF) AND (DRMJ11b = 2 OR DK/REF)] Después que usted
usó menos o dejó de usar marihuana o hachís en los últimos 12 meses, ¿usó marihuana
o hachís otra vez, o alguna sustancia ilícita para evitar de estos síntomas?
1
Sí
2
No
DK/REF
Presione F2 para ver estos síntomas otra vez
DRCCXXa [IF DRCC11 = 1] Usted acaba de mencionar que tuvo síntomas después de usar menos o
dejar de usar [COKEFILL]*. En los últimos 12 meses, ¿usó usted cocaína o “crack” otra
vez, metanfetamina, estimulantes que normalmente se venden con una receta médica o
alguna sustancia ilícita para evitar o recuperarse de estos síntomas?
1
Sí
2
No
DK/REF
Presione F2 para ver los síntomas otra vez
DRCCXXb: [IF DRCC11 = 2 OR DK/REF] Esta pregunta es también acerca de las ocasiones en los
últimos 12 meses después que usted usó menos o dejó de usar [COKEFILL].
Durante alguna de esas ocasiones, ¿usó [COKEFILL] otra vez, metanfetamina,
estimulantes que normalmente se venden con una receta médica o alguna sustancia
ilícita para evitar o recuperarse de esos síntomas?
1
Sí
2
No
DK/REF
Presione F2 para ver estos síntomas otra vez
D-18
DRCCXXc: [IF DRCC10a = 2] Esta pregunta es también acerca de las ocasiones en los últimos 12
meses después que usted usó menos o dejó de usar [COKEFILL].
Durante alguna de esas ocasiones, ¿usó [COKEFILL] otra vez, metanfetamina,
estimulantes que normalmente se venden con una receta médica o alguna sustancia
ilícita para evitar sentirse deprimido o decaído?
1
Sí
2
No
DK/REF
DR(Drug)23a During the past 12 months, was there ever a time when you wanted to use [drug] so
much that you couldn’t think of anything else?
1
Yes
2
No
DK/REF
DR(Drug)23b [IF DR(Drug)23a = 2, DK/REF] During the past 12 months, was there ever a time
when you had a strong desire or urge to use [drug]?
1
Yes
2
No
DK/REF
History
DSM-5 has added a new criterion to SUDs, called “craving.” There is some discrepancy in how the
craving criterion is described in the DSM-5. In the section introduction to SUDs, craving is described as
“an intense desire or urge for the drug that may occur at any time but is more likely when in an
environment where the drug was previously obtained or used. . . . Craving is queried by asking if there
has ever been a time when they had such strong urges to take the drug that they could not think of
anything else” (APA, 2013, p. 483). Later in the chapter, the criteria tables for SUD note the criterion as
“Craving, or a strong desire or urge to use [the drug]” (APA, 2013, p. 491). Based on these two slightly
different descriptions, two versions of a “craving item” were drafted, with the second version being asked
if the respondent did not endorse the first version. The craving criterion would be met if the respondent
endorsed either. Both question wordings mirrored text used in the DSM.
Findings
All participants answered either 23a or 23a and 23b.
Overall, participants understood the language of the questions but the subjective nature of the wording
led to inconsistent responses.
For alcohol, three out of the thirteen participants endorsed 23a and most participants seemed to interpret
23a as intended (4000001, 4000030, 3000027, 1000093, 1000030, 4000015, 3000055, 2000101, and
2000042).
However, several participants (2000053, 3000038, and 3000033) interpreted 23a as being slightly more
severe than intended, interpreting it to mean strong urges to the point where the person couldn’t do
anything else rather than they couldn’t think of anything else. For example, 2000053 responded “You’re
D-19
so consumed by the thought that you just couldn’t’ do anything else, you’d go search for it, find a way to
pay for it. I just picture isolating and keeping yourself at home until you can get alcohol in some way.”
However, it is likely that these feelings, “couldn’t think of anything else” and “couldn’t do anything else,”
often occur together. For example, participant 3000033 said, “Basically, it’s saying that you had to drink
alcohol because it was all you could think about. You couldn’t get nothing else done until you had a
drink.” For one respondent (participant 300038), this interpretation that the question is asking about not
being able do anything else may have caused a false negative. She understood this question as asking
“That I wanted to drink so bad I couldn’t do nothing else.” She answered “no,” explaining that she did so
“Because it didn’t stop me from doing anything. I don’t work, but there’s a lot to do at home.”
For alcohol, 23b was endorsed by ten participants and not endorsed by only one person (3000027). For
3000027, it was clear that this was a true negative. However, responses to cognitive probing for other
participants were less clear. For example, participant 2000101 answered ‘Yes” to 23b, but when asked,
“What does the phrase ‘strong desire or urge to drink alcohol’ mean to you as it’s used in this question?”
she answered, “Immediate or small thing. For a minute or two I thought ’I'd like to go out for a drink, then
it goes away.” Similarly, only one participant who received 23b for marijuana responded “no” to this
question (2000101), and only one person who received 23b for cocaine said “no” to this question
(1000030).
For 23b, one participant (1000093) seemed to link “strong” with desire but not with urge. When asked
how they came up with their answer, they said ”Because of stress I prefer to have a glass of wine. I
definitely have urges to drink.”
These results suggest that there may be a slight risk of false negatives for the wording of 23a and a high
risk of false positives for 23b. However, interpreting these results is complicated by the vague and slightly
inconsistent description of craving in the DSM-5. False positives are a great concern for this item because
it is part of the diagnostic algorithm for scoring substance abuse symptoms, and a respondent needs only
to endorse two items to meet DSM-5 criteria for an SUD.
Cognitive testing about the meaning and use of the term ”craving” indicated that the word craving meant
different levels of severity to different people and therefore should not be used in the question wording.
Recommendations
In consultation with our clinicians (Dr. Edlund and Dr. Karg) and after reviewing the literature (specifically
“Alcohol: Science, Policy, and Public Health” by Oxford University Press which notes that: “Craving is thus
explained as pathologically amplified incentive salience in the presence of drug associated cues that
leads to an exaggerated motivation for drugs and probably to compulsive drug taking” [Sommer, 2013, p.
88]), RTI recommends replacing the word “strong” with “intense” in 23b as shown below:
During the past 12 months, was there ever a time when you had an intense desire or urge to use
[drug]?
Additionally, do not conduct further testing on the alternate version that used the word ”crave” because
there is too much variation in meaning.
D-20
SAMHSA Resolution
Keep both DR23a and DR23b as worded for Round 2. While both “intense” and “strong” are used in the
DSM-5 definition of craving, we suggest keeping the word “strong” in the question (because it is a simpler
word), but probing about the word “intense.” We agree the word “crave” should not be used in the
questions.
Spanish-Language Review Findings
DRMJ23a
En los últimos 12 meses, ¿hubo alguna ocasión cuando usted tenía tantas ganas de usar
marihuana o hachís que no podía pensar en nada más?
1
Sí
2
No
DK/REF
Dr. Canino recommended a more colloquial translation for ocasión: “hubo alguna vez”; however, this
is like saying “was there an ever when . . .” and may sound awkward.
Dr. Algerίa proposes a simplified change. She recommends saying “Alguna vez en los últimos 12 meses,
¿tuvo . . . , which is saying “At any time in the past 12 months, did you. . . .?”
DRMJ23b
[IF DRMJ23a = 2, DK/REF] En los últimos 12 meses, ¿hubo alguna ocasión cuando usted
tuvo un fuerte deseo o urgencia de usar marihuana o hachís?
1
Sí
2
No
DK/REF
Dr. Canino provided an alternate translation for this item (¿hubo alguna ocasión cuando usted tuvo un
deseo fuerte o un deseo apremiante de usar marihuana o hachis?), which she believes captures better
the intent of the question. However, like the English version a proper translation of the word urge is
crucial for this item because it is the translation of the crux of the criterion.
Dr. Alegría’s recommended alternate translation for “strong desire or urge” is “fuerte deseo o necesidad”
(strong desire or need.” However, it appears that the term “necesidad” (need) may not closely convey the
English version “urge.”
Final Recommendation
Based on the cognitive interviewing findings, SAMHSA instruction, and feedback from the Spanishlanguage expert reviewers, the English items will not be changed in Round 2 of the cognitive interviewing.
Probing for 23b will test the word intense (e.g., “During the past 12 months, was there ever a time when
you had an intense desire or urge to use [drug]?”) for the first substance endorsed. If an additional
substance is endorsed, probing will be done on a variant used in the National Longitudinal Alcohol
Epidemiology Survey, which asked respondents “During the past 12 months, was there ever a time when
you had a very strong desire or urge to use [drug]?”
D-21
Spanish-language cognitive interviewing will test a version that combines Dr. Canino and Dr. Alegrίa’s
suggestions by changing the first part of DR23a and DR23b to read “At any time in the past 12 months,
did you . . .” and revising the phrasing for “strong desire or urge” from the Spanish for “strong desire or
urgency” for DR23b to the Spanish for “strong desire or urgent desire.” The testing versions are noted
below.
DRMJ23a
Alguna vez en los últimos 12 meses, ¿tuvo tantas ganas de usar marihuana o hachís
que no podía pensar en nada más?
1
Sí
2
No
DK/REF
DRMJ23b
[IF DRMJ23a = 2, DK/REF] Alguna vez en los últimos 12 meses, ¿tuvo usted un deseo
fuerte o un deseo apremiante de usar marihuana o hachís?
1
Sí
2
No
DK/REF
Additional Documentation
Spanish language and content review produced the following suggestions for items not currently slated
for modification. These revisions are more consistent with the translation for DRMJ10, and Dr. Canino
suggested that they would be more understandable by respondents. These changes may be explored if
future revisions of NSDUH are undertaken.
DRMJ08
[IF MAR12MON = 1-3] En los últimos 12 meses, ¿quiso o trató de usar menos marihuana
o hachís o de dejar de usarlo? , ¿ quiso o trató de usar menos o dejó de usar marihuana
o hachís?
DRMJ09
[IF DRMJ08 = 1] En los últimos 12 meses, ¿logró usar menos o dejó de usar menos
marihuana o hachís o dejar de usarlo todas las veces que quiso o trató de hacerlo?
DRMJ13
[IF MAR12MON = 1-3] En los últimos 12 meses, ¿tuvo algún problema emocional, de
nervios o de la salud mental que quizá haya pudo haber sido causado o empeorado por
usar marihuana o hachís?
DRMJ14
[IF DRMJ13 = 1] ¿Continuó usando marihuana o hachís aún cuando pensaba que le
estaba causando problemas emocionales, de nervios o de la salud mental?
DRMJ15
[IF DRMJ13 = 2 OR DK/REF OR DRMJ14 = 2 OR DK/REF] En los últimos 12 meses,
¿tuvo algún problema de salud física que quizá haya pudo haber sido causado o
empeorado por usar marihuana o hachís?
DRMJ17
[IF MAR12MON = 1-3] Esta pregunta se trata de actividades importantes como trabajar, ir
a estudiar, cuidar niños o hacer cosas divertidas como pasatiempos, jugar deportes y
pasar tiempo con los amigos y la familia.
D-22
En los últimos 12 meses, ¿el usar marihuana o hachís le hizo abandonar o dedicar menos tiempo a
hacer estos tipos de actividades importantes?
DRMJ18
[IF MAR12MON = 1-3] A veces las personas que usan marihuana o hachís tienen
problemas serios en su hogar, en el trabajo o en la escuela, tales como:
•
•
•
•
descuidar de sus hijos
faltar al trabajo o a la escuela
desempeñarse mal en el trabajo o en los estudios
perder su trabajo o abandonar los estudios
En los últimos 12 meses, ¿su uso de marihuana o hachís, ¿ le causó problemas serios como esos en su
hogar, en el trabajo o en la escuela?
DRMJ19
[IF MAR12MON = 1-3] En los últimos 12 meses, ¿usaba marihuana o hachís en forma
regular y luego hacía algo que lo hubiera expuesto al algún peligro físico porque estaba
usando marihuana o hachís?
References
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.).
Washington, DC: Author.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Washington, DC: Author.
Sommer, W. H. (2013). Pathophysiology of alcohol addiction. In P. Boyle, P. Boffetta, A. B. Lowenfels, H.
Burns, O. Brawley, W. Zatonski, & J. Rehm (Eds.), Alcohol: Science, policy and public health (chapter
10). Oxford: Oxford University Press.
D-23
Appendix E: DSM-5 R2 Memo
Memo
To:
Substance Abuse and Mental Health Services Administration (SAMHSA), Center for
Behavioral Health Statistics and Quality (CBHSQ)
From:
Emily Geisen, Cristie Glasheen, Gretchen McHenry, Patty LeBaron, Jeanne Snodgrass,
Rosanna Quiroz, Mark Edlund, Rhonda Karg, Doug Currivan
Date:
August 18, 2015
Re:
DSM-5 Round 2 Cognitive Interviewing Summary and Recommendations
Purpose
The purpose of this project is to evaluate the diagnostic changes between the fourth (DSM-IV) and fifth
(DSM-5) editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and to develop and
test revisions to the substance abuse modules of the National Survey on Drug Use and Health (NSDUH)
to produce estimates of DSM-5-based substance use disorders (American Psychological Association,
1994, 2013).
After completing a review of diagnostic changes, the DSM-5 project staff revised and developed new
NSDUH items to reflect DSM-5 criteria for substance use disorders. The revisions and new items were
reviewed by substantive and methodological experts, and further changes were made. Following these
changes, draft items were tested in the first round of cognitive interviewing, which was completed on
April 23, 2015. Following that round of testing, revisions were made to the survey questions, including
obtaining Spanish translations, and a second round of English and Spanish testing was completed on
August 4, 2015. This memo provides a summary of the findings of the second round of cognitive
interviewing and recommendations for item revisions for the third round of cognitive interviewing.
Background
At the direction of SAMHSA management, DSM-5 changes are limited to the addition of a craving
question for all drugs and withdrawal questions for marijuana/hashish. For consistency, final
marijuana/hashish withdrawal symptom questions may require minor changes to symptom questions for
other substances. Any additional findings and recommendations will continue to be included for
documentation purposes. However, SAMHSA resolutions for Round 2 were limited to withdrawal and
craving assessment.
Participants
For the Round 2 English cognitive interviews, nine adult participants were recruited in Chicago, Illinois;
Research Triangle Park, North Carolina; and Portland, Oregon. Three of these adults were recruited from
E-1
a treatment facility in Chicago, and the rest were recruited via Craigslist ads. Six adolescent participants
were recruited from treatment facilities in Durham, North Carolina, and the Washington, DC, area. For the
Round 2 Spanish cognitive interviews, six adults were recruited in Research Triangle Park, North
Carolina, by posting flyers in treatment centers and conducting in-person recruitment at local Hispanic or
Latino organizations, such as community centers and Spanish grocery stores. Participants were also
recruited via word of mouth. To be eligible, participants had to report using alcohol or marijuana/hashish
at least six times in the past year; using cocaine, heroin, or methamphetamine at least once in the past
year; or misusing prescription drugs in the past year. To test new marijuana/hashish withdrawal
questions, as well as the other revised substance use dependence questions, RTI selected a majority of
marijuana/hashish users. Although participants self-reported certain drug use during the screener, they
may not have received the substance dependence module for that substance if they did not use the
substance frequently enough (alcohol or marijuana/hashish).
Table 1 presents a list of the English-speaking cognitive interview participants by demographics and the
substance dependence modules received. Throughout the findings, participants are referred to by their
CaseIDs to provide a better understanding of how participants interpreted the questions. Table 2 provides
the same information for Spanish-speaking participants.
Table 1. English Participant Characteristics
CaseID
Age
Range
Sex
Race
1000166
18-34
Male
White
1000175
18-34
Male
Other: Jewish
1000185
18-34
Male
White
9878900
35-54
Male
White
2000221
55 or
older
Female
White
4000401
12-17
Male
White
Male
Other
Male
White
2000270
4000267
55 or
older
55 or
older
Ethnicity
Education
Not
Hispanic
Not
Hispanic
Not
Hispanic
Not
Hispanic
Not
Hispanic
Not
Hispanic
High school
diploma or GED
Some college, but
no degree
High school
diploma or GED
Some college, but
no degree
Hispanic
Not
Hispanic
Not
Hispanic
Not
Hispanic
Not
Hispanic
2000289
18-34
Female
White
3000102
12-17
Male
Black or African
American
2000356
55 or
older
Female
White
3000101
12-17
Male
White
Hispanic
3000103
12-17
Male
3000104
12-17
Female
Black or African
American
Black or African
American
4000402
12-17
Male
Not
Hispanic
Not
Hispanic
Not
Hispanic
White
E-2
Graduate degree
High school or
less
Associate’s
degree
Some college, but
no degree
Received Substance Dependence
Modules for:
Alcohol, marijuana/hashish, illegal
drugs, and prescription drugs
Alcohol, illegal drugs, and
prescription drugs
Alcohol, marijuana/hashish, illegal
drugs, and prescription drugs
Alcohol, marijuana/hashish, and
prescription drugs
Alcohol, marijuana/hashish, illegal
drugs, and prescription drugs
Alcohol, marijuana/hashish, and
illegal drugs
Alcohol and marijuana/hashish
Alcohol, marijuana/hashish, and
illegal drugs
Graduate degree
Alcohol and marijuana/hashish
High school or
less
Alcohol and marijuana/hashish
Bachelor’s degree
Alcohol
High school or
less
High school or
less
High school or
less
High school or
less
Alcohol, marijuana/hashish, and
prescription drugs
Alcohol, marijuana/hashish, and
prescription drugs
Alcohol, marijuana/hashish, and
prescription drugs
Alcohol, marijuana/hashish, and
illegal drugs
Table 2. Spanish Participant Characteristics
Sex
Ethnicity
Country of
Origin
Education
Received Substance Dependence
Modules for:
Male
Hispanic
Peru
High school
Alcohol
Male
Hispanic
El Salvador
Alcohol
18-54
Female
Hispanic
Mexico
Some college
Less than high
school
5000004
18-54
Male
Hispanic
Mexico
5000005
18-54
Male
Hispanic
Mexico
5000006
55 or
older
Male
Hispanic
Mexico
5000002
Age
Range
55 or
older
18-54
5000003
CaseID
5000001
Some college
Less than high
school
Less than high
school
Alcohol
Alcohol, marijuana/hashish, and illegal
drugs
Alcohol and marijuana/hashish
Alcohol and marijuana/hashish
Organization
The findings of Round 2 cognitive interviewing are organized as follows:
•
•
•
•
question text,
brief background of the revision/addition,
English and Spanish cognitive interview findings, and
recommendations.
DR(DRUG)10
During the past 12 months did you cut down or stop [using Drug] at least one time?
History
This question is a revised version of the existing NSDUH question DR(DRUG)10: “During the past 12
months did you cut down or stop [using Drug] at least one time?” This item is used as part of the skip
pattern to determine who will receive the withdrawal symptom questions. During review of the NSDUH
items, concern was raised that the items immediately preceding this question may create a context effect,
in which people are considering only times that they intentionally cut down on using a substance and not
times that they went without for other reasons (e.g., they ran out of money or had to work). The phrase
“whether you wanted to or not” was added in Round 1 to try to prompt individuals to think about these
other times.
However, results from Round 1 revealed that the phrase “whether you wanted to or not” was confusing to
participants, particularly adolescents. For Round 2, the phrase was removed and the original question
wording was used.
English Findings
Overall, 10 participants answered this question for alcohol, 9 for marijuana/hashish, 5 for cocaine, 1 for
heroin, 2 for prescription pain relievers, 1 for prescription tranquilizers, and 1 for prescription sedatives.
E-3
In general, people understood the wording of the DR(DRUG)10 question. This is an improvement
compared with Round 1, in which some participants found the “whether you wanted to or not” clause to
be confusing. However, the majority of participants reported that they were thinking only of intentional
times of cutting down or quitting when they answered this question. For example:
•
•
•
•
1000166 reported the clause to mean “Did I try [to cut down/quit] and was I successful?”
1000175 said that the question meant “consciously stop or lessen.”
3000104 said “It means basically did you try to stop drinking, like not use it anymore.”
2000270 said “It’s asking me if I tried to smoke less weed in the past year.”
The 15 participants in Round 2 were probed on this item for 29 substances. In 12 instances, participants
provided information indicating that they were thinking only about times they went without intentionally.
Notably, when participants with polysubstance use were probed a second time on the wording of this
question, most recognized the actual intent of this question and also considered times that they went
without for any reason. Their understanding was likely an artefact of the cognitive interview process, as
interviewers specifically probed people on whether they went without using the substance for any reason.
For the majority of participants, alcohol was the first substance discussed, and of the 10 alcohol
responses, 6 respondents reported thinking only about intentional times.
Furthermore, several participants did not think to include visits to rehabilitation as times they cut back or
stopped using a substance. This pattern was also seen in Round 1. For example, 4000401 answered “no”
to DRALC10 but then reported having been in rehabilitation for 2 months and not being able to drink at all
during that time. The participant did not recall that time because he was thinking only about his behavior
“normally.” A similar response was noted for the same participant on DRMJ10, for which he did not report
the 2 months of rehabilitation as a time of cutting down or stopping.
There are two concerns regarding the misinterpretation of the question. The first concern is that a
respondent who does not endorse this item but should do so is not asked the withdrawal question(s),
which may lead to a false negative (technically, a lost endorsement) for withdrawal symptoms. However, if
casual users who do not have a history of heavy or prolonged use endorse this item and then
misunderstand and misreport withdrawal symptoms (the 11 questions), they may have a false positive for
withdrawal symptoms that could have been avoided if they had not endorsed DR(DRUG)10.
Of the 12 “no” responses to the DR(DRUG)10 question, participants indicated in each case that they had
gone without the drug at some point. For 9 out of the 12 instances, participants indicated infrequent or
sporadic use, suggesting that they did not have heavy or prolonged use and would not meet the level to
induce withdrawal.
Despite these participants’ answer of “no” to the question, cognitive interviewers instructed them to
change their answer to “yes” in order to receive the withdrawal questions. Of these nine cases, no
participants reported withdrawal symptoms, indicating that if these participants had answered “yes” to
DR(drug)10 initially, the response would not have led to false positives.
The three instances in which infrequent intensity was not reported were for the same adolescent
participant, who reported withdrawal for all three substance (4000401 for alcohol, marijuana/hashish,
cocaine). Moreover, the participant noted that he was an “addict” or “pothead” or volunteered the word
“withdrawal” when being asked about symptoms.
E-4
A modified version of DR(DRUG)10 was also probed. The probe asked, “If this question had asked,
‘During the past 12 months, did you go without drinking alcohol at least one time, for any reason?’ how
would you have answered? Why?” Although the interpretation of this question must be tempered because
of potential context effects from the prior probing, some responses were promising.
For example, one participant (4000267) who interpreted the initial DR(DRUG)10 question to mean asking
about intentional times of stopping quitting responded, “If you said, ‘Go without for any reason’ the
question would be pointless.” Further probing indicated that he thought it would be pointless because
“you’re no longer asking about the decision, the conscious choice, not to drink,” which is exactly the
purpose of the rewording.
However, one respondent noted that the alternate version of DR(DRUG)10 did not ask about cutting
back, a limitation that would need to be addressed.
In summary, although most participants interpreted the question to be asking about cutting back or
stopping use of the substance intentionally, only one participant provided a false negative for withdrawal,
and it was for three substances.
Spanish Findings
Of the six Spanish-speaking participants, only two received question 10. They received the question for
both alcohol and marijuana/hashish.
For alcohol, both participants answered “yes,” indicating that they tried to stop drinking briefly. Participant
5000004 said, “I tried doing it [cutting down/stopping] once. I normally drink beer after work, when I’m
stressed. But when I have free time and I’m not stressed, I stop drinking.” Participant 5000005 said,
“Because I took a break from drinking a couple of days.”
For marijuana/hashish, participant 5000004 said “no,” indicating that “the question is more about if I were
an addict, but I’m not. I use it three times per week.” Therefore, because he considered himself an
infrequent user without a need to cut down or stop, he answered “no.” However, it is unlikely that this
person suffered withdrawal symptoms due to his infrequent use.
Participant 5000005 answered “yes” and said, “I wasn’t smoking the same amount because I couldn’t get
it. . . . I didn’t have any money. I couldn’t afford it.” Interestingly though, when interviewers asked if the
question was asking about any time he went without using marijuana/hashish for a while or just the times
he wanted to cut down or stop, he said it was asking about the times he wanted to stop smoking.
When asked how they would answer the alternate question about going “without the substance for at
least one time,” the participants said that their answers would be the same in all four instances.
Recommendations
The third round of cognitive interviewing will be the last opportunity to test potential variants. Although
only one participant provided a false negative, the fact that most people interpreted the question to ask
about intentionally cutting back or stopping remains a concern.
E-5
One possibility is to keep item DR(DRUG)10, because it is an existing item, but eliminate the skip pattern
for withdrawal items so that all respondents in the substance abuse modules receive the withdrawal
questions. On the basis of results from Round 2, it does not appear that having infrequent users receive
the withdrawal questions leads to false positives. Round 3 can be used to verify whether this change
results in any false positives for the withdrawal symptom questions. Although two or three additional
questions would be asked per respondent per substance, the change might improve overall reporting.
SAMHSA decision: Keep DR(Drug)10 as is, with current skip pattern.
DRMJ11a
[IF DRMJ09 or DRMJ10 = 1] Please look at the symptoms listed below. During the past
12 months, did you have any of these symptoms after you cut down or stopped using
marijuana or hashish?
•
•
•
•
•
•
Stomach ache
Shaking or tremors
Sweating
Fever
Chills
Headache
1
Yes
2
No
DK/REF
DRMJ11b
[IF DRMJ09 or DRMJ10 = 1] During the past 12 months, did you have [IF DRMJ11a = 1
then fill 2, IF DRMJ11a = 2, DK/REF then fill 3] or more of these symptoms after you cut
down or stopped using marijuana or hashish?
•
•
•
•
•
•
Feeling irritable or angry
Feeling anxious or nervous
Having trouble sleeping
Losing your appetite or losing weight without trying to
Feeling like you couldn’t sit still
Feeling depressed
1
Yes
2
No
DK/REF
History
DSM-5 added a withdrawal syndrome to the marijuana use disorder criteria. Symptoms are broken into
two groups (physical and psychological). Respondents must have three or more symptoms, one of which
can be from the physical symptom list. Even if a respondent has all of the physical symptoms, the
response counts as only one of the three symptoms needed to meet the marijuana syndrome criteria.
This complexity required the use of two questions to assess this criteria. If respondents endorse 11a, the
fill for 11b is 2; otherwise, the 11b question requires a 3.
E-6
Overall these questions worked well in Round 1, and only minor revisions were recommended for
Round 2:
•
•
•
DRMJ11a: Changed “pain in the stomach area” to “stomach ache.”
DRMJ11b: Changed “feeling anxious” to “feeling anxious or nervous,” which more accurately
represents the DSM-5 criteria.
Bolded the number of symptoms to better emphasize to respondents how many are required.
DRMJ11a and DRMJ11b English Findings
Nine participants were asked about marijuana/hashish withdrawal symptoms in 11a and 11b. Three
people endorsed the physical symptoms of withdrawal in 11a, and five endorsed the psychological
symptoms in 11b.
All participants reported understanding both 11a and 11b, although one participant (3000103) reported
that he was thinking about anxiety when answering 11a, which was not a symptom listed until 11b.
However, this participant did experience other marijuana/hashish withdrawal symptoms listed in 11a, so
the response did not result in a false positive for marijuana/hashish withdrawal.
In addition, interviewers were asked to verify that participants were counting the correct number of
symptoms to endorse 11b, because incorrect responses emerged as a problem in the first round of
cognitive interviewing. This time, participants appeared to be indicating the correct number of symptoms,
probably as a result of the bolding added to the number of symptoms in the question text.
Although withdrawal questions for other substances were not specifically tested, one participant
(4000401) answered “yes” to the withdrawal question for alcohol, although he had only one symptom and
not two. This did not appear to be an issue for any other substances.
When asked about the use of the word “symptom” as opposed to a feeling or experience, most
participants said that they would respond the same way to either wording. However, participant 1000166
indicated that “symptom” better linked the list to the act of cutting down or quitting, and participant
9878900 reported, “An ‘experience’? That doesn’t sound like something that happened continuously; it is
a shortened episode, not constant. ‘Feelings’ is not a good word for it.”
Conversely, participant 4000401 said, “Maybe the second one [experience]. ‘Symptoms’ sounds like you
have a problem. Maybe by ‘experiences,’ it’s less like you’re putting a label on it.” Another participant
(3000101) expressed a similar sentiment: “’Did you experience’ is better. ‘Symptoms’ doesn’t sound like
the correct terminology to use. Why? When I think of symptoms, it’s like a serious disease. Are these
feelings or experiences themselves not very serious or is cutting down using marijuana/hashish not very
serious? ‘Cutting down’ isn’t serious.”
Regarding the use of the term “feelings,” participant 3000101 said, “I don’t consider those feelings.”
Among those who expressed a preference, “symptoms” and “experiences” were unanimously preferred
over “feelings.”
E-7
DRMJ11a and DRMJ11b Spanish Findings
Only two Spanish participants (5000005 and 5000006) received this question for marijuana/hashish. One
participant answered “no” to both symptom questions, and the other participant answered “yes” to both
symptom questions.
The participant (5000005) who answered “no” thought that the language for the symptoms was clear and
preferred the term “síntomas” (symptoms) rather than “algunas de estas cosas” (any of these things).
When probed about whether the symptoms were “síntomas abstinencia” (abstinence or withdrawal
symptoms), he did not know the word “abstinencia” and was not able to answer even with additional
probing. However, the word “abstinencia” was used only in probing, not in the actual question.
The participant (5000006) who answered “yes” thought that the language for the symptoms was clear but
noted that “dolor de cuerpo” (body aches) was not listed as a symptom, although he experienced them
because of withdrawal.
Recommendations
The recommendation for these items is to keep the wording the same. Although some participants
preferred the word “experience,” no participants volunteered that “symptoms” was problematic. Changing
the term could lead to false positives if participants interpret experiences more loosely than symptoms.
SAMHSA decision: Keep the wording as is for these items.
DR(DRUG)X1 (STIMULANTS AND NONSTIMULANTS)
[IF DRCC11 = 1] You just mentioned that you had symptoms after you cut down or stopped using
[COKEFILL]. During the past 12 months, did you use cocaine or crack again, methamphetamine,
prescription stimulants, or any illegal substance to avoid or get over these symptoms?
1
Yes
2
No
DK/REF
DR(DRUG)X2 (STIMULANTS)
[IF DRCC11 = 2 OR DK/REF] This question is also about the times during the past 12 months after you
cut down or stopped using [COKEFILL].
During any of those times, did you use [COKEFILL] again, methamphetamine, prescription stimulants,
or any illegal substance to avoid these symptoms?
1
Yes
2
No
DK/REF
DR(DRUG)X2 (NONSTIMULANTS)
[IF (DRMJ11a = 2 OR DK/REF) AND (DRMJ11b = 2 OR DK/REF)] After you cut down or stopped using
marijuana or hashish during the past 12 months, did you use marijuana or hashish again, or any illegal
substance to avoid these symptoms?
1
Yes
2
No
DK/REF
E-8
DR(DRUG)10b (STIMULANTS ONLY)
[IF DRCC10a = 2] This question is also about the times during the past 12 months after you cut down
or stopped using [COKEFILL].
During any of those times, did you use [COKEFILL] again, methamphetamine, prescription stimulants,
or any illegal substance to avoid feeling blue or down?
1
Yes
2
No
DK/REF
History
DSM-5 criteria indicate that people can meet criteria for withdrawal by either having the symptoms of
withdrawal syndrome (assessed in the DR(DRUG)11 questions) or using the substance or a
pharmacologically similar substance to avoid, prevent, or get over the symptoms of withdrawal syndrome.
This question has never been assessed in NSDUH. Two versions were proposed: (a) one for those who
endorsed symptoms, and (b) one for those who did not. This question is vital to (1) identify people who
never experienced withdrawal because they prevented it by using a replacement substance, and
(2) identify people who may not have had enough symptoms to meet the criteria for withdrawal syndrome
because they went back to using the substance to avoid the symptoms (e.g., someone has only two of
three required symptoms because they started using again before they developed a third symptom).
Results from Round 1 revealed that respondents did not understand the question consistently to mean
using a similar substance pharmacologically to get over or avoid symptoms. Many respondents provided
responses indicating that they used a substance to get high (e.g., if they could not get their substance of
choice, they would use an alternate substance) or to self-medicate. To address this confusion, the
following changes were made to X1 and X2:
•
•
•
•
•
X1: Changed “you experienced symptoms” to “you had symptoms.”
X1/X2: Added the word “again” after the substance of interest; for example, “During the past 12
months, did you use marijuana or hashish again, or. . . .”
X1/X2: Bolded the phrase “avoid or get over” or “avoid”
X1/X2: Provided an F2 hot key so that they could see all symptoms again, if needed.
X2: Added the phrase “After you cut down or stopped using [substance].”
The Round 2 cognitive interviews also identified a skip pattern problem with stimulant-type drugs
(cocaine/crack, methamphetamine, and prescription stimulants). If respondents indicated that they did not
have sadness or depression (e.g., “yes” to question 10a), they were skipped out of the withdrawal
questions. To address this problem, question 10b was added for stimulant substances only.
DR(DRUG)X1 Findings (Stimulants and Nonstimulants)
Thirteen participants (1000166, 1000175, 1000185, 2000221, 2000270, 2000356, 3000101, 3000102,
30000103, 30000104, 4000401, 4000402, and 9878900) answered question DR(DRUG)X1 for a total of
21 substances. In 13 instances, respondents answered “yes,” and in the remaining 8 instances,
respondents answered “no.”
E-9
Of the 13 “yes” responses, most respondents appeared to answer the question correctly. They used
another substance to avoid or get over the withdrawal symptoms they indicated having, and the
substance used was pharmacologically similar. One exception to the “pharmacologically similar” rule is
that one respondent who reported “trouble sleeping” as an alcohol withdrawal symptom reported using
marijuana/hashish to help him sleep. Although these substances are not pharmacologically similar,
trouble sleeping is a withdrawal symptom for both, so it seems reasonable that one would use either
substance to get over or avoid that symptom.
For three participants (1000166 for alcohol, 3000103 for marijuana/hashish, 3000104 for
marijuana/hashish) who answered “yes,” it was hard for them to determine if they used another substance
specifically to get over withdrawal symptoms or simply to get high again. Often it was for both reasons:
when they were high, they did not have withdrawal symptoms.
One participant (4000401 for alcohol) indicated that he has severe anxiety and often uses substances to
help with the anxiety. When he stops using the substance, he has anxiety, but it is unclear to him whether
the anxiety is a withdrawal symptom. He answered “yes” to the question indicating that he takes other
substances to help with the anxiety when he is not drinking alcohol.
Only two participants (3000101 for marijuana/hashish and 2000221 for methamphetamine) answered
“yes” who clearly should not have done so. In both cases, the participants indicated that they used
another substance only after stopping, not to get over or avoid symptoms. Although these participants
answered incorrectly, the responses would not lead to false positives for withdrawal because they already
answered “yes” to the withdrawal symptom questions.
Participants who answered “no” appeared to understand the question. They noted that their symptoms
were not bad enough to use another substance or they suffered through the symptoms. For example,
2000356 said, “I just sat around and was anxious. I didn’t drink alcohol or take the sedatives or pain
killers or whatever.”
None of the participants who received this question pressed F2 to see the symptoms. When asked what
symptoms they were thinking of, most participants responded with the specific symptoms they had
indicating having or indicated that they were thinking of “general withdrawal symptoms.” A couple of
participants mentioned symptoms that were not specifically listed for the substance or general feelings,
such as “feeling sideways,” “feeling heavy,” or “flu-like symptoms.” Some participants who used multiple
substances seemed to think of all the withdrawal symptoms they might have experienced, not just ones
associated with the specific substances being mentioned.
DR(DRUG)X2 Findings (Stimulants and Nonstimulants)
Eight participants (1000166, 1000175, 2000270, 2000289, 3000101, 3000102, 4000267, and 4000402)
answered question DR(DRUG)X2 for a total of 14 substances. Only one participant answered “yes” for
one substance. All other responses were “no.”
One participant (1000166 for marijuana/hashish) answered “yes,” but clarified that he was on
marijuana/hashish or opiates every day, so he would not know whether he had symptoms. Therefore, this
response seems to be a false positive, because he did not take other substances specifically to avoid
withdrawal, although that might have been an outcome of continual substance use.
E-10
The remaining participants answered “no.” However, some participants (1000175, 4000267) seemed
confused by the question, noting that they did not have any symptoms. Participant 4000267 said, “If you
said ‘no’ on the previous question, it would follow that this would be ‘no.’” He did not understand how you
could say “yes” to avoid symptoms if you did not have any symptoms.
Two participants (2000270, 4000402) seemed to base their answers on whether they used the
substances mentioned, not on the use of these substances to avoid symptoms. When asked why he
answered “no,” participant 2000270 said, “I don’t use prescription sedatives or tranquilizers.” During
probing he noticed the “illegal substances” clause and commented that he smoked cannabis (which is not
considered a pharmacological substance), but that he was living in Washington state and it was not illegal
there. Participant 4000402 said, “I’ve never used prescription sedatives or tranquilizers.” He thought the
question was asking, “Did you use prescription sedatives or tranquilizers to cut down or stop drinking
alcohol in the past 12 months?”
None of the participants pressed F2 when answering the question.
Two versions of this question were tested: one for stimulants and one for non-stimulants. The stimulants
version includes the extra sentence, “This question is also about the times during the past 12 months
after you cut down or stopped using [substance].” There did not appear to be a difference in
understanding between these two versions.
DR(DRUG)10b Findings (Stimulants Only)
Only four participants (1000175, 4000402, 4000166, 4000267) answered this question about four total
substances. Three participants answered “yes,” and one answered “no.”
All participants who answered “yes” answered incorrectly, according to the DSM-5 criteria for this
question. Participant 1000175 answered “yes” and said, “I used other drugs but that was unrelated to
stimulants. I did not use them in the same time frame.” Participant 4000402 answered “yes” because he
had smoked marijuana/hashish 20 minutes after using cocaine to lower his heart rate, so that his heart
would not beat too fast while using cocaine. Participant 1000166 initially answered “no,” but changed his
answer to “yes.” He indicated that he took heroin to avoid wanting to take cocaine. These cases would be
considered false positives for withdrawal.
Participant 4000267 appeared to understand the question. He noted that he did not have symptoms when
he used cocaine in the past 12 months but that he had these symptoms when he used cocaine frequently
in his youth. He referred to this as a “hair of the dog” question—using a bit of the substance taken initially
to help one feel better.
None of the participants pressed F2 when answering the question.
Spanish Findings
Five of the Spanish-speaking participants received DRALCX1 for alcohol. All but one participant
(5000005) answered “no.” Participant 5000005 answered “yes,” correctly indicating that when he cut
back, he experienced nervousness and anxiety and that he drank again soon after stopping and did not
have the symptoms. Of the four participants who answered “no,” three (5000006, 5000004, and 5000001)
received the question by error because they answered “yes” to DRALC11, thinking of symptoms from
E-11
drinking too much rather than symptoms of withdrawal. As a result, they did not fully understand the intent
of DRALCX1. The fourth participant (5000002) understood the question but answered “no” because he
“didn’t get to that point” of needing to drink again to get over his symptoms of hand trembling and anxiety.
One participant received DRALCX2 and indicated “no” because he had those symptoms (vomiting,
headache, feeling sleepy) whether he drank or not. This response suggests that he did not understand
DRALC11 to be asking about symptoms of withdrawal.
One participant received DRMJX1, and one participant received DRMJX2 for marijuana/hashish. Neither
participants had difficulty with these questions for marijuana/hashish. One participant (5000006) did not
remember the marijuana/hashish symptoms, but this participant indicated not having any symptoms and
not smoking again when he stopped.
Recommendations
There were six instances in which English-speaking participants provided false positives to
DR(DRUG)X1, DR(DRUG)X2, or DR(DRUG)10b. Most of these false positives were likely due to the
length and complexity of the question. Participants likely formed their answer before fully reading/hearing
the entire question. The question is complex in that it asks respondents to (1) think about when they
stopped or cut back in the past 12 months, (2) whether they used the substance again or another
substance, and (3) whether they used that substance to avoid or get over symptoms.
One possible solution is to revise the question text so that avoiding or getting over symptoms is
mentioned before use of other substances. For example, “In order to avoid or get over these symptoms,
did you use marijuana/hashish or hashish again, or any illegal substance?”
Another recommendation is to remove the extra sentence that was used for the stimulants version of the
question to reduce the overall length of the question.
For DR(DRUG)X2 and DR(DRUG)10b only, the recommendation is to revise “avoid” to “prevent.” This
change may help with participants’ confusion about never having had the symptoms. “Avoid” implies
having the symptoms at some point, which many respondents did not. “Prevent,” on the other hand,
implies that the symptoms are a possibility but does not imply having had them. The phrase “to get rid of
or prevent” was tested for DR(DRUG)X1, but the use of “prevent” on DR(DRUG)X2 was not tested. Given
that X2 is for respondents who do not have symptoms, the use of “prevent” might make more sense on
this question. For DR(DRUG)X1, the recommendation is to keep “avoid or get over” because this wording
was not problematic.
SAMHSA decision: Agree with using “prevent” rather than “avoid” for X2 and 10b. Please keep all other
wording as is, but recommend testing these changes to X1 and X2: for X1 and X2, test dropping “During
the past 12 months” in the second sentence of X1 and the first sentence of X2, and probe to find out if
participants are still thinking about that time frame. Show the 12-month calendar on the screen, if
possible, as a reminder.
E-12
For example:
DRMJX1
[IF DRMJ11a = 1 OR DRMJ11b = 1] You just mentioned that you had symptoms after you
cut down or stopped using marijuana or hashish in the past 12 months. In order to avoid
or get over these symptoms, did you use marijuana or hashish again, or any illegal
substance?
1
Yes
2
No
DK/REF
Press F2 to see these symptoms again
DRMJX2
[IF (DRMJ11a = 2 OR DK/REF) AND (DRMJ11b = 2 OR DK/REF)] In order to prevent
having any of these symptoms after you cut down or stopped using marijuana or hashish
in the past 12 months, did you use marijuana or hashish again, or any illegal substance?
1
Yes
2
No
DK/REF
Press F2 to see these symptoms again
DRST10b
[IF DRCC10a = 2] In order to prevent feeling blue or down after you cut down or stopped
using [COKEFILL] in the past 12 months, did you use [COKEFILL] again,
methamphetamine, prescription stimulants, or any illegal substance?
1
Yes
2
No
DK/REF
Press F2 to see these symptoms again
Furthermore, although participants did not tend to press the F2 button, this button should be kept for now.
In Round 3, we recommend probing participants more specifically on whether they noticed the button and
whether they would prefer that the symptoms be listed on the screen.
SAMHSA decision: Agree to keep the F2 key, and if RTI has other ideas for
probing/reminding participants about the specific symptoms, please include these.
Although the Spanish-speaking participants seemed to have difficulty with these questions for alcohol, the
problem appeared to be due to an issue with DRALC11, which asks about alcohol withdrawal symptoms.
Participants misunderstood the question to be asking about symptoms of drinking too much or symptoms
they get when they drink. A similar problem was noted with English-speaking adolescents in Round 1.
Because DRALC11 is not listed under the current directive, no recommendations or improvement can be
made at this time.
DR(DRUG)23a During the past 12 months, was there ever a time when you wanted to use [drug] so
much that you couldn’t think of anything else?
1
Yes
2
No
DK/REF
E-13
DR(DRUG)23b [IF DR(DRUG)23a = 2, DK/REF] During the past 12 months, was there ever a time
when you had a strong desire or urge to use [drug]?
1
Yes
2
No
DK/REF
History
DSM-5 added a new criterion to substance use disorders, called “craving.” There is some discrepancy in
how the craving criterion is described in DSM-5. In the introduction to substance use disorders (APA,
2013, p. 483), craving is described as “an intense desire or urge for the drug that may occur at any time
but is more likely when in an environment where the drug was previously obtained or used. . . . Craving is
queried by asking if there has ever been a time when they had such strong urges to take the drug that
they could not think of anything else.” Later in the chapter, the criteria tables for substance use disorder
note the criterion as “craving, or a strong desire or urge to use [the drug].” On the basis of these two
slightly different descriptions, two versions of a craving item were drafted, with the second version being
asked if the respondent did not endorse the first version. The craving criterion would be met if the
respondent endorsed either version. Both question wordings mirrored text used in DSM-5.
Results from Round 1 revealed that some respondents may be interpreting the DR(DRUG)23a question
too severely (i.e., couldn’t do anything else) and that the DR(DRUG)23b question may be getting a
number of false positives.
No revisions were made to these questions, but the probing strategy was revised to determine whether
these questions suffered from false negatives or false positives.
English Findings
All participants answered either 23a or 23a and 23b.
Overall, participants appeared to understand question 23a without a problem. Several participants who
answered “yes” provided responses that clearly indicated they could not think of anything else. Participant
4000402 said, “In the past, I’ve had experiences where I can’t think of anything besides marijuana.”
Participant 4000401 said, “Was there ever a time when every cell of your body wanted to use cocaine
and you couldn’t get it out of your head until you used it?”
Four participants (2000221, 1000166, 1000185, 2000289) described this experience as “craving.” Two
participants indicated that it was “obsession” (2000270, 2000221). Both participants indicated that being
“obsessed” with something is the same as not being able to think of anything else.
One participant (1000175) initially answered “no” and then changed his mind to “yes,” indicating that
when he was actually using cocaine, all he could think about was using more. However, it did not occupy
his thoughts in the same way when he was not using it.
In Round 1, there was some concern that participants interpreted the question slightly more severely than
intended. In Round 2, cognitive interviewers were instructed to probe on these comments further. Further
probing revealed that participants understood the question as intended. For example, one participant
E-14
(3000104) said that the question meant “you couldn’t think about nothing else or do nothing else besides
getting drunk.” The interviewer probed on this response, and the respondent said, “I think people can
have alcohol on their mind and still do stuff.” The participant understood that the question was asking
about both (or either) of those situations (can’t think of anything else or can’t do anything else).
For 23b, participants seemed to differ in their view of the intensity of the question. When participants
answered “yes,” they tended to indicate that it was because they “really wanted to do it,” “look forward to
it,” or “really enjoyed it.” When participants answered “no,” they tended to indicate that they did not use
the substance that much, were not an addict, or were not obsessed. One participant said “no,” meaning
that the question was asking about needing to “right away.”
Interviewers asked participants what they thought about the phrase “very strong desire or urge” to drink
alcohol. Regardless of how they answered 23b, about half of the participants indicated that this wording
was more or less the same as “strong desire or urge” and would not change their answer. Other
participants said that it sounded stronger. Participant 3000103 said that it sounded worse: “Almost like
you’re trying to say you’re addicted to it or something.” Participant 4000401 said that it was worse: “I feel
like that cuts out some of the times where I wanted to drink but it wasn’t so intense where I would rob a
store just to get money for alcohol.” Participant 1000166 said that a very strong desire or urge was closer
to a need than a want.
Spanish Findings
All six participants received 23a for alcohol, and three participants received it for marijuana/hashish. All
participants appeared to understand 23a without difficulty.
Five participants received 23b for alcohol, and two received it for marijuana/hashish. None of the
participants who received the question understood “deseo apremiante” (pressing desire), which was the
translation recommended for “urge.” Participants recommended alternate wording such as “necesidad
urgente” (urgent need), “deseo immediate” (immediate desire), “deseo intense” (intense desire), and
“deseo urgent” (urgent desire). All participants understood “deseo fuerte” (strong desire) as intended.
Recommendations
The recommendation is to keep 23a as is, because it appears to be working well.
For 23b, comments such as “really wanted to” suggest that participants are not interpreting this question
as strongly as they should because the DSM-5 criteria suggest an “exaggerated motivation” for the
substance. However, the use of “very strong” compared with “strong” did not seem to be any different for
many participants.
One possibility is to put the word “strong” before both “desire” and “urge,” because some people may be
reading it as simply an urge to use the substance—not necessarily a strong urge.
DRMJ23b
[IF DR(DRUG)23a = 2, DK/REF] During the past 12 months, was there ever a time when
you had a strong desire or a strong urge to use marijuana or hashish?
E-15
Another possibility is to ask only about a strong urge and not a strong desire, which many people
interpreted as “really wanting.”
DRMJ23b
[IF DR(DRUG)23a = 2, DK/REF] During the past 12 months, was there ever a time when
you had a strong urge to use marijuana or hashish?
SAMHSA decision: Use this version (above), i.e., “strong urge.”
A third possibility is to ask about an “intense desire” and a “strong urge.”
DRMJ23b
[IF DR(DRUG)23a = 2, DK/REF] During the past 12 months, was there ever a time when
you had an intense desire or a strong urge to use marijuana or hashish?
For the Spanish translation, the recommendation is to replace “deseo apremiante” (pressing desire) with
an alternate phrase. Following are some possible solutions:
•
•
“deseo fuerte o la necesidad de . . .” (strong desire or the need to . . .”). The word “necesidad”
(need) was initially recommended by Dr. Alegría. However, there was concern that the term
“necesidad” (need) did not adequately convey “urge.”
“deseo fuerte o ansias de . . .” (strong desire or longing to . . .”). Note that the term “ansias”
means an “excessive” type of desire in Spanish.
References
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.).
Washington, DC: Author.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Washington, DC: Author.
E-16
Appendix F: DSM-5 R3 Memo
Memo
To:
Substance Abuse and Mental Health Services Administration (SAMHSA), Center for
Behavioral Health Statistics and Quality (CBHSQ)
From:
Emily Geisen, Cristie Glasheen, Gretchen McHenry, Patty LeBaron, Jeanne Snodgrass,
Rosanna Quiroz, Mark Edlund, Rhonda Karg, Doug Currivan
Date:
October 28, 2015
Re:
DSM-5 Round 3 Cognitive Interviewing Summary and Recommendations
1.
Purpose
The purpose of this project is to evaluate the diagnostic changes between the fourth (DSM-IV) and fifth
(DSM-5) editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and to develop and
test revisions to the substance abuse modules of the National Survey on Drug Use and Health (NSDUH)
to produce estimates of DSM-5-based substance use disorders (SUDs) (American Psychiatric
Association [APA], 1994, 2013).
After completing a review of diagnostic changes, the DSM-5 project staff revised and developed new
NSDUH items to reflect DSM-5 criteria for SUDs. The revisions and new items were reviewed by
substantive and methodological experts, and further changes were made. Following these changes, draft
items were tested in the first round of cognitive interviewing, which was completed on April 23, 2015.
Following that round of testing, revisions were made to the survey questions, including obtaining Spanishlanguage translations, and a second round of English- and Spanish-language testing was completed on
August 4, 2015. Following the second round of testing, revisions were made to the English- and Spanishlanguage survey questions, and a third and final round of testing of the English-language questionnaire
was completed on September 24, 2015. The final round of testing on the Spanish-language questionnaire
was completed on October 5, 2015.
This memo provides a summary of the findings of the third round of cognitive interviewing and
recommendations for item revisions for use in the 2017 NSDUH.
2.
Background
At the direction of Substance Abuse and Mental Health Services Administration (SAMHSA) management,
DSM-5 changes are limited to the addition of a craving question for all drugs and withdrawal questions for
marijuana/hashish. For consistency, final marijuana/hashish withdrawal symptom questions may require
minor changes to the symptom questions for other substances. Any additional findings and
recommendations will continue to be included for documentation purposes. However, SAMHSA
resolutions for Round 2 were limited to withdrawal and craving assessment.
F-1
3.
Participants
For the Round 3 English-language cognitive interviews, 10 adult participants were recruited in Chicago,
Illinois; Research Triangle Park, North Carolina; and Portland, Oregon. One of these adults was recruited
from a treatment facility in Chicago, and the rest were recruited via Craigslist advertisements. Four
adolescent participants were recruited from treatment facilities in Durham, North Carolina, and in the
Washington, DC, area.
For the Round 3 Spanish-language cognitive interviews, six adults were recruited in Research Triangle
Park, North Carolina, by posting flyers in treatment centers and conducting in-person recruitment at local
Hispanic or Latino organizations, such as community centers and Hispanic grocery stores. Participants
were also recruited via word of mouth.
To be eligible, participants had to report using alcohol or marijuana/hashish at least six times in the past
year; using cocaine, heroin, or methamphetamine at least once in the past year; or misusing prescription
drugs in the past year. To test new marijuana/hashish withdrawal questions, as well as the other revised
substance use dependence questions, RTI International staff selected a majority of marijuana/hashish
users.1 Although participants self-reported certain drug use during the screener, they may not have
received the substance dependence module for that substance if they did not use the substance
frequently enough (alcohol or marijuana/hashish).
Table 1 presents a list of the English-speaking cognitive interview participants by demographics and the
substance dependence modules received. Throughout the findings, participants are referred to by their
CaseIDs to provide a better understanding of how participants interpreted the questions. Table 2 provides
the same information for Spanish-speaking participants.
Table 1. English-Speaking Participant Characteristics
CaseID
Age
Range
Gender
Race
1000101
12-17
Male
White
Male
White
Male
Black
1000333
1000438
55 or
older
55 or
older
1000685
12-17
Male
White
1000721
12-17
Female
White
Ethnicity
Education
Not
Hispanic
Not
Hispanic
Not
Hispanic
Not
Hispanic
Not
Hispanic
High school or
less
Bachelor’s
degree
Bachelor’s
degree
High school or
less
High school or
less
Received Substance Dependence
Modules for:
Alcohol, marijuana/hashish, prescription pain
relievers
Alcohol, marijuana/hashish
Alcohol, marijuana/hashish, prescription pain
relievers
Alcohol, marijuana/hashish
Marijuana/hashish, cocaine, prescription pain
relievers
(continued)
1
RTI International is a registered trademark and a trade name of Research Triangle Institute.
F-2
Table 1. English-Speaking Participant Characteristics (continued)
CaseID
2000391
Age
Range
55 or
older
Gender
Race
Male
White
2000425
35-54
Female
White
2000512
55 or
older
Female
White
3000401
12-17
Male
Black
3000477
55 or
older
Male
Black
3000499
18-34
Female
Black
4000534
35-54
Male
Black
4000542
18-34
Male
White
4000553
35-54
Male
White
Ethnicity
Education
Not
Hispanic
Not
Hispanic
Not
Hispanic
Not
Hispanic
Not
Hispanic
Not
Hispanic
Not
Hispanic
Not
Hispanic
Hispanic
Some college, but no
degree
Some college, but no
degree
Received Substance Dependence
Modules for:
Alcohol, marijuana/hashish, prescription
pain relievers
Alcohol, marijuana/hashish
Associate’s degree
Alcohol
High school or less
Marijuana/hashish
High school or less
Alcohol, marijuana/hashish
High school or less
Alcohol
Associate’s degree
Alcohol, marijuana/hashish, cocaine,
heroin
Some college, but no
degree
Associate’s degree
Alcohol
Alcohol
Table 2. Spanish-Speaking Participant Characteristics
5000007
5000008
5000009
5000010
5000011
Age
Range
35-54
18-34
18-34
35-54
18-34
5000012
18-34
CaseID
4.
Hispanic
Hispanic
Hispanic
Hispanic
Hispanic
Country
of Origin
Mexico
Mexico
Mexico
Mexico
Guatemala
Less than high school
Less than high school
High school
Less than high school
High school
Received Substance Dependence
Modules for:
Alcohol
Marijuana/hashish, alcohol
Marijuana/hashish
Alcohol, cocaine
Marijuana/hashish, alcohol
Hispanic
Honduras
High school
Alcohol
Gender
Ethnicity
Male
Male
Male
Male
Male
Male
Education
Organization
The findings of the Round 3 cognitive interviewing are organized as follows:
•
•
•
•
question text,
brief background of the revision/addition,
English- and Spanish-language cognitive interview findings, and
recommendations.
F-3
4.1
DR(DRUG)10
DR(DRUG)10
During the past 12 months did you cut down or stop [using Drug] at least one time?
En los últimos 12 meses, ¿redujo la cantidad o dejó de [usar Drug] por lo menos una vez?
4.1.1
DR(DRUG)10 History
This question is a revised version of the existing NSDUH question DR(DRUG)10: “During the past
12 months did you cut down or stop [using Drug] at least one time?” This item is used as part of the skip
pattern to determine who will receive the withdrawal symptom questions. During review of the NSDUH
items, concern was raised that the items immediately preceding this question may create a context effect,
in which people are considering only times that they intentionally cut down on using a substance and not
times that they went without for other reasons (e.g., they ran out of money or had to work). The phrase
“whether you wanted to or not” was added in Round 1 to try to prompt individuals to think about these
other times.
However, results from Round 1 revealed that the phrase “whether you wanted to or not” was confusing to
participants, particularly adolescents. For Round 2, the phrase was removed, and the original question
wording was used. No changes to the question were made for Round 3.
4.1.2
DR(DRUG)10 English-Language Findings
This question was asked for 17 substances. Six participants answered this question for alcohol, six for
marijuana/hashish, one for cocaine, one for heroin, and three for prescription pain relievers.
There were no changes to the wording of this question between Rounds 2 and 3, and understanding was
similar to Round 2.
Participants answered “yes” to this question for 11 substances. Reasons for saying “yes” are summarized
below:
•
deliberately cut back:
○
○
○
•
•
•
to get school work done (1000101 for marijuana/hashish),
cut back to save money (2000425 for marijuana/hashish),
usage was getting out of control (2000425, 2000512, 4000534, 4000542 for alcohol);
in rehabilitation (i.e., “rehab”) (1000685 for marijuana/hashish);
did not use frequently (1000721 and 2000391 for pain relievers, 4000534 for heroin); and
got sick, went to the hospital and stopped (2000391 for marijuana/hashish) (however, he did not
want to stop but had to and was uncertain whether he should answer “yes”).
Three participants answered “no” to this question, each for two substances. One participant answered
“no” for two substances (1000333 for alcohol and marijuana/hashish) because he did not use these
substances very much and did not consider cutting back or stopping. The interviewer asked him to
F-4
change his answer to “yes” for alcohol to see how he would have answered the withdrawal question. He
did not report any withdrawal symptoms.
For the other four substances, the two participants (1000101 for alcohol and pain relievers and 4000534
for marijuana/hashish and cocaine) answered "no" because when they were using in the past 12 months,
they never cut back or stopped in their opinion. However, both respondents had been in rehab and had
since stopped using substances altogether. When probed, both participants interpreted the questions to
be asking about their experiences prior to rehab. It is interesting to note that this occurred for the second
substance as well despite the influence of probing. In addition, participant 4000534 commented that he
cut back on cocaine prior to going to rehab to save money (e.g., “I bought 2 bags instead of 4 bags”), but
he did not think that counted for this question. The cognitive interviewer asked this participant if he cut
down or stopped because he had to work, could not get a hold of any, was in rehab, or some other
reason. The participant answered, “Yes to all of these. The difference is that this is external. I wanted to
use as much as I could all of the time.”
For three of the four substances above, the cognitive interviewer asked the participants to change their
answers to "yes" so that they would receive the withdrawal questions. In all three of these cases
(1000101 for alcohol and pain relievers and 4000534 for marijuana/hashish), the participants reported
withdrawal symptoms, indicating that their response to question 10 (Q10) would have led to false
negatives for withdrawal. For the fourth case (4000534 for cocaine), the interviewer did not have him
change his answer due to time. However, the participant volunteered that he did not have withdrawal
symptoms, so it is likely this would not have been a false negative.
Participants were also asked the meaning of “cut down or stop using.” All of the participants who received
this probe understood the phrase correctly.
The primary concern with this question is that respondents tend to understand the questions as asking
about intentional times they cut down, such as when the participants thought their usage was getting out
of control, wanted to save money, or get schoolwork done. When the participants stopped using for other
reasons, such as running out of money or because a family member made them go to rehab, they were
less likely to include those situations.
4.1.3
DR(DRUG)10 Spanish-Language Findings
Only three Spanish-speaking participants received this question. Two participants answered “yes,” both
referencing intentional cutting down in their responses”
•
•
Participant 5000008 answered “yes” and explained, “When I smoke it [marijuana/hashish], it’s not
like I have to smoke it. I can go without smoking it for 2 or 3 days.”
Participant 5000009 answered “yes” and explained, “Because there are days when I smoke and
there are days that I don’t smoke.”
However, one participant (5000010), a “casual drinker” answered “no,” stating, “I have not stopped
drinking.” He later indicated that he does go without drinking for work because, “If I drink too much, then I
cannot work,” but he does not consider this cutting back or stopping. He explained, “I drink on and off, but
I continue drinking.” Although there were times that he went without drinking, he was not asked the
withdrawal questions. Because he is a casual drinker, it is unlikely that he experienced withdrawal.
F-5
4.1.4
DR(DRUG)10 Recommendations
The concern with this question is that some participants understood the question to be asking about
deliberately cutting down or stopping. This is most likely because the question is preceded by Q08 and
Q09, which ask about wanting to or trying to cut down or stop.
The phrase “whether you wanted to or not” was added in Round 1, but participants found the wording
confusing. We recommend addressing the same issue, but using wording that might be clearer to
respondents. Specifically, we recommend adding the following clarification sentence after the survey
question as follows:
During the past 12 months, did you cut down or stop [using Drug] at least one time? This includes any
time when you had to cut down or stop because you could not get a hold of any, ran out of money,
went to rehab, or some other reason.
However, this option has not been cognitively tested.
4.2
DRMJ11a and DRMJ11b
DRMJ11a
[IF DRMJ09 or DRMJ10 = 1] Please look at the symptoms listed below. During the past
12 months, did you have any of these symptoms after you cut down or stopped using
marijuana or hashish?
•
•
•
•
•
•
Stomach ache
Shaking or tremors
Sweating
Fever
Chills
Headache
1
Yes
2
No
DK/REF
[IF DRMJ09 or DRMJ10 = 1] Por favor mire la siguiente lista de síntomas. En los últimos 12 meses,
¿tuvo alguno de estos síntomas después de reducir el uso o dejar de usar marihuana o
hachís?
•
•
•
•
•
•
Dolor de estómago
Agitación o temblores en el cuerpo
Sudor
Fiebre
Escalofríos
Dolor de cabeza
1
Sí
2
No
DK/REF
F-6
DRMJ11b
[IF DRMJ09 or DRMJ10 = 1] During the past 12 months, did you have [IF DRMJ11a = 1
then fill 2, IF DRMJ11a = 2, DK/REF then fill 3] or more of these symptoms after you cut
down or stopped using marijuana or hashish?
•
•
•
•
•
•
Feeling irritable or angry
Feeling anxious or nervous
Having trouble sleeping
Losing your appetite or losing weight without trying to
Feeling like you couldn’t sit still
Feeling depressed
1
Yes
2
No
DK/REF
IF DRMJ09 =1 OR DRMJ10 = 1] En los últimos 12 meses, ¿tuvo [IF DRMJ11a = 1 then fill 2, IF
DRMJ11a = 2, DK/REF then fill 3] o más de estos síntomas después que redujo el uso o dejó de usar
marihuana o hachís?
•
•
•
•
•
•
Se sintió irritable o enojado
Se sintió ansioso o nervioso
Tuvo problemas para dormir
Perdió el apetito o bajó de peso sin tratar de hacerlo
Se sintió inquieto
Se sintió deprimido
1
Sí
2
No
DK/REF
4.2.1
DRMJ11a and DRMJ11b History
DSM-5 added a withdrawal syndrome to the marijuana/hashish use disorder criteria. Symptoms are
broken into two groups (physical and psychological). Respondents must have three or more symptoms,
one of which can be from the physical symptom list. Even if a respondent has all of the physical
symptoms, the response counts as only one of the three symptoms needed to meet the
marijuana/hashish syndrome criteria. This complexity required the use of two questions to assess this
criteria. If respondents endorse DRMJ11a, the fill for DRMJ11b is 2; otherwise, the DRMJ11b question
requires a 3.
Overall, these questions worked well in Round 1, and only minor revisions were recommended for
Round 2:
•
•
•
For DRMJ11a, “pain in the stomach area” was changed to “stomach ache.”
For DRMJ11b, “feeling anxious” was changed to “feeling anxious or nervous,” which more
accurately represents the DSM-5 criteria.
The number of symptoms was bolded to better emphasize to respondents how many are
required.
No changes were made to these questions in Round 3.
F-7
4.2.2
DRMJ11a and DRMJ11b English-Language Findings
Nine participants were asked about marijuana/hashish withdrawal symptoms in DRMJ11a and DRMJ11b.
Three respondents endorsed the physical symptoms in DRMJ11a, and seven respondents endorsed the
psychological symptoms in DRMJ11b.
There was no wording change between Rounds 2 and 3 for either question. These questions were in
general well understood in both rounds of cognitive interviewing.
One participant (1000685) reported a false positive for DRMJ11b because he had only two of the
psychological symptoms and needed three to correctly answer "Yes" to this question.
Those who said "yes" to DRMJ11a were easily able to recognize these as withdrawal symptoms, and all
of the participants answering "yes" (1000101, 1000721, and 3000477) agreed that “withdrawal” was the
correct term for these feelings or experiences. The seven respondents who indicated "yes" for DRMJ11b
(1000101, 1000685, 1000721, 2000391, 2000425, 3000401, and 3000407) all also agreed that the
psychological symptoms are withdrawal symptoms. There were no recommendations on what else these
could be called in either question.
4.2.3
DRMJ11a and DRMJ11b Spanish-Language Findings
Overall, Spanish-speaking participants appeared to understand the question. Participant 5000008 said
“no,” indicating that he did not smoke enough to get symptoms.
4.2.4
DRMJ11a and DRMJ11b Recommendations
Overall, these questions appear to be working well. The one exception is that in each round, at least one
participant answered incorrectly because he or she did not have the required number of symptoms.
It is possible that by the time participants finish reading or listening to the list of symptoms, they have
forgotten how many were required. One option may be to revise the response options to include the
number of symptoms required; for example:
1 Yes, I had 2 or more of these symptoms.
2 No, I did not have 2 or more of these symptoms.
However, to be consistent, this change should be made to all of the withdrawal questions, which could
have an effect on trend data for substances other than marijuana/hashish.
F-8
4.3
DR(DRUG)X1, DR(DRUG)X2, and DR(DRUG)10b
DR(DRUG)X1
[IF DRCC11 = 1] You just mentioned that you had symptoms after you cut down or stopped using
[COKEFILL]. Did you use cocaine or crack again, methamphetamine, prescription stimulants, or any
illegal substance to avoid or get over these symptoms?
1
Yes
2
No
DK/REF
[IF DRCC11 = 1]
Usted acaba de mencionar que tuvo síntomas después de reducir el uso o dejar de usar [COKEFILL].
¿Usó usted cocaína o “crack” otra vez, metanfetamina, estimulantes que normalmente se venden con
una receta médica o alguna sustancia ilícita para evitar o recuperarse de estos síntomas?
1
Sí
2
No
DK/REF
DR(DRUG)X2
[IF (DRMJ11a = 2 OR DK/REF) AND (DRMJ11b = 2 OR DK/REF)] After you cut down or stopped
using marijuana or hashish, did you use marijuana or hashish again, or any illegal substance to prevent
these symptoms?
1
Yes
2
No
DK/REF
[IF DRCC11 = 2 OR DK/REF]
Después que usted redujo el uso o dejó de usar [COKEFILL], ¿usó cocaína o “crack” otra vez,
metanfetamina, estimulantes que normalmente se venden con una receta médica o alguna sustancia
ilícita para prevenir esos síntomas?
1
Sí
2
No
DK/REF
DR(DRUG)10b (STIMULANTS ONLY)
[IF DRCC10a = 2] This question is also about the times after you cut down or stopped using
[COKEFILL].
During any of those times, did you use [COKEFILL] again, methamphetamine, prescription stimulants,
or any illegal substance to prevent feeling blue or down?
1
Yes
2
No
DK/REF
[IF DRCC10a = 2] Esta pregunta es también acerca de las ocasiones después que usted redujo el uso
o dejó de usar [COKEFILL].
Durante alguna de esas ocasiones, ¿usó cocaína o “crack” otra vez, metanfetamina, estimulantes que
normalmente se venden con una receta médica o alguna sustancia ilícita para prevenir sentirse
deprimido o decaído?
1
Sí
2
No
DK/REF
F-9
4.3.1
DR(DRUG)X1, DR(DRUG)X2, and DR(DRUG)10b (STIMULANTS ONLY) History
DSM-5 criteria indicate that people can meet the criteria for withdrawal either by having the symptoms of
the withdrawal syndrome, as assessed in the DR(DRUG)11 questions, or by using the substance or a
pharmacologically similar substance to avoid, prevent, or get over the symptoms of the withdrawal
syndrome. This question has never been assessed in NSDUH. Two versions were proposed: (a) one for
those who endorsed symptoms, and (b) one for those who did not. This question is vital to (1) identify
people who never experienced withdrawal because they prevented it by using a replacement substance,
and (2) identify people who may not have had enough symptoms to meet the criteria for the withdrawal
syndrome because they went back to using the substance to avoid the symptoms (e.g., someone has
only two of three required symptoms because he or she started using again before developing a third
symptom).
Results from Round 1 revealed that respondents did not understand the question consistently to mean
using a similar substance pharmacologically to get over or avoid symptoms. Many respondents provided
responses indicating that they used a substance to get high (e.g., if they could not get their substance of
choice, they would use an alternate substance) or to self-medicate. To address this confusion, the
following changes were made to DR(DRUG)X1 and DR(DRUG)X2:
•
•
•
•
•
For DR(DRUG)X1, “you experienced symptoms” was changed to “you had symptoms.”
For DR(DRUG)X1 and DR(DRUG)X2, the word “again” was added after the substance of interest
(e.g., “During the past 12 months, did you use marijuana or hashish again, or . . .”).
For DR(DRUG)X1 and DR(DRUG)X2, the phrase “avoid or get over” or the word “avoid” was
bolded.
For DR(DRUG)X1 and DR(DRUG)X2, an F2 hot key was provided so that respondents could see
all of the symptoms again, if needed.
For DR(DRUG)X2, the phrase “After you cut down or stopped using [substance]” was added.
The Round 2 cognitive interviews also identified a skip pattern problem with stimulant-type drugs (cocaine
or crack, methamphetamine, and prescription stimulants). If respondents indicated that they did not have
sadness or depression (e.g., “yes” to Q10a), they were skipped out of the withdrawal questions. To
address this problem, DR(DRUG)10b was added for stimulant substances only.
The questions were revised in round 3 by removing the clause “during the past 12 months” to make the
question shorter and easier for respondents to understand. In DR(DRUG)X2 and DR(DRUG)10b, the
word “avoid” was replaced with “prevent” to increase clarity.
4.3.2
DR(DRUG)X1 English-Language Findings
A total of 11 unique participants received this question for one or more substances.
Five participants answered "yes" to this question for six substances. In two cases, participants (3000401,
3000477) answered "yes" because they used the substance again, but it was not specifically clear that
they used the substance to “get over or avoid” the specific withdrawal symptoms:
•
Participant 3000401 commented, “I was in the house, bored, ain’t got nothing to do, I wanted it.”
The only symptom he specifically mentioned was feeling depressed.
F-10
•
Participant 3000477 did not appear to understand the question, and answered "yes" for alcohol
and marijuana/hashish simply because he used those substances again.
The remaining three participants appeared to answer "yes" correctly:
•
•
•
Participant 1000685 said that it was hard to get over and that he would feel irritable (one of the
withdrawal symptoms) and would tell himself that he would use just one more time.
Participant 1000721 said that he would use marijuana/hashish again to both avoid/get over
symptoms and just to get high again.
Participant 4000534 said that he had minor symptoms and would “either sweat it out or might
have to get more heroin.”
Six participants answered "no" to this question for seven substances:
•
•
•
In one case, a participant (1000101 for marijuana/hashish) initially answered "no" and changed
his answer to "yes" only because of probing. He originally answered "no" because he was
thinking primarily about when he was in rehab. The interviewer reminded him about the other
times he cut down or quit, and he did acknowledge that he used marijuana/hashish again to
relieve the symptoms.
In another case, the participant (2000512 for alcohol) indicated that when he starts to experience
certain symptoms (e.g., shakes) is when he decides to cut down. He indicated that he cuts back
gradually (e.g., cut down by half every couple of days). In his mind, he is not using again to
prevent/avoid symptoms but cutting down to prevent/avoid dependence. It is unclear whether
"yes" or "no" is the correct answer to this question for his situation.
In the remaining five cases, participants answered correctly.
For Round 3, this question was revised so that the reference period was removed to make the question
shorter. We probed participants on what time period they were thinking about. One participant indicated a
time period that started over 12 months ago, but continued into the reference period of the past
12 months. All of the other participants provided a specific period within the past 12 months, but none
specifically said that he or she was thinking about the full 12 months. However, this did not appear to
affect how the participants would answer because they were thinking about the times they experienced
withdrawal, which was usually a brief period of time.
The one exception may be participant 1000101 who initially answered "no" because he was thinking
about his time since rehab and not the other times during the past 12 months. However, it is unlikely that
including the reference period would have made a difference because the other times during the past
12 months were not as salient as his rehab experience.
Participants did appear to notice the instruction to press F2. Participants were split about whether it would
be better for the symptoms to appear on the screen or not.
4.3.3
DR(DRUG)X2 and DR(DRUG)10b English-Language Findings
A total of 11 participants received one of these questions for 14 substances. Participants answered "no"
for all of the cases except for two. In these two instances, participants answered "Yes" incorrectly, which
would lead to false positives for withdrawal:
F-11
•
•
Participant 1000438 thought the question was asking if he experienced any of the symptoms
listed after he cut down. He said "yes" because he experienced trouble sleeping. He did not
answer "yes" to the previous withdrawal question because he had only the one symptom, and it
required two symptoms. This participant did press the F2 key to see all of the symptoms.
Furthermore, this participant misunderstood the question in the same way for the other two
substances (marijuana/hashish and pain relievers) that he was asked about.
Participant 2000425 did not initially realize the question was about preventing symptoms and
answered "yes" because he used alcohol again.
Of the remaining 12 cases where participants answered "no," one participant (4000534) answered
incorrectly. He originally answered "no," but then reported that he had a drug cocktail (sedatives and
tranquilizers) in rehab to help with the alcohol withdrawal. He was not thinking of this when he answered
this question, resulting in a false negative.
Of the participants who correctly answered "no," two participant (2000395 and 4000534) said the question
was asking about substituting one substance for another. However, it is unclear whether they understood
the question was asking if they did this (or used the same substance again) to prevent symptoms.
Similar to DR(DRUG)X1, participants were asked what time period they were thinking of. Participants
answered “the past 12 months” in six instances. For the remaining cases, participants provided a specific
period that was within the past 12 months, such as “summertime” or “past 3 months.”
All but one participant indicated that he or she saw the F2 instruction, but only one participant pressed it.
Most participants said that providing the instruction on screen was fine, but some thought it would be
better if the symptoms appeared on screen. However, the one participant (1000438) who did press F2
incorrectly answered the question because he thought it was asking if he had those symptoms.
4.3.4
DR(DRUG)X1, DR(DRUG)X2, and DR(DRUG)10b Spanish-Language Findings
Two participants received DR(DRUG)X1. One participant (5000007) answered “yes,” indicating that he
would drink another beer “to control myself a bit, to control my body.” The other participant (5000011)
answered “no” but did not understand the question. This participant incorrectly answered “yes” to the
withdrawal question because he felt those symptoms as a result of drinking, not from stopping or cutting
back.
Five Spanish-speaking participants received DR(DRUG)X2 or DR(DRUG)10b for six substances. Only
one participant (5000012) appeared to fully understand the question saying, “It means if I used
tranquilizers to avoid the alcohol effects.” Other participants seemed to partially understand. For example,
participant 5000008 said it was asking, “If I needed medical care in order to stop drinking.” The participant
was referring to prescription tranquilizers or sedatives as medical care.
Two participants even more difficulty with the question expressing confusion. Participant 5000010
received DR(DRUG)10b for cocaine. He was confused by the question stating that he was not
“depressed or down.” However, he correctly answered “no.” Participant 5000011 said the question was
asking, “If I use marijuana, how I’m feeling. But I feel fine. I don’t use it much, it doesn’t affect me.”
F-12
All participants said the instruction on the screen to see the symptoms was fine, despite sometimes
mentioning the wrong symptoms (e.g., alcohol symptoms when on the marijuana/hashish question).
However, these participants did not actually experience any withdrawal symptoms.
All participants who received these questions said they were thinking about the past 12 months.
4.3.5
DR(DRUG)X1, DR(DRUG)X2, and DR(DRUG)10b Recommendations
We recommend removing the DR(DRUG)X1, DR(DRUG)X2, and DR(DRUG)10b questions because
participants do not understand the questions as intended, leading to data quality concerns.
The DR(DRUG)X1 question was somewhat difficult for people to answer accurately because it was hard
for them to determine whether they used the drug again specifically to prevent symptoms or just to get
high again. In addition, in each round of testing, there were participants who answered "yes" simply
because they used the substance again, and not because they used a substance to avoid or get over
symptoms (four in Round 1, two in Round 2, and two in Round 3). Furthermore, the DR(DRUG)X1
question is not actually necessary because it is asked only if the respondent had withdrawal symptoms in
the past 12 months. Therefore, the withdrawal criteria has already been met.
We also recommending deleting DR(DRUG)X2 and DR(DRUG)10b. Over three rounds of English testing,
there were seven false positives (one in Round 1, four in Round2, and two in Round 3). As with
DR(DRUG)X1, these participants answered "yes" simply because they used the substance or another
substance again. Furthermore, over the three rounds, no participants correctly answered "yes." In Round
3, there was one participant who should have answered "yes" because he received a drug cocktail during
rehab, but he was not thinking about that and answered "no" (a false positive). This suggests that this
question is not helpful in capturing people who meet the withdrawal criteria and would likely lead to a
number of false positives.
However, if the questions are kept, we recommend revising the question text so that avoiding or getting
over symptoms is mentioned before use of other substances. This may better emphasize the aspect of
the question that is less frequent, reducing false positives. For example, “In order to avoid or get over
these symptoms, did you use marijuana or hashish again, or any illegal substance?”
DRMJX1
[IF DRMJ11a = 1 OR DRMJ11b = 1] You just mentioned that you had symptoms after you
cut down or stopped using marijuana or hashish in the past 12 months. In order to avoid
or get over these symptoms, did you use marijuana or hashish again, or any illegal
substance?
1
Yes
2
No
DK/REF
Press F2 to see these symptoms again
DRMJX2
[IF (DRMJ11a = 2 OR DK/REF) AND (DRMJ11b = 2 OR DK/REF)] In order to prevent
having these symptoms after you cut down or stopped using marijuana or hashish in the
past 12 months, did you use marijuana or hashish again, or any illegal substance?
1
Yes
2
No
DK/REF
Press F2 to see these symptoms again
F-13
Furthermore, we do not recommend displaying the symptoms on the screen. If the symptoms appeared
on the screen, some respondents might misinterpret the question in the same way that participant
1000438 did.
4.4
DR(DRUG)23a and DR(DRUG)23b
DR(DRUG)23a
During the past 12 months, was there ever a time when you wanted to use [drug] so much that you
couldn’t think of anything else?
1
Yes
2
No
DK/REF
Algunas vez en los últimos 12 meses, ¿tuvo usted tantas ganas de usar [drug] que no podía pensar en
nada más?
1
Sí
2
No
DK/REF
DR(DRUG)23b
[IF DR(DRUG)23a = 2, DK/REF] During the past 12 months, was there ever a time when you had a
strong urge to use [drug]?
1
Yes
2
No
DK/REF
[IF DRCC23a = 2, DK/REF] Algunas vez en los últimos 12 meses, ¿tuvo usted un deseo fuerte o la
necesidad de usar [drug]?
1
Sí
2
No
DK/REF
4.4.1
DR(DRUG)23a and DR(DRUG)23b History
For SUDs, DSM-5 added a new criterion called “craving.” There is some discrepancy in how the craving
criterion is described in DSM-5. In the introduction to SUDs, craving is described as “an intense desire or
urge for the drug that may occur at any time but is more likely when in an environment where the drug
was previously obtained or used. . . . Craving is queried by asking if there has ever been a time when
they had such strong urges to take the drug that they could not think of anything else” (APA, 2013,
p. 483). Later in the chapter, the criteria tables for SUDs note the criterion as “craving, or a strong desire
or urge to use [the drug].” On the basis of these two slightly different descriptions, two versions of a
craving item were drafted, with the second version being asked if the respondent did not endorse the first
version. The craving criterion would be met if the respondent endorsed either version. Both question
wordings mirrored text used in DSM-5.
Results from Round 1 revealed that some respondents may be interpreting the DR(DRUG)23a question
too severely (i.e., couldn’t do anything else) and that the DR(DRUG)23b question may be getting a
number of false positives.
F-14
No revisions were made to these questions in Round 2, but the probing strategy was revised to determine
whether these questions suffered from false negatives or false positives.
In Round 3, the English version of DR(DRUG)23b was revised to ask about a “strong urge” instead of a
“strong desire or urge.” This change was made because participants’ understanding of the word “desire”
did not appear to match the DSM-5 criteria for craving.
The Spanish version was revised from “deseo apremiante” (pressing desire) to “deseo fuerte or la
necesidad” (strong desire or the need to).
4.4.2
DR(DRUG)23a and DR(DRUG)23b English-Language Findings
All 14 participants answered DR(DRUG)23a for a total of 29 substances. Consistent with the prior two
rounds, participants appeared to understand DR(DRUG)23a without a problem.
Twelve participants answered DR(DRUG)23b for a total of 24 substances.
The revised language “strong urge” improved the reporting to this question. When participants explained
why they answered "yes," it appeared to fit the definition of craving. For example:
•
•
•
Participant 2000512 said, “I was thinking of a particular incident that got me so upset, I just had to
drink.”
Participant 2000425 said, “Maybe if a stressful event happens, then I have an urge to drink. If I
know it’s going to be a hot day and me and my buddy are going fishing or rafting or something,
then yeah, I feel the urge to drink.”
Participant 4000534 said, “Used it to self-medicate. Made sure I had drugs.”
When participants answered "no," their responses seemed consistent with having a desire, but not a
strong desire or strong urge. For example, participant 1000333 who answered "no" explained, “If I go to
the game, I’m going to want to have a beer. That’s just what I want to do. If I don’t have a beer, I’m not
going to die or anything.”
We also asked participants if they would have answered differently if we asked about a “strong desire or
urge.” Only one participant who answered "no" said he would have answered "yes." Two other
participants struggled somewhat with the question by saying they had a desire to use, but not a strong
desire. None of the participants who answered "yes" said it would have changed their answer.
Overall, the findings suggest that “strong urge” was clearer to respondents than “strong desire or urge”
and did not appear to lead to any false positives.
4.4.3
DR(DRUG)23a and DR(DRUG)23b Spanish-Language Findings
All but one participant appeared to understand DR(DRUG)23a correctly. Participant (5000011) answered
“yes” to alcohol indicating that he had an urge to drink. His response did not indicate that he wanted to
drink so much he could not think of anything else. However, his indication that he had an urge to drink is
consistent with the criteria for DR(DRUG)23b. As such, it should probably not be considered a false
negative.
F-15
Five participants received DR(DRUG)23b for at least one substance and all appeared to correctly
understand the phrase,“deseo fuerte or la necesidad” in DR(DRUG)23b.
Participants were then asked about the difference between “ganas fuertes” (strong cravings) and “deseo
fuerte” (strong desire). Three participants (5000008, 5000011, 5000012) thought that “ganas fuertes”
(strong cravings) meant the same thing as “deseo fuerte” (strong desire). Two participants (5000009 and
5000010) thought that the terms were different. Participant 5000009 could not elaborate on the
difference, but 5000010 said “ganas fuertes” meant having less desire than “deseo fuerte.”
Participants were also asked about the difference between “deseo intenso” (intense desire) and “deseo
fuerte.” All four participants who answered “no” to DR(DRUG)23b thought the two terms were the same
and would not have changed their answer. The one participant (5000008) who answered “yes” thought
that “deseo intenso” (intense desire) was stronger than “deseo fuerte.” This participant said he would
have answered “no” for marijuana/hashish if the question said “deseo intenso.”
4.4.4
DR(DRUG)23a and DR(DRUG)23b Recommendations
We recommend keeping the phrase “strong urge” in English and the phrase “deseo fuerte or la
necesidad” used in Round 3.
The only change we recommend is removing the word “ever.” Because this question asks about the past
12 months, the use of the word “ever” may be confusing. Instead, the question can be revised to ask if
there was at least one time:
DRMJ23b
[IF DR(DRUG)23a = 2, DK/REF] During the past 12 months, was there at least one time
when you had a strong urge to use marijuana or hashish?
References
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.).
Washington, DC: Author.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Washington, DC: Author.
F-16
Appendix G: DSM-5 Dependence Module – English
Proposed DSM5 Substance Dependence and Abuse for 2017 NSDUH CAI Administration
(10/28/2015)
INTRODR
[IF CIG30DAY = 1 OR ALC12MON = 1 OR 2 OR 3 OR MAR12MON = 1 OR 2
OR 3 OR COC12MON = 1 OR CRK12MON = 1 OR HER12MON = 1 OR
HAL12MON = 1 OR INH12MON = 1 OR MET12MON = 1 OR PAI12MON = 1
OR TRA12MON = 1 OR STI12MON = 1 OR SED12MON = 1] Now we’d like
for you to tell us about your experiences with the
[CIG30DAY = 1 AND ALC12MON = 4 AND (MAR12MON = 4 AND
COC12MON = 2 AND CRK12MON = 2 AND HER12MON = 2 AND
HAL12MON = 2 AND INH12MON = 2 AND MET12MON = 2 AND
PAI12MON = 2 AND TRA12MON = 2 AND STI12MON = 2 AND
SED12MON = 2)] cigarettes you smoked.
[CIG30DAY = 1 AND ALC12MON = 1 OR 2 OR 3 AND (MAR12MON = 4
AND COC12MON = 2 AND CRK12MON = 2 AND HER12MON = 2 AND
HAL12MON = 2 AND INH12MON = 2 AND MET12MON = 2 AND
PAI12MON = 2 AND TRA12MON = 2 AND STI12MON = 2 AND
SED12MON = 2)] cigarettes you smoked and the alcohol you drank.
[CIG30DAY = 2 AND ALC12MON =1 OR 2 OR 3 AND (MAR12MON = 4
AND COC12MON = 2 AND CRK12MON = 2 AND HER12MON = 2 AND
HAL12MON = 2 AND INH12MON = 2 AND MET12MON = 2 AND
PAI12MON = 2 AND TRA12MON = 2 AND STI12MON = 2 AND
SED12MON = 2)] alcohol you drank.
[CIG30DAY = 1 AND ALC12MON = 4 AND (MAR12MON = 1 OR 2 OR 3 OR
COC12MON = 1 OR CRK12MON = 1 OR HER12MON = 1 OR HAL12MON =
1 OR INH12MON = 1 OR MET12MON = 1 OR PAI12MON = 1 OR
TRA12MON = 1 OR STI12MON = 1 OR SED12MON = 1)] cigarettes you
smoked and the other drugs that you used.
[CIG30DAY = 2 AND ALC12MON = 1 OR 2 OR 3 OR AND (MAR12MON = 1
OR 2 OR 3 OR COC12MON = 1 OR CRK12MON = 1 OR HER12MON = 1 OR
HAL12MON = 1 OR INH12MON = 1 OR MET12MON = 1 OR PAI12MON = 1
OR TRA12MON = 1 OR STI12MON = 1 OR SED12MON = 1)] alcohol you
drank and the other drugs that you used.
[CIG30DAY = 1 AND ALC12MON = 1 OR 2 OR 3 AND (MAR12MON = 1 OR
2 OR 3 OR COC12MON = 1 OR CRK12MON = 1 OR HER12MON = 1 OR
HAL12MON = 1 OR INH12MON = 1 OR MET12MON = 1 OR PAI12MON = 1
OR TRA12MON = 1 OR STI12MON = 1 OR SED12MON = 1)]cigarettes you
smoked, the alcohol you drank, and the other drugs that you used.
[CIG30DAY = 2 AND ALC12MON = 4 AND (MAR12MON = 1 OR 2 OR 3 OR
G-1
COC12MON = 1 OR CRK12MON =1 OR HER12MON = 1 OR HAL12MON =
1 OR INH12MON = 1 OR MET12MON = 1 OR PAI12MON = 1 OR
TRA12MON = 1 OR STI12MON = 1 OR SED12MON = 1)]drugs that you used.
Press [ENTER] to continue.
DRCIG
[IF CIG30DAY = 1] Think about your use of cigarettes during the past 30 days
as you answer these next questions.
Press [ENTER] to continue.
PROGRAMMER: SHOW 30 DAY CALENDAR
DRCGE01
[IF CIG30DAY = 1] Please think about how true each statement is of you.
After not smoking for a while, you need to smoke in order to feel less restless and
irritable.
1
Not at all true
2
Somewhat true
3
Moderately true
4
Very true
5
Extremely true
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
DRCGE02
[IF CIG30DAY = 1] When you don’t smoke for a few hours, you start to crave
cigarettes.
1
Not at all true
2
Somewhat true
3
Moderately true
4
Very true
5
Extremely true
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
DRCGE03
[IF CIG30DAY = 1] You sometimes have strong cravings for a cigarette where it
feels like you’re in the grip of a force you can’t control.
1
Not at all true
2
Somewhat true
3
Moderately true
4
Very true
5
Extremely true
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
G-2
DRCGE04
[IF CIG30DAY = 1] You feel a sense of control over your smoking—that is, you
can “take it or leave it” at any time.
1
Not at all true
2
Somewhat true
3
Moderately true
4
Very true
5
Extremely true
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
DRCGE05
[IF CIG30DAY = 1] You tend to avoid places that don’t allow smoking, even if
you would otherwise enjoy them.
1
Not at all true
2
Somewhat true
3
Moderately true
4
Very true
5
Extremely true
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
DRCGE06a [IF CIG30DAY = 1] Do you have any friends who do not smoke cigarettes?
1
Yes
2
No
DK/REF
DRCGE06b [IF DRCGE06a = 1] Think about your use of cigarettes during the past 30 days
as you answer these next questions. There are times when you choose not to be
around your friends who don’t smoke because they won’t like it if you smoke.
DRCGE07
1
Not at all true
2
Somewhat true
3
Moderately true
4
Very true
5
Extremely true
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
[IF CIG30DAY = 1]
[ADD IF DRCGE06b = BLANK] Think about your use of cigarettes during the
past 30 days as you answer these next questions.
Even if you’re traveling a long distance, you’d rather not travel by airplane
G-3
because you wouldn’t be allowed to smoke.
1
Not at all true
2
Somewhat true
3
Moderately true
4
Very true
5
Extremely true
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
DRCGE08
[IF CIG30DAY = 1] You sometimes worry that you will run out of cigarettes.
1
Not at all true
2
Somewhat true
3
Moderately true
4
Very true
5
Extremely true
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
DRCGE09
[IF CIG30DAY = 1] You smoke cigarettes fairly regularly throughout the day.
1
Not at all true
2
Somewhat true
3
Moderately true
4
Very true
5
Extremely true
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
DRCGE10
[IF CIG30DAY = 1] You smoke about the same amount on weekends as on
weekdays.
1
Not at all true
2
Somewhat true
3
Moderately true
4
Very true
5
Extremely true
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
DRCGE11
[IF CIG30DAY = 1] You smoke just about the same number of cigarettes from
day to day.
1
2
Not at all true
Somewhat true
G-4
3
Moderately true
4
Very true
5
Extremely true
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
DRCGE12
[IF CIG30DAY = 1] It’s hard to say how many cigarettes you smoke per day
because the number often changes.
1
Not at all true
2
Somewhat true
3
Moderately true
4
Very true
5
Extremely true
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
DRCGE13
[IF CIG30DAY = 1] It’s normal for you to smoke several cigarettes in an hour,
then not have another one until hours later.
1
Not at all true
2
Somewhat true
3
Moderately true
4
Very true
5
Extremely true
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
DRCGE14
[IF CIG30DAY = 1] The number of cigarettes you smoke per day is often
influenced by other things—how you’re feeling, or what you’re doing, for
example.
1
Not at all true
2
Somewhat true
3
Moderately true
4
Very true
5
Extremely true
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
DRCGE15
[IF CIG30DAY = 1] Your smoking is not affected much by other things. For
example, you smoke about the same amount whether you’re relaxing or working,
happy or sad, alone or with others.
1
2
Not at all true
Somewhat true
G-5
3
Moderately true
4
Very true
5
Extremely true
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
DRCGE16
[IF CIG30DAY = 1] Since you started smoking, the amount you smoke has
increased.
1
Not at all true
2
Somewhat true
3
Moderately true
4
Very true
5
Extremely true
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
DRCGE17
[IF CIG30DAY = 1] Compared to when you first started smoking, you need to
smoke a lot more now in order to be satisfied.
1
Not at all true
2
Somewhat true
3
Moderately true
4
Very true
5
Extremely true
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
DRCGE18
[IF CIG30DAY = 1] Compared to when you first started smoking, you can smoke
much, much more now before you start to feel anything.
1
Not at all true
2
Somewhat true
3
Moderately true
4
Very true
5
Extremely true
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
DRCGE19a [IF CIG30DAY = 1 AND (CG07 = 30 OR CG07DKRE = 6] How soon after you
wake up do you have your first cigarette?
1
2
3
4
Within the first 5 minutes after you wake up
Between 6 and 30 minutes after you wake up
Between 31 and 60 minutes after you wake up
More than 60 minutes after you wake up
G-6
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
DRCGE19b [IF DRCGE19a = BLANK AND CIG30DAY = 1 AND (CG07 = 1 - 29 OR
CG07DKRE - 1-5] On the days that you smoke, how soon after you wake up do
you have your first cigarette?
1
Within the first 5 minutes after you wake up
2
Between 6 and 30 minutes after you wake up
3
Between 31 and 60 minutes after you wake up
4
More than 60 minutes after you wake up
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
DRALC
[IF ALC12MON = 1 - 3] Think about your use of alcohol during the past 12
months as you answer these next questions.
Press [ENTER] to continue.
DRALC01
[IF ALC12MON = 1 - 3] During the past 12 months, was there a month or more
when you spent a lot of your time getting or drinking alcohol?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC02
[IF DRALC01 = 2 OR DK/REF] During the past 12 months, was there a month or
more when you spent a lot of time getting over the effects of the alcohol you
drank?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC04
[IF ALC12MON = 1 - 3] During the past 12 months, did you try to set limits on
how often or how much alcohol you would drink?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC05
[IF DRALC04 = 1] Were you able to keep to the limits you set, or did you often
drink more than you intended to?
G-7
1
Usually kept to the limits set
2
Often drank more than intended
DK/REF
DRALC06
[IF ALC12MON = 1 - 3] During the past 12 months, did you need to drink more
alcohol than you used to in order to get the effect you wanted?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC07
[IF DRALCO6 = 2 OR DK/REF] During the past 12 months, did you notice that
drinking the same amount of alcohol had less effect on you than it used to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC08
[IF ALC12MON = 1 - 3] During the past 12 months, did you want to or try to
cut down or stop drinking alcohol?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC09
[IF DRALC08 = 1] During the past 12 months, were you able to cut down or stop
drinking alcohol every time you wanted to or tried to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC10
[IF DRALC08 = 2 OR DK/REF OR DRALC09 = 2 OR DK/REF] During the past
12 months, did you cut down or stop drinking at least one time?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC11
[IF DRALC09 = 1 OR DRALC10 = 1] Please look at the symptoms listed below.
G-8
During the past 12 months, did you have 2 or more of these symptoms after you
cut down or stopped drinking alcohol?
•
•
•
•
•
•
•
•
Sweating or feeling that your heart was beating fast
Having your hands tremble
Having trouble sleeping
Vomiting or feeling nauseous
Seeing, hearing, or feeling things that weren’t really there
Feeling like you couldn’t sit still
Feeling anxious
Having seizures or fits
1
Yes
2
No
DK/REF
DRALC12
[IF DRALC11 = 1] Please look at the symptoms listed below. During the past 12
months, did you have 2 or more of these symptoms at the same time that lasted
for longer than a day after you cut back or stopped drinking alcohol?
•
•
•
•
•
•
•
•
Sweating or feeling that your heart was beating fast
Having your hands tremble
Having trouble sleeping
Vomiting or feeling nauseous
Seeing, hearing, or feeling things that weren’t really there
Feeling like you couldn’t sit still
Feeling anxious
Having seizures or fits
1
Yes
2
No
DK/REF
DRALC12a [IF DRALC11 = 1] You just mentioned that you had symptoms after you cut
down or stopped drinking alcohol. Did you drink alcohol again, use prescription
sedatives or tranquilizers, or any illegal substance to avoid or get over these
symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Press [F2] to see these symptoms again
G-9
DRALC12b [IF DRALC11 = 2 OR DK/REF] After you cut down or stopped drinking alcohol,
did you drink alcohol again, use prescription sedatives or tranquilizers, or any
illegal substance to prevent these symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Press [F2] to see these symptoms again
DRALC13
[IF ALC12MON = 1 - 3] During the past 12 months, did you have any problems
with your emotions, nerves, or mental health that were probably caused or made
worse by drinking alcohol?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC14
[IF DRALC13 = 1] Did you continue to drink alcohol even though you thought
drinking was causing you to have problems with your emotions, nerves, or mental
health?
1
Yes
2
No
DK/REF
DRALC15
[IF DRALC13 = 2 OR DK/REF OR DRALC14 = 2 OR DK/REF] During the past
12 months, did you have any physical health problems that were probably caused
or made worse by drinking alcohol?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC16
[IF DRALC15 = 1] Did you continue to drink alcohol even though you thought
drinking was causing you to have physical problems?
1
Yes
2
No
DK/REF
DRALC17
[IF ALC12MON = 1 - 3] This question is about important activities such as
G-10
working, going to school, taking care of children, doing fun things such as
hobbies and sports, and spending time with friends and family.
During the past 12 months, did drinking alcohol cause you to give up or spend
less time doing these types of important activities?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC18
[IF ALC12MON = 1 - 3] Sometimes people who drink alcohol have serious
problems at home, work or school—such as:
•
•
•
•
neglecting their children
missing work or school
doing a poor job at work or school
losing a job or dropping out of school
During the past 12 months, did drinking alcohol cause you to have serious
problems like this either at home, work, or school?
1
Yes
2
No
DK/REF
DRALC19
[IF ALC12MON = 1 - 3] During the past 12 months, did you regularly drink
alcohol and then do something where being drunk might have put you in physical
danger?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC20
[IF ALC12MON = 1 - 3] During the past 12 months, did drinking alcohol cause
you to do things that repeatedly got you in trouble with the law?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC21
[IF ALC12MON = 1 - 3] During the past 12 months, did you have any problems
with family or friends that were probably caused by your drinking?
G-11
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC22
[IF DRALC21 = 1] Did you continue to drink alcohol even though you thought
your drinking caused problems with family or friends?
1
Yes
2
No
DK/REF
DRALC23a During the past 12 months, was there ever a time when you wanted to drink
alcohol so much that you couldn’t think of anything else?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC23b [If DRALC23a = 2, DK/REF] During the past 12 months, was there ever a time
when you had a strong urge to drink alcohol?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Marijuana
DRMJ
[IF MAR12MON = 1 - 3] Think about your use of marijuana or hashish during the
past 12 months as you answer these next questions.
Press [ENTER] to continue.
DRMJ01 [IF MAR12MON = 1 - 3] During the past 12 months, was there a month or more
when you spent a lot of your time getting or using marijuana or hashish?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ02 [IF DRMJ01 = 2 OR DK/REF] During the past 12 months, was there a month or
more when you spent a lot of your time getting over the effects of the marijuana or
hashish you used?
G-12
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ04 [IF MAR12MON = 1 - 3] During the past 12 months, did you try to set limits on how
often or how much marijuana or hashish you would use?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ05 [IF DRMJ04 = 1] Were you able to keep to the limits you set, or did you often use
marijuana or hashish more than you intended to?
1
Usually kept to the limits set
2
Often used more than intended
DK/REF
DRMJ06 [IF MAR12MON = 1 - 3] During the past 12 months, did you need to use more
marijuana or hashish than you used to in order to get the effect you wanted?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ07 [IF DRMJ06 = 2 OR DK/REF] During the past 12 months, did you notice that using
the same amount of marijuana or hashish had less effect on you than it used to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ08 [IF MAR12MON = 1 - 3] During the past 12 months, did you want to or try to cut
down or stop using marijuana or hashish?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ09 [IF DRMJ08 = 1] During the past 12 months, were you able to cut down or stop
using marijuana or hashish every time you wanted to or tried to?
G-13
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ10 [IF DRMJC08 = 2 OR DK/REF OR DRMJC09 = 2 OR DK/REF] During the past 12
months did you cut down or stop using marijuana or hashish at least one time?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
G-14
DRMJ11a [IF DRMJ09 = 1 OR DRMJ10 = 1] Please look at the symptoms listed below. During
the past 12 months, did you have any of these symptoms after you cut down or
stopped using marijuana or hashish?
Stomach ache
Shaking or tremors
Sweating
Fever
Chills
Headache
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ11b [IF D75RMJ09 = 1 OR DRMJ10 = 1] During the past 12 months, did you have [IF
DRMJ11a = 1 then fill 2, IF DRMJ11a = 2, DK/REF then fill 3] or more of these
symptoms after you cut down or stopped using marijuana or hashish?
Feeling irritable or angry
Feeling anxious or nervous
Having trouble sleeping
Losing your appetite or losing weight without trying to
Feeling like you couldn’t sit still
Feeling depressed
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ12a [IF DRMJ11a = 1 OR DRMJ11b = 1] You just mentioned that you had symptoms
after you cut down or stopped using marijuana or hashish. Did you use marijuana
or hashish again, or any illegal substance to avoid or get over these symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Press [F2] to see these symptoms again
G-15
DRMJ12b [IF (DRMJ11a = 2 OR DK/REF) AND (DRMJ11b = 2 OR DK/REF)] After you cut
down or stopped using marijuana or hashish, did you use marijuana or hashish
again, or any illegal substance to prevent these symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Press [F2] to see these symptoms again
DRMJ13 [IF MAR12MON = 1 - 3] During the past 12 months, did you have any problems
with your emotions, nerves, or mental health that were probably caused or made
worse by your use of marijuana or hashish?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ14 [IF DRMJ13 = 1] Did you continue to use marijuana or hashish even though you
thought it was causing you to have problems with your emotions, nerves, or mental
health?
1
Yes
2
No
DK/REF
DRMJ15 [IF DRMJ13 = 2 OR DK/REF OR DRMJ14 = 2 OR DK/REF] During the past 12
months, did you have any physical health problems that were probably caused or
made worse by your use of marijuana or hashish?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ16 [IF DRMJ15 = 1] Did you continue to use marijuana or hashish even though you
thought it was causing you to have physical problems?
1
Yes
2
No
DK/REF
G-16
DRMJ17 [IF MAR12MON = 1 - 3] This question is about important activities such as working,
going to school, taking care of children, doing fun things such as hobbies and sports,
and spending time with friends and family.
During the past 12 months, did using marijuana or hashish cause you to give up or
spend less time doing these types of important activities?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ18 [IF MAR12MON = 1 - 3] Sometimes people who use marijuana or hashish have
serious problems at home, work or school—such as:
•
•
•
•
neglecting their children
missing work or school
doing a poor job at work or school
losing a job or dropping out of school
During the past 12 months, did using marijuana or hashish cause you to have
serious problems like this either at home, work, or school?
1
Yes
2
No
DK/REF
DRMJ19 [IF MAR12MON = 1 - 3] During the past 12 months, did you regularly use
marijuana or hashish and then do something where using marijuana or hashish
might have put you in physical danger?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ20 [IF MAR12MON = 1 - 3] During the past 12 months, did using marijuana or
hashish cause you to do things that repeatedly got you in trouble with the law?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
G-17
DRMJ21 [IF MAR12MON = 1 - 3] During the past 12 months, did you have any problems
with family or friends that were probably caused by your use of marijuana or
hashish?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ22 [IF DRMJ21 = 1] Did you continue to use marijuana or hashish even though you
thought it caused problems with family or friends?
1
Yes
2
No
DK/REF
DRMJ23a During the past 12 months, was there ever a time when you wanted to use marijuana
or hashish so much that you couldn’t think of anything else?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ23b [IF DRMJ23a = 2, DK/REF] During the past 12 months, was there ever a time when
you had a strong urge to use marijuana or hashish?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC
[IF COC12MON = 1 OR CRK12MON = 1] Think about your use of cocaine [IF
CRK12MON = 1] , including the form of cocaine called ‘crack’ during the past 12
months as you answer these next questions.
Press [ENTER] to continue.
DEFINE COKEFILL:
IF COC12MON = 1 AND CRK12MON NE 1, THEN COKEFILL = ‘cocaine’
IF COC12MON = 1 AND CRK12MON = 1 THEN COKEFILL = ‘cocaine or ‘crack’
IF COC12MON NE 1 AND CRK12MON = 1 THEN COKEFILL = ‘crack’
ELSE COKEFILL = BLANK
G-18
DRCC01 [IF COC12MON = 1 OR CRK12MON = 1] During the past 12 months, was there a
month or more when you spent a lot of your time getting or using [COKEFILL]?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC02 [IF DRCC01 = 2 OR DK/REF] During the past 12 months, was there a month or
more when you spent a lot of your time getting over the effects of the [COKEFILL]
you used?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC04 [IF COC12MON = 1 OR CRK12MON = 1] During the past 12 months, did you try to
set limits on how often or how much [COKEFILL] you would use?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC05 [IF DRCC04 = 1] Were you able to keep to the limits you set, or did you often use
[COKEFILL] more than you intended to?
1
Usually kept to the limits set
2
Often used more than intended
DK/REF
DRCC06 [IF COC12MON = 1 OR CRK12MON = 1] During the past 12 months, did you need
to use more [COKEFILL] than you used to in order to get the effect you wanted?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC07 [IF DRCC06 = 2 OR DK/REF] During the past 12 months, did you notice that using
the same amount of [COKEFILL] had less effect on you than it used to?
1
Yes
2
No
DK/REF
G-19
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC08 [IF COC12MON = 1 OR CRK12MON = 1] During the past 12 months, did you want
to or try to cut down or stop using [COKEFILL]?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC09 [IF DRCC08 = 1] During the past 12 months, were you able to cut down or stop
using [COKEFILL] every time you wanted to or tried to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC10 [IF DRCC8 = 2 OR DK/REF OR DRCC9 = 2 OR DK/REF] During the past 12
months, did you cut down or stop using [COKEFILL] at least one time?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC10a [IF DRCC09 = 1 OR DRCC10 = 1] During the past 12 months, have you felt kind of
blue or down when you cut down or stopped using [COKEFILL]?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC10b [IF DRCC10a = 2] This question is also about the times after you cut down or
stopped using [COKEFILL].
During any of those times, did you use cocaine or ‘crack’ again, methamphetamine,
prescription stimulants, or any illegal substance to prevent feeling blue or down?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC11 [IF DRCC10a = 1] Please look at the symptoms listed below. During the past 12
G-20
months, did you have 2 or more of these symptoms after you cut down or stopped
using [COKEFILL]?
•
•
•
•
•
Feeling tired or exhausted
Having bad dreams
Having trouble sleeping or sleeping more than you normally do
Feeling hungry more often
Feeling either very slowed down or like you couldn’t sit still
1
Yes
2
No
DK/REF
DRCC12 [IF DRCC11 = 1] Please look at the symptoms listed below. During the past 12
months, did you have 2 or more of these symptoms at the same time that lasted for
longer than a day after you cut back or stopped using [COKEFILL]?
•
•
•
•
•
Feeling tired or exhausted
Having bad dreams
Having trouble sleeping or sleeping more than you normally do
Feeling hungry more often
Feeling either very slowed down or like you couldn’t sit still
1
Yes
2
No
DK/REF
DRCC12a [IF DRCC11 = 1] You just mentioned that you had symptoms after you cut down or
stopped using [COKEFILL]. Did you use cocaine or ‘crack’ again,
methamphetamine, prescription stimulants, or any illegal substance to avoid or get
over these symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Press [F2] to see these symptoms again
DRCC12b [IF DRCC11 = 2 OR DK/REF] After you cut down or stopped using [COKEFILL],
did you use cocaine or ‘crack’ again, methamphetamine, prescription stimulants, or
any illegal substance to prevent these symptoms?
1
2
Yes
No
G-21
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Press [F2] to see these symptoms again
DRCC13 [IF COC12MON = 1 OR CRK12MON = 1] During the past 12 months, did you have
any problems with your emotions, nerves, or mental health that were probably caused
or made worse by your use of [COKEFILL]?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC14 [IF DRCC13 = 1] Did you continue to use [COKEFILL] even though you thought it
was causing you to have problems with your emotions, nerves, or mental health?
1
Yes
2
No
DK/REF
DRCC15 [IF DRCC13 = 2 OR DK/REF OR DRCC14 = 2 OR DK/REF] During the past 12
months, did you have any physical health problems that were probably caused or
made worse by your use of [COKEFILL]?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC16 [IF DRCC15 = 1] Did you continue to use [COKEFILL] even though you thought it
was causing you to have physical problems?
1
Yes
2
No
DK/REF
DRCC17 [IF COC12MON = 1 OR CRK12MON = 1] This question is about important
activities such as working, going to school, taking care of children, doing fun things
such as hobbies and sports, and spending time with friends and family.
During the past 12 months, did using [COKEFILL] cause you to give up or spend
less time doing these types of important activities?
1
Yes
G-22
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC18 [IF COC12MON = 1 OR CRK12MON = 1] Sometimes people who use
[COKEFILL] have serious problems at home, work or school—such as:
•
•
•
•
neglecting their children
missing work or school
doing a poor job at work or school
losing a job or dropping out of school
During the past 12 months, did using [COKEFILL] cause you to have serious
problems like this either at home, work, or school?
1
Yes
2
No
DK/REF
DRCC19 [IF COC12MON = 1 OR CRK12MON = 1] During the past 12 months, did you
regularly use [COKEFILL] and then do something where using [COKEFILL]
might have put you in physical danger?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC20 [IF COC12MON = 1 OR CRK12MON = 1] During the past 12 months, did using
[COKEFILL] cause you to do things that repeatedly got you in trouble with the law?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC21 [IF COC12MON = 1 OR CRK12MON = 1] During the past 12 months, did you have
any problems with family or friends that were probably caused by your use of
[COKEFILL]?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC22 [IF DRCC21 = 1] Did you continue to use [COKEFILL] even though you thought it
G-23
caused problems with family or friends?
1
Yes
2
No
DK/REF
DRCC23a During the past 12 months, was there ever a time when you wanted to use
[COKEFILL] so much that you couldn’t think of anything else?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC23b [IF DRCC23a = 2, DK/REF] During the past 12 months, was there ever a time when
you had a strong urge to use [COKEFILL]?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Heroin
DRHE
[IF HER12MON = 1] Think about your use of heroin during the past 12 months as
you answer these next questions.
Press [ENTER] to continue.
DRHE01 [IF HER12MON = 1] During the past 12 months, was there a month or more when
you spent a lot of your time getting or using heroin?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE02 [IF DRHE01 = 2 OR DK/REF] During the past 12 months, was there a month or
more when you spent a lot of your time getting over the effects of the heroin you
used?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
G-24
DRHE04 [IF HER12MON = 1] During the past 12 months, did you try to set limits on how
often or how much heroin you would use?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE05 [IF DRHE04 = 1] Were you able to keep to the limits you set, or did you often use
heroin more than you intended to?
1
Usually kept to the limits set
2
Often used more than intended
DK/REF
DRHE06 [IF HER12MON = 1] During the past 12 months, did you need to use more heroin
than you used to in order to get the effect you wanted?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE07 [IF DRHE06 = 2 OR DK/REF] During the past 12 months, did you notice that using
the same amount of heroin had less effect on you than it used to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE08 [IF HER12MON = 1] During the past 12 months, did you want to or try to cut down
or stop using heroin?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE09 [IF DRHE08 = 1] During the past 12 months, were you able to cut down or stop
using heroin every time you wanted to or tried to?
1
Yes
2
No
DK/REF
G-25
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE10 [IF DRHE08 = 2 OR DK/REF OR DRHE09 = 2 OR DK/REF] During the past 12
months, did you cut down or stop using heroin at least one time?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE11 [IF DRHE09 = 1 OR DRHE10 = 1] Please look at the symptoms listed below. During
the past 12 months, did you have 3 or more of these symptoms after you cut down or
stopped using heroin?
•
•
•
•
•
•
•
•
•
Feeling kind of blue or down
Vomiting or feeling nauseous
Having cramps or muscle aches
Having teary eyes or a runny nose
Feeling sweaty, having enlarged eye pupils, or having body hair standing up
on your skin
Having diarrhea
Yawning
Having a fever
Having trouble sleeping
1
Yes
2
No
DK/REF
DRHE12 [IF DRHE11 = 1] Please look at the symptoms listed below. During the past 12
months, did you have 3 or more of these symptoms at the same time that lasted for
longer than a day after you cut back or stopped using heroin?
•
•
•
•
•
•
•
•
•
Feeling kind of blue or down
Vomiting or feeling nauseous
Having cramps or muscle aches
Having teary eyes or a runny nose
Feeling sweaty, having enlarged eye pupils, or having body hair standing up
on your skin
Having diarrhea
Yawning
Having a fever
Having trouble sleeping
1
2
Yes
No
G-26
DK/REF
DRHE12a [IF DRHE11 = 1] You just mentioned that you had symptoms after you cut down or
stopped using heroin. Did you use heroin again, prescription pain relievers, or any
illegal substance to avoid or get over these symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Press [F2] to see these symptoms again
DRHE12b [IF DRHE11 = 2 OR DK/REF] After you cut down or stopped using heroin, did you
use heroin again, prescription pain relievers, or any illegal substance to prevent these
symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Press [F2] to see these symptoms again
DRHE13 [IF HER12MON = 1] During the past 12 months, did you have any problems with
your emotions, nerves, or mental health that were probably caused or made worse by
your use of heroin?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE14 [IF DRHE13 = 1] Did you continue to use heroin even though you thought it was
causing you to have problems with your emotions, nerves, or mental health?
1
Yes
2
No
DK/REF
DRHE15 [IF DRHE13 = 2 OR DK/REF OR DRHE14 = 2 OR DK/REF] During the past 12
months, did you have any physical health problems that were probably caused or
made worse by your use of heroin?
G-27
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE16 [IF DRHE15 = 1] Did you continue to use heroin even though you thought it was
causing you to have physical problems?
1
Yes
2
No
DK/REF
DRHE17 [IF HER12MON = 1] This question is about important activities such as working,
going to school, taking care of children, doing fun things such as hobbies and sports,
and spending time with friends and family.
During the past 12 months, did using heroin cause you to give up or spend less time
doing these types of important activities?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE18 [IF HER12MON = 1] Sometimes people who use heroin have serious problems at
home, work or school—such as:
•
•
•
•
neglecting their children
missing work or school
doing a poor job at work or school
losing a job or dropping out of school
During the past 12 months, did using heroin cause you to have serious problems like
this either at home, work, or school?
1
Yes
2
No
DK/REF
DRHE19 [IF HER12MON = 1] During the past 12 months, did you regularly use heroin and
then do something where using heroin might have put you in physical danger?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
G-28
DRHE20 [IF HER12MON = 1] During the past 12 months, did using heroin cause you to do
things that repeatedly got you in trouble with the law?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE21 [IF HER12MON = 1] During the past 12 months, did you have any problems with
family or friends that were probably caused by your use of heroin?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE22 [IF DRHE21 = 1] Did you continue to use heroin even though you thought it caused
problems with family or friends?
1
Yes
2
No
DK/REF
DRHE23a During the past 12 months, was there ever a time when you wanted to use heroin so
much that you couldn’t think of anything else?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE23b [If DRHE23a = 2, DK/REF] During the past 12 months, was there ever a time when
you had a strong urge to use heroin?
1
Yes
2
No
DK/REFPROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS
[IF HAL12MON = 1] Think about your use of hallucinogens, such as LSD, ‘acid’,
PCP, ‘Ecstasy’ or ‘Molly’, psilocybin or mushrooms, mescaline, or peyote during the
past 12 months as you answer these next questions.
Press [ENTER] to continue.
DRLS01 [IF HAL12MON = 1] During the past 12 months, was there a month or more when
G-29
you spent a lot of your time getting or using hallucinogens?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS02 [IF DRLS01 = 2 OR DK/REF] During the past 12 months, was there a month or more
when you spent a lot of your time getting over the effects of the hallucinogens you
used?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS04 [IF HAL12MON = 1] During the past 12 months, did you try to set limits on how
often or how much hallucinogens you would use?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS05 [IF DRLS04 = 1] Were you able to keep to the limits you set, or did you often use
hallucinogens more than you intended to?
1
Usually kept to the limits set
2
Often used more than intended
DK/REF
DRLS06 [IF HAL12MON = 1] During the past 12 months, did you need to use more
hallucinogens than you used to in order to get the effect you wanted?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS07 IF DRLS06 = 2 OR DK/REF] During the past 12 months, did you notice that using
the same amount of hallucinogens had less effect on you than it used to?
1
Yes
2
No
DK/REF
G-30
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS08 [IF HAL12MON = 1] During the past 12 months, did you want to or try to cut down
or stop using hallucinogens?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS09 [IF DRLS08 = 1] During the past 12 months, were you able to cut down or stop using
hallucinogens every time you wanted to or tried to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS13 [IF HAL12MON = 1] During the past 12 months, did you have any problems with
your emotions, nerves, or mental health that were probably caused or made worse by
your use of hallucinogens?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS14 [IF DRLS13 = 1] Did you continue to use hallucinogens even though you thought
this was causing you to have problems with your emotions, nerves, or mental health?
1
Yes
2
No
DK/REF
DRLS15 [IF DRLS13 = 2 OR DK/REF OR DRLS14 = 2 OR DK/REF] During the past 12
months, did you have any physical health problems that were probably caused or
made worse by your use of hallucinogens?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS16 [IF DRLS15 = 1] Did you continue to use hallucinogens even though you thought
this was causing you to have physical problems?
G-31
1
Yes
2
No
DK/REF
DRLS17 [IF HAL12MON = 1] This question is about important activities such as working,
going to school, taking care of children, doing fun things such as hobbies and sports,
and spending time with friends and family.
During the past 12 months, did using hallucinogens cause you to give up or spend
less time doing these types of important activities?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS18 [IF HAL12MON = 1] Sometimes people who use hallucinogens have serious
problems at home, work or school—such as:
•
•
•
•
neglecting their children
missing work or school
doing a poor job at work or school
losing a job or dropping out of school
During the past 12 months, did using hallucinogens cause you to have serious
problems like this either at home, work, or school?
1
Yes
2
No
DK/REF
DRLS19 [IF HAL12MON = 1] During the past 12 months, did you regularly use
hallucinogens and then do something where using hallucinogens put you in physical
danger?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS20 [IF HAL12MON = 1] During the past 12 months, did using hallucinogens cause you
to do things that repeatedly got you in trouble with the law?
1
Yes
G-32
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS21 [IF HAL12MON = 1] During the past 12 months, did you have any problems with
family or friends that were probably caused by your use of hallucinogens?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS22 [IF DRLS21 = 1] Did you continue to use hallucinogens even though you thought
this caused problems with family or friends?
1
Yes
2
No
DK/REF
DRLS23a During the past 12 months, was there ever a time when you wanted to use
hallucinogens so much that you couldn’t think of anything else?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS23b [IF DRLS23a = 2, DK/REF] During the past 12 months, was there ever a time when
you had a strong urge to use hallucinogens?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN
[IF INH12MON = 1] Think about your use of inhalants, such as amyl nitrite,
‘poppers,’ nitrous oxide, gasoline or lighter fluids, glue, spray paints, or correction
fluids during the past 12 months as you answer these next questions.
Press [ENTER] to continue.
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN01 [IF INH12MON = 1] During the past 12 months, was there a month or more when
you spent a lot of your time getting or using inhalants?
1
Yes
G-33
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN02 [IF DRIN01 = 2 OR DK/REF] During the past 12 months, was there a month or more
when you spent a lot of your time getting over the effects of the inhalants you used?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN04 [IF INH12MON = 1] During the past 12 months, did you try to set limits on how
often or how much inhalants you would use?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN05 [IF DRIN04 = 1] Were you able to keep to the limits you set, or did you often use
inhalants more than you intended to?
1
Usually kept to the limits set
2
Often used more than intended
DK/REF
DRIN06 [IF INH12MON = 1] During the past 12 months, did you need to use more inhalants
than you used to in order to get the effect you wanted?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN07 [IF DRIN06 = 2 OR DK/REF] During the past 12 months, did you notice that using
the same amount of inhalants had less effect on you than it used to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN08 [IF INH12MON = 1] During the past 12 months, did you want to or try to cut down
or stop using inhalants?
G-34
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN09 [IF DRIN08 = 1] During the past 12 months, were you able to cut down or stop using
inhalants every time you wanted to or tried to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN13 [IF INH12MON = 1] During the past 12 months, did you have any problems with
your emotions, nerves, or mental health that were probably caused or made worse by
your use of inhalants?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN14 [IF DRIN13 = 1] Did you continue to use inhalants even though you thought this
was causing you to have problems with your emotions, nerves, or mental health?
1
Yes
2
No
DK/REF
DRIN15 [IF DRIN13 = 2 OR DK/REF OR DRIN14 = 2 OR DK/REF] During the past 12
months, did you have any physical health problems that were probably caused or
made worse by your use of inhalants?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN16 [IF DRIN15 = 1] Did you continue to use inhalants even though you thought this
was causing you to have physical problems?
1
Yes
2
No
DK/REF
DRIN17 [IF INH12MON = 1] This question is about important activities such as working,
G-35
going to school, taking care of children, doing fun things such as hobbies and sports,
and spending time with friends and family.
During the past 12 months, did using inhalants cause you to give up or spend less
time doing these types of important activities?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN18 [IF INH12MON = 1] Sometimes people who use inhalants have serious problems at
home, work or school—such as:
•
•
•
•
neglecting their children
missing work or school
doing a poor job at work or school
losing a job or dropping out of school
During the past 12 months, did using inhalants cause you to have serious problems
like this either at home, work, or school?
1
Yes
2
No
DK/REF
DRIN19 [IF INH12MON = 1] During the past 12 months, did you regularly use inhalants and
then do something where using inhalants might have put you in physical danger?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN20 [IF INH12MON = 1] During the past 12 months, did using inhalants cause you to do
things that repeatedly got you in trouble with the law?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN21 [IF INH12MON = 1] During the past 12 months, did you have any problems with
family or friends that were probably caused by your use of inhalants?
G-36
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN22 [IF DRIN21 = 1] Did you continue to use inhalants even though you thought this
caused problems with family or friends?
1
Yes
2
No
DK/REF
DRIN23a During the past 12 months, was there ever a time when you wanted to use inhalants
so much that you couldn’t think of anything else?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN23b [IF DRIN23a = 2, DK/REF] During the past 12 months, was there ever a time when
you had a strong urge to use inhalants?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME
[IF MET12MON = 1] Think about your use of methamphetamine during the past 12
months as you answer these next questions.
Press [ENTER] to continue.
DRME01 [IF MET12MON = 1] During the past 12 months, was there a month or more when
you spent a lot of your time getting or using methamphetamine?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME02 [IF DRME01 = 2 OR DK/REF] During the past 12 months, was there a month or
more when you spent a lot of your time getting over the effects of the
methamphetamine you used?
G-37
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME04 [IF MET12MON = 1] During the past 12 months, did you try to set limits on how
often or how much methamphetamine you would use?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME05 [IF DRME04 = 1] Were you able to keep to the limits you set, or did you often use
methamphetamine more than you intended to?
1
Usually kept to the limits set
2
Often used more than intended
DK/REF
DRME06 [IF MET12MON = 1] During the past 12 months, did you need to use more
methamphetamine than you used to in order to get the effect you wanted?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME07 [IF DRME06 = 2 OR DK/REF] During the past 12 months, did you notice that using
the same amount of methamphetamine had less effect on you than it used to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME08 [IF MET12MON = 1] During the past 12 months, did you want to or try to cut down
or stop using methamphetamine?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME09 [IF DRME08 = 1] During the past 12 months, were you able to cut down or stop
using methamphetamine every time you wanted to or tried to?
G-38
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME10 [IF DRME08 = 2 OR DK/REF OR DRME09 = 2 OR DK/REF] During the past 12
months, did you cut down or stop using methamphetamine at least one time?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME10a [IF DRME09 = 1 OR DRME10 = 1] During the past 12 months, have you felt kind
of blue or down when you cut down or stopped using methamphetamine?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME10b [IF DRME10a = 2] This question is also about the times after you cut down or
stopped using methamphetamine.
During any of those times, did you use methamphetamine again, cocaine or ‘crack,’
prescription stimulants, or any illegal substance to prevent feeling blue or down?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME11 [IF DRME10a = 1] Please look at the symptoms listed below. During the past 12
months, did you have 2 or more of these symptoms after you cut down or stopped
using methamphetamine?
•
•
•
•
•
Feeling tired or exhausted
Having bad dreams
Having trouble sleeping or sleeping more than you normally do
Feeling hungry more often
Feeling either very slowed down or like you couldn’t sit still
1
Yes
2
No
DK/REF
G-39
DRME12 [IF DRME11 = 1] Please look at the symptoms listed below. During the past 12
months, did you have 2 or more of these symptoms at the same time that lasted for
longer than a day after you cut back or stopped using methamphetamine?
•
•
•
•
•
Feeling tired or exhausted
Having bad dreams
Having trouble sleeping or sleeping more than you normally do
Feeling hungry more often
Feeling either very slowed down or like you couldn’t sit still
1
Yes
2
No
DK/REF
DRME12a [IF DRME11 = 1] You just mentioned that you had symptoms after you cut down or
stopped using methamphetamine. Did you use methamphetamine again, cocaine or
‘crack,’ prescription stimulants, or any illegal substance to avoid or get over these
symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Press [F2] to see these symptoms again
DRME12b [If DRME11 = 2 OR DK/REF] After you cut down or stopped using
methamphetamine , did you use methamphetamine again, cocaine or ‘crack,’
prescription stimulants, or any illegal substance to prevent these symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Press [F2] to see these symptoms again
DRME13 [IF MET12MON = 1] During the past 12 months, did you have any problems with
your emotions, nerves, or mental health that were probably caused or made worse by
your use of methamphetamine?
1
Yes
2
No
DK/REF
G-40
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME14 [IF DRME13 = 1] Did you continue to use methamphetamine even though you
thought it was causing you to have problems with your emotions, nerves, or mental
health?
1
Yes
2
No
DK/REF
DRME15 [IF DRME13 = 2 OR DK/REF OR DRME14 = 2 OR DK/REF] During the past 12
months, did you have any physical health problems that were probably caused or
made worse by your use of methamphetamine?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME16 [IF DRME15 = 1] Did you continue to use methamphetamine even though you
thought it was causing you to have physical problems?
1
Yes
2
No
DK/REF
DRME17 [IF MET12MON = 1] This question is about important activities such as working,
going to school, taking care of children, doing fun things such as hobbies and sports,
and spending time with friends and family.
During the past 12 months, did using methamphetamine cause you to give up or
spend less time doing these types of important activities?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME18 [IF MET12MON = 1] Sometimes people who use methamphetamine have serious
problems at home, work or school—such as:
•
•
•
•
neglecting their children
missing work or school
doing a poor job at work or school
losing a job or dropping out of school
G-41
During the past 12 months, did using methamphetamine cause you to have serious
problems like this either at home, work, or school?
1
Yes
2
No
DK/REF
DRME19 [IF MET12MON = 1] During the past 12 months, did you regularly use
methamphetamine and then do something where using methamphetamine might
have put you in physical danger?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME20 [IF MET12MON = 1] During the past 12 months, did using methamphetamine
cause you to do things that repeatedly got you in trouble with the law?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME21 [IF MET12MON = 1] During the past 12 months, did you have any problems with
family or friends that were probably caused by your use of methamphetamine?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME22 [IF DRME21 = 1] Did you continue to use methamphetamine even though you
thought it caused problems with family or friends?
1
Yes
2
No
DK/REF
DRME23a During the past 12 months, was there ever a time when you wanted to use
methamphetamine so much that you couldn’t think of anything else?
1
Yes
2
No
DK/REFPROGRAMMER: SHOW 12 MONTH CALENDAR
G-42
DRME23b [If DRME23a = 2, DK/REF] During the past 12 months, was there ever a time when
you had a strong urge to use methamphetamine
1
Yes
2
No
DK/REFPROGRAMMER: SHOW 12 MONTH CALENDAR
Rx Pain Relievers
DRPR [IF PAI12MON = 1] Think about your use of prescription pain relievers during the
past 12 months as you answer these next questions. Remember, we are only interested
in prescription pain relievers that you used in any way a doctor did not direct you
to.
Earlier the computer recorded that in the past 12 months you used [IF
PRMISCOUNT = 1 FILL PRFILL2][IF PRMISCOUNT ≥ 2 FILL WITH “the pain
relievers listed below” ] in a way a doctor did not direct you to use [PRNUMFILL].
[IF PRMISCOUNT ≥ 2 FILL WITH DRUG NAMES FROM PRY01-PRY36
BELOW. USE MULTIPLE COLUMNS AS NEEDED. IF PRYOTH = 1, ADD
"Some other prescription pain reliever".]
The next questions refer to [IF PRYOTH NE 1 AND PRMISCOUNT=1 FILL
PRFILL2 as a prescription pain reliever; IF PRYOTH = 1 AND PRMISCOUNT=1
FILL WITH “this other prescription pain reliever”; IF PRMISCOUNT ≥ 2 FILL
WITH “these as prescription pain relievers”].
Press [ENTER] to continue.
DRPR01 [IF PAI12MON = 1] During the past 12 months, was there a month or more when
you spent a lot of your time getting or using prescription pain relievers?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR02 [IF DRPR01 = 2 OR DK/REF] During the past 12 months, was there a month or more
when you spent a lot of your time getting over the effects of the prescription pain
relievers you used?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
G-43
DRPR04 [IF PAI12MON = 1] During the past 12 months, did you try to set limits on how
often or how much prescription pain relievers you would use?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR05 [IF DRPR04 = 1] Were you able to keep to the limits you set, or did you often use
prescription pain relievers more than you intended to?
1
Usually kept to the limits set
2
Often used more than intended
DK/REF
DRPR06 [IF PAI12MON = 1] During the past 12 months, did you need to use more
prescription pain relievers than you used to in order to get the effect you wanted?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR07 [IF DRPR06 = 2 OR DK/REF] During the past 12 months, did you notice that using
the same amount of prescription pain relievers had less effect on you than it used
to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR08 [IF PAI12MON = 1] During the past 12 months, did you want to or try to cut down
or stop using prescription pain relievers?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR09 [IF DRPR08 = 1] During the past 12 months, were you able to cut down or stop
using prescription pain relievers every time you wanted to or tried to?
1
Yes
2
No
DK/REF
G-44
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR10 [IF DRPR08 = 2 OR DK/REF OR DRPR09 = 2 OR DK/REF] During the past 12
months, did you cut down or stop using prescription pain relievers at least one
time?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR11 [IF DRPR09 = 1 OR DRPR10 = 1] Please look at the symptoms listed below. During
the past 12 months, did you have 3 or more of these symptoms after you cut down or
stopped using prescription pain relievers?
•
•
•
•
•
•
•
•
•
Feeling kind of blue or down
Vomiting or feeling nauseous
Having cramps or muscle aches
Having teary eyes or a runny nose
Feeling sweaty, having enlarged eye pupils, or having body hair standing up
on your skin
Having diarrhea
Yawning
Having a fever
Having trouble sleeping
1
Yes
2
No
DK/REF
DRPR12 [IF DRPR11 = 1] Please look at the symptoms listed below. During the past 12
months, did you have 3 or more of these symptoms at the same time that lasted for
longer than a day after you cut back or stopped using prescription pain relievers?
•
•
•
•
•
•
•
•
•
Feeling kind of blue or down
Vomiting or feeling nauseous
Having cramps or muscle aches
Having teary eyes or a runny nose
Feeling sweaty, having enlarged eye pupils, or having body hair standing up
on your skin
Having diarrhea
Yawning
Having a fever
Having trouble sleeping
1
Yes
G-45
2
No
DK/REF
DRPR12a
[IF DRPR11 = 1] You just mentioned that you had symptoms after you cut down
or stopped using prescription pain relievers. Did you use prescription pain relievers
again, heroin, or any illegal substance to avoid or get over these symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Press [F2] to see these symptoms again
DRPR12b [IF DRPR11 = 2 OR DK/REF] After you cut down or stopped using prescription
pain relievers, did you use prescription pain relievers again, heroin, or any illegal
substance to prevent these symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Press [F2] to see these symptoms again
DRPR13 [IF PAI12MON = 1] During the past 12 months, did you have any problems with
your emotions, nerves, or mental health that were probably caused or made worse by
your use of prescription pain relievers?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR14 [IF DRPR13 = 1] Did you continue to use prescription pain relievers even though
you thought this was causing you to have problems with your emotions, nerves, or
mental health?
1
Yes
2
No
DK/REF
DRPR15 [IF DRPR13 = 2 OR DK/REF OR DRPR14 = 2 OR DK/REF] During the past 12
months, did you have any physical health problems that were probably caused or
G-46
made worse by your use of prescription pain relievers?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR16 [IF DRPR15 = 1] Did you continue to use prescription pain relievers even though
you thought this was causing you to have physical problems?
1
Yes
2
No
DK/REF
DRPR17 [IF PAI12MON = 1] This question is about important activities such as working,
going to school, taking care of children, doing fun things such as hobbies and sports,
and spending time with friends and family.
During the past 12 months, did using prescription pain relievers cause you to give
up or spend less time doing these types of important activities?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR18 [IF PAI12MON = 1] Sometimes people who use prescription pain relievers have
serious problems at home, work or school—such as:
•
•
•
•
neglecting their children
missing work or school
doing a poor job at work or school
losing a job or dropping out of school
During the past 12 months, did using prescription pain relievers cause you to have
serious problems like this either at home, work, or school?
1
Yes
2
No
DK/REF
DRPR19 [IF PAI12MON = 1] During the past 12 months, did you regularly use prescription
pain relievers and then do something where using prescription pain relievers might
have put you in physical danger?
1
Yes
G-47
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR20 [IF PAI12MON = 1] During the past 12 months, did using prescription pain
relievers cause you to do things that repeatedly got you in trouble with the law?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR21 [IF PAI12MON = 1] During the past 12 months, did you have any problems with
family or friends that were probably caused by your use of prescription pain
relievers?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR22 [IF DRPR21 = 1] Did you continue to use prescription pain relievers even though
you thought this caused problems with family or friends?
1
Yes
2
No
DK/REF
DRPR23a During the past 12 months, was there ever a time when you wanted to use
prescription pain relievers so much that you couldn’t think of anything else?
1
Yes
2
No
DK/REFPROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR23b [IF DRPR23a = 2, DK/REF] During the past 12 months, was there ever a time when
you had a strong urge to use prescription pain relievers?
1
Yes
2
No
DK/REFPROGRAMMER: SHOW 12 MONTH CALENDAR
Rx Tranquilizers
DRTR [IF TRA12MON = 1] Think about your use of prescription tranquilizers during the
past 12 months as you answer these next questions. Remember, we are only interested
in prescription tranquilizers that you used in any way a doctor did not direct you to.
G-48
Earlier the computer recorded that in the past 12 months you used [IF
TRMISCOUNT = 1 FILL TRFILL2][IF TRMISCOUNT ≥ 2 FILL WITH “the
tranquilizers listed below” ] in a way a doctor did not direct you to use
[TRNUMFILL].
[IF TRMISCOUNT ≥ 2 FILL WITH DRUG NAMES FROM TRY01- TRY12
BELOW. USE MULTIPLE COLUMNS AS NEEDED. IF TRYOTH = 1, ADD
"Some other prescription tranquilizer".]
The next questions refer to [IF TRYOTH NE 1 AND TRMISCOUNT = 1 FILL
TRFILL2 as a prescription tranquilizer; IF TRYOTH = 1 AND TRMISCOUNT = 1
FILL WITH “this other prescription tranquilizer”; IF TRMISCOUNT ≥ 2 FILL WITH
“these as prescription tranquilizers”].
Press [ENTER] to continue.
DRTR01 [IF TRA12MON = 1] During the past 12 months, was there a month or more when
you spent a lot of your time getting or using prescription tranquilizers?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR02 [IF DRTR01 = 2 OR DK/REF] During the past 12 months, was there a month or
more when you spent a lot of your time getting over the effects of the prescription
tranquilizers you used?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR04 [IF TRA12MON = 1] During the past 12 months, did you try to set limits on how
often or how much prescription tranquilizers you would use?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR05 [IF DRTR04 = 1] Were you able to keep to the limits you set, or did you often use
prescription tranquilizers more than you intended to?
1
Usually kept to the limits set
G-49
2
Often used more than intended
DK/REF
DRTR06 [IF TRA12MON = 1] During the past 12 months, did you need to use more
prescription tranquilizers than you used to in order to get the effect you wanted?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR07 [IF DRTR06 = 2 OR DK/REF] During the past 12 months, did you notice that using
the same amount of prescription tranquilizers had less effect on you than it used to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR08 [IF TRA12MON = 1] During the past 12 months, did you want to or try to cut down
or stop using prescription tranquilizers?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR09 [IF DRTR08 = 1] During the past 12 months, were you able to cut down or stop
using prescription tranquilizers every time you wanted to or tried to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR10 [IF DRTR08 = 2 OR DK/REF OR DRTR09 = 2 OR DK/REF] During the past 12
months, did you cut down or stop using prescription tranquilizers at least one
time?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR11 [IF DRTR09 = 1 OR DRTR10 = 1] Please look at the symptoms listed below. During
the past 12 months, did you have 2 or more of these symptoms after you cut down or
stopped using prescription tranquilizers?
G-50
•
•
•
•
•
•
•
•
Sweating or feeling that your heart was beating fast
Having your hands tremble
Having trouble sleeping
Vomiting or feeling nauseous
Seeing, hearing, or feeling things that weren’t really there
Feeling like you couldn’t sit still
Feeling anxious
Having seizures or fits
1
Yes
2
No
DK/REF
DRTR12a [IF DRTR11 = 1] You just mentioned that you had symptoms after you cut down or
stopped using prescription tranquilizers. Did you use prescription tranquilizers
again, drink alcohol, use prescription sedatives, or any illegal substance to avoid or
get over these symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Press [F2] to see these symptoms again
DRTR12b [IF DRTR11 = 2 OR DK/REF] After you cut down or stopped using prescription
tranquilizers, did you use prescription tranquilizers again, drink alcohol, use
prescription sedatives, or any illegal substance to prevent these symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Press [F2] to see these symptoms again
DRTR13 [IF TRA12MON = 1] During the past 12 months, did you have any problems with
your emotions, nerves, or mental health that were probably caused or made worse by
your use of prescription tranquilizers?
1
Yes
2
No
DK/REF
G-51
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR14 [IF DRTR13 = 1] Did you continue to use prescription tranquilizers even though
you thought this was causing you to have problems with your emotions, nerves, or
mental health?
1
Yes
2
No
DK/REF
DRTR15 [IF DRTR13 = 2 OR DK/REF OR DRTR14 = 2 OR DK/REF] During the past 12
months, did you have any physical health problems that were probably caused or
made worse by your use of prescription tranquilizers?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR16 [IF DRTR15 = 1] Did you continue to use prescription tranquilizers even though
you thought this was causing you to have physical problems?
1
Yes
2
No
DK/REF
DRTR17 [IF TRA12MON = 1] This question is about important activities such as working,
going to school, taking care of children, doing fun things such as hobbies and sports,
and spending time with friends and family.
During the past 12 months, did using prescription tranquilizers cause you to give up
or spend less time doing these types of important activities?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR18 [IF TRA12MON = 1] Sometimes people who use prescription tranquilizers have
serious problems at home, work or school—such as:
•
•
•
•
neglecting their children
missing work or school
doing a poor job at work or school
losing a job or dropping out of school
G-52
During the past 12 months, did using prescription tranquilizers cause you to have
serious problems like this either at home, work, or school?
1
Yes
2
No
DK/REF
DRTR19 [IF TRA12MON = 1] During the past 12 months, did you regularly use prescription
tranquilizers and then do something where using prescription tranquilizers might
have put you in physical danger?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR20 [IF TRA12MON = 1] During the past 12 months, did using prescription
tranquilizers cause you to do things that repeatedly got you in trouble with the law?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR21 [IF TRA12MON = 1] During the past 12 months, did you have any problems with
family or friends that were probably caused by your use of prescription
tranquilizers?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR22 [IF DRTR21 = 1] Did you continue to use prescription tranquilizers even though
you thought this caused problems with family or friends?
1
Yes
2
No
DK/REF
DRTR23a During the past 12 months, was there ever a time when you wanted to use
prescription tranquilizers so much that you couldn’t think of anything else?
1
Yes
2
No
DK/REFPROGRAMMER: SHOW 12 MONTH CALENDAR
G-53
DRTR23b [If DRTR23a = 2, DK/REF] During the past 12 months, was there ever a time when
you had a strong urge to use prescription tranquilizers?
1
Yes
2
No
DK/REFPROGRAMMER: SHOW 12 MONTH CALENDAR
Rx Stimulants
DRST
[IF ST12MON = 1] Think about your use of prescription stimulants during the past
12 months as you answer these next questions. Remember, we are only interested in
prescription stimulants that you used in any way a doctor did not direct you to.
Earlier the computer recorded that in the past 12 months you used [IF
STMISCOUNT =1 FILL STFILL2][IF STMISCOUNT ≥ 2 FILL WITH “the
stimulants listed below” ] in a way a doctor did not direct you to use
[STNUMFILL].
[IF STMISCOUNT ≥ 2 FILL WITH DRUG NAMES FROM STY01-STY26
BELOW. USE MULTIPLE COLUMNS AS NEEDED. IF STYOTH = 1, ADD
"Some other prescription stimulant".]
The next questions refer to [IF STYOTH NE 1 AND STMISCOUNT = 1 FILL
STFILL2 as a prescription stimulant; IF STYOTH = 1 AND STMISCOUNT = 1 FILL
WITH “this other prescription stimulant”; IF STMISCOUNT ≥ 2 FILL WITH “these
as prescription stimulants”].
Press [ENTER] to continue.
DRST01 [IF STI12MON = 1] During the past 12 months, was there a month or more when you
spent a lot of your time getting or using prescription stimulants?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST02 [IF DRST01 = 2 OR DK/REF] During the past 12 months, was there a month or more
when you spent a lot of your time getting over the effects of the prescription
stimulants you used?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
G-54
DRST04 [IF STI12MON = 1] During the past 12 months, did you try to set limits on how often
or how much prescription stimulants you would use?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST05 [IF DRST04 = 1] Were you able to keep to the limits you set, or did you often use
prescription stimulants more than you intended to?
1
Usually kept to the limits set
2
Often used more than intended
DK/REF
DRST06 [IF STI12MON = 1] During the past 12 months, did you need to use more
prescription stimulants than you used to in order to get the effect you wanted?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST07 [IF DRST06 = 2 OR DK/REF] During the past 12 months, did you notice that using
the same amount of prescription stimulants had less effect on you than it used to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST08 [IF STI12MON = 1] During the past 12 months, did you want to or try to cut down
or stop using prescription stimulants?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST09 [IF DRST08 = 1] During the past 12 months, were you able to cut down or stop using
prescription stimulants every time you wanted to or tried to?
1
Yes
2
No
DK/REF
G-55
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST10 [IF DRST08 = 2 OR DK/REF OR DRST09 = 2 OR DK/REF] During the past 12
months, did you cut down or stop using prescription stimulants at least one time?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST10a [IF DRST09 = 1 OR DRST10 = 1] During the past 12 months, have you felt kind of
blue or down when you cut down or stopped using prescription stimulants?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST10b IF DRST10a = 2] This question is also about the times after you cut down or stopped
using prescription stimulants.
During any of those times, did you use prescription stimulants again,
methamphetamine, cocaine or ‘crack,’ or any illegal substance to prevent feeling
blue or down?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST11 [IF DRST10a = 1] Please look at the symptoms listed below. During the past 12
months, did you have 2 or more of these symptoms after you cut down or stopped
using prescription stimulants?
•
•
•
•
•
Feeling tired or exhausted
Having bad dreams
Having trouble sleeping or sleeping more than you normally do
Feeling hungry more often
Feeling either very slowed down or like you couldn’t sit still
1
Yes
2
No
DK/REF
DRST12 [IF DRST11 = 1] Please look at the symptoms listed below. During the past 12
months, did you have 2 or more of these symptoms at the same time that lasted for
G-56
longer than a day after you cut back or stopped using prescription stimulants?
•
•
•
•
•
Feeling tired or exhausted
Having bad dreams
Having trouble sleeping or sleeping more than you normally do
Feeling hungry more often
Feeling either very slowed down or like you couldn’t sit still
1
Yes
2
No
DK/REF
DRST12a [IF DRST11 = 1] You just mentioned that you had symptoms after you cut down or
stopped using prescription stimulants. Did you use prescription stimulants again,
methamphetamine, cocaine or ‘crack,’ or any illegal substance to avoid or get over
these symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Press [F2] to see these symptoms again
DRST12b [IF DRST11 = 2 OR DK/REF] After you cut down or stopped using prescription
stimulants, did you use prescription stimulants again, methamphetamine, cocaine or
‘crack,’ or any illegal substance to prevent these symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Press [F2] to see these symptoms again
DRST13 [IF STI12MON = 1] During the past 12 months, did you have any problems with
your emotions, nerves, or mental health that were probably caused or made worse by
your use of prescription stimulants?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
G-57
DRST14 [IF DRST13 = 1] Did you continue to use prescription stimulants even though you
thought this was causing you to have problems with your emotions, nerves, or mental
health?
1
Yes
2
No
DK/REF
DRST15 [IF DRST13 = 2 OR DK/REF OR DRST14 = 2 OR DK/REF] During the past 12
months, did you have any physical health problems that were probably caused or
made worse by your use of prescription stimulants?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST16 [IF DRST15 = 1] Did you continue to use prescription stimulants even though this
was causing you to have physical problems?
1
Yes
2
No
DK/REF
DRST17 [IF STI12MON = 1] This question is about important activities such as working,
going to school, taking care of children, doing fun things such as hobbies and sports,
and spending time with friends and family.
During the past 12 months, did using prescription stimulants cause you to give up
or spend less time doing these types of important activities?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST18 [IF STI12MON = 1] Sometimes people who use prescription stimulants have
serious problems at home, work or school—such as:
•
•
•
•
neglecting their children
missing work or school
doing a poor job at work or school
losing a job or dropping out of school
During the past 12 months, did using prescription stimulants cause you to have
serious problems like this either at home, work, or school?
G-58
1
Yes
2
No
DK/REF
DRST19 [IF STI12MON = 1] During the past 12 months, did you regularly use prescription
stimulants and then do something where using prescription stimulants might have
put you in physical danger?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST20 [IF STI12MON = 1] During the past 12 months, did using prescription stimulants
cause you to do things that repeatedly got you in trouble with the law?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST21 [IF STI12MON = 1] During the past 12 months, did you have any problems with
family or friends that were probably caused by your use of prescription stimulants?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST22 [IF DRST21 = 1] Did you continue to use prescription stimulants even though you
thought this caused problems with family or friends?
1
Yes
2
No
DK/REF
DRST23a During the past 12 months, was there ever a time when you wanted to use
prescription stimulants so much that you couldn’t think of anything else?
1
Yes
2
No
DK/REFPROGRAMMER: SHOW 12 MONTH CALENDAR
DRST23b [IF DRST23a = 2, DK/REF] During the past 12 months, was there ever a time when
you had a strong urge to use prescription stimulants?
G-59
1
Yes
2
No
DK/REFPROGRAMMER: SHOW 12 MONTH CALENDAR
Rx Sedatives
DRSV [IF SV12MON = 1] Think about your use of prescription sedatives during the past
12 months as you answer these next questions. Remember, we are only interested in
prescription sedatives that you used in any way a doctor did not direct you to.
Earlier the computer recorded that in the past 12 months you used [IF
SVMISCOUNT = 1 FILL SVFILL2][IF SVMISCOUNT ≥ 2 FILL WITH “the
sedatives listed below” ] in a way a doctor did not direct you to use
[SVNUMFILL].
[IF SVMISCOUNT ≥ 2 FILL WITH DRUG NAMES FROM SVY01-SVY14
BELOW. USE MULTIPLE COLUMNS AS NEEDED. IF SVYOTH = 1, ADD
"Some other prescription sedative".]
The next questions refer to [IF SVYOTH NE 1 AND SVMISCOUNT = 1 FILL
SVFILL2 as a prescription sedative; IF SVYOTH = 1 AND SVMISCOUNT = 1 FILL
WITH “this other prescription sedative”; IF SVMISCOUNT ≥ 2 FILL WITH “these
as prescription sedatives”].
Press [ENTER] to continue.
DRSV01 [IF SED12MON = 1] During the past 12 months, was there a month or more when
you spent a lot of your time getting or using prescription sedatives?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV02 [IF DRSV01 = 2 OR DK/REF] During the past 12 months, was there a month or
more when you spent a lot of your time getting over the effects of the prescription
sedatives you used?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV04 [IF SED12MON = 1] During the past 12 months, did you try to set limits on how
often or how much prescription sedatives you would use?
1
Yes
G-60
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV05 [IF DRSV04 = 1] Were you able to keep to the limits you set, or did you often use
prescription sedatives more than you intended to?
1
Usually kept to the limits set
2
Often used more than intended
DK/REF
DRSV06 [IF SED12MON = 1] During the past 12 months, did you need to use more
prescription sedatives than you used to in order to get the effect you wanted?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV07 [IF DRSV06 = 2 OR DK/REF] During the past 12 months, did you notice that using
the same amount of prescription sedatives had less effect on you than it used to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV08 [IF SED12MON = 1] During the past 12 months, did you want to or try to cut down
or stop using prescription sedatives?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV09 [IF DRSV08 = 1] During the past 12 months, were you able to cut down or stop
using prescription sedatives every time you wanted to or tried to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV10 [IF DRSV08 = 2 OR DK/REF OR DRSV09 = 2 OR DK/REF] During the past 12
months, did you cut down or stop using prescription sedatives at least one time?
G-61
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV11 [IF DRSV09 = 1 OR DRSV10 = 1] Please look at the symptoms listed below. During
the past 12 months, did you have 2 or more of these symptoms after you cut down or
stopped using prescription sedatives?
•
•
•
•
•
•
•
•
Sweating or feeling that your heart was beating fast
Having your hands tremble
Having trouble sleeping
Vomiting or feeling nauseous
Seeing, hearing, or feeling things that weren’t really there
Feeling like you couldn’t sit still
Feeling anxious
Having seizures or fits
1
Yes
2
No
DK/REF
DRSV12 [IF DRSV11 = 1] Please look at the symptoms listed below. During the past 12
months, did you have 2 or more of these symptoms at the same time that lasted for
longer than a day after you cut back or stopped using prescription sedatives?
•
•
•
•
•
•
•
•
Sweating or feeling that your heart was beating fast
Having your hands tremble
Having trouble sleeping or sleeping more than you normally do
Vomiting or feeling nauseous
Seeing, hearing, or feeling things that weren’t really there
Feeling like you couldn’t sit still
Feeling anxious
Having seizures or fits
1
Yes
2
No
DK/REF
DRSV12a [IF DRSV11 = 1] You just mentioned that you had symptoms after you cut down or
stopped using prescription sedatives. Did you use prescription sedatives again, drink
alcohol, use prescription tranquilizers, or any illegal substance to avoid or get over
these symptoms?
1
2
Yes
No
G-62
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Press [F2] to see these symptoms again
DRSV12b
[IF DRSV11 = 2 OR DK/REF] After you cut down or stopped using prescription
sedatives, did you use prescription sedatives again, drink alcohol, use prescription
tranquilizers, or any illegal substance to prevent these symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Press [F2] to see these symptoms again
DRSV13 [IF SED12MON = 1] During the past 12 months, did you have any problems with
your emotions, nerves, or mental health that were probably caused or made worse by
your use of prescription sedatives?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV14 [IF DRSV13 = 1] Did you continue to use prescription sedatives even though you
thought this was causing you to have problems with your emotions, nerves, or mental
health?
1
Yes
2
No
DK/REF
DRSV15 [IF DRSV13 = 2 OR DK/REF OR DRSV14 = 2 OR DK/REF] During the past 12
months, did you have any physical health problems that were probably caused or
made worse by your use of prescription sedatives?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV16 [IF DRSV15 = 1] Did you continue to use prescription sedatives even though you
thought this was causing you to have physical problems?
G-63
1
Yes
2
No
DK/REF
DRSV17 [IF SED12MON = 1] This question is about important activities such as working,
going to school, taking care of children, doing fun things such as hobbies and sports,
and spending time with friends and family.
During the past 12 months, did using prescription sedatives cause you to give up or
spend less time doing these types of important activities?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV18 [IF SED12MON = 1] Sometimes people who use prescription sedatives have
serious problems at home, work or school—such as:
•
•
•
•
neglecting their children
missing work or school
doing a poor job at work or school
losing a job or dropping out of school
During the past 12 months, did using prescription sedatives cause you to have
serious problems like this either at home, work, or school?
1
Yes
2
No
DK/REF
DRSV19 [IF SED12MON = 1] During the past 12 months, did you regularly use prescription
sedatives and then do something where using prescription sedatives might have put
you in physical danger?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV20 [IF SED12MON = 1] During the past 12 months, did using prescription sedatives
cause you to do things that repeatedly got you in trouble with the law?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
G-64
DRSV21 [IF SED12MON = 1] During the past 12 months, did you have any problems with
family or friends that were probably caused by your use of prescription sedatives?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV22 [IF DRSV21 = 1] Did you continue to use prescription sedatives even though you
thought this caused problems with family or friends?
1
Yes
2
No
DK/REF
DRSV23a During the past 12 months, was there ever a time when you wanted to use
prescription sedatives so much that you couldn’t think of anything else?
1
Yes
2
No
DK/REFPROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV23b [IF DRSV23a = 2, DK/REF] During the past 12 months, was there ever a time when
you had a strong urge to use prescription sedatives?
1
Yes
2
No
DK/REFPROGRAMMER: SHOW 12 MONTH CALENDAR
G-65
Appendix H: DSM-5 Dependence Module – Spanish
Proposed DSM5 Substance Dependence and Abuse for 2017 NSDUH Spanish CAI
Administration (10/28/2015)
INTRODR
[IF CIG30DAY = 1 OR ALC12MON = 1 OR 2 OR 3 OR MAR12MON = 1 OR 2
OR 3 OR COC12MON = 1 OR CRK12MON = 1 OR HER12MON = 1 OR
HAL12MON = 1 OR INH12MON = 1 OR MET12MON = 1 OR PAI12MON = 1
OR TRA12MON = 1 OR STI12MON = 1 OR SED12MON = 1] Ahora, nos
gustaría que usted nos contara acerca de sus experiencias con
[CIG30DAY = 1 AND ALC12MON = 4 AND (MAR12MON = 4 AND
COC12MON = 2 AND CRK12MON = 2 AND HER12MON = 2 AND
HAL12MON = 2 AND INH12MON = 2 AND MET12MON = 2 AND
PAI12MON = 2 AND TRA12MON = 2 AND STI12MON = 2 AND
SED12MON = 2)] los cigarrillos que fumó.
[CIG30DAY = 1 AND ALC12MON = 1 OR 2 OR 3 AND (MAR12MON = 4
AND COC12MON = 2 AND CRK12MON = 2 AND HER12MON = 2 AND
HAL12MON = 2 AND INH12MON = 2 AND MET12MON = 2 AND
PAI12MON = 2 AND TRA12MON = 2 AND STI12MON = 2 AND
SED12MON = 2)] los cigarrillos que fumó y el alcohol que bebió.
[CIG30DAY = 2 AND ALC12MON = 1 OR 2 OR 3 AND (MAR12MON = 4
AND COC12MON = 2 AND CRK12MON = 2 AND HER12MON = 2 AND
HAL12MON = 2 AND INH12MON = 2 AND MET12MON = 2 AND
PAI12MON = 2 AND TRA12MON = 2 AND STI12MON = 2 AND
SED12MON = 2)] el alcohol que bebió.
[CIG30DAY = 1 AND ALC12MON = 4 AND (MAR12MON = 1 OR 2 OR 3 OR
COC12MON = 1 OR CRK12MON =1 OR HER12MON = 1 OR HAL12MON =
1 OR INH12MON = 1 OR MET12MON = 1 OR PAI12MON = 1 OR
TRA12MON = 1 OR STI12MON = 1 OR SED12MON = 1)] los cigarrillos que
fumó y las drogas que usó.
[CIG30DAY = 2 AND ALC12MON = 1 OR 2 OR 3 OR AND (MAR12MON = 1
OR 2 OR 3 OR COC12MON = 1 OR CRK12MON =1 OR HER12MON = 1 OR
HAL12MON = 1 OR INH12MON = 1 OR MET12MON = 1 OR PAI12MON = 1
OR TRA12MON = 1 OR STI12MON = 1 OR SED12MON = 1)] el alcohol que
bebió y las drogas que usó.
[CIG30DAY = 1 AND ALC12MON = 1 OR 2 OR 3 AND (MAR12MON = 1 OR
2 OR 3 OR COC12MON = 1 OR CRK12MON =1 OR HER12MON = 1 OR
HAL12MON = 1 OR INH12MON = 1 OR MET12MON = 1 OR PAI12MON = 1
OR TRA12MON = 1 OR STI12MON = 1 OR SED12MON = 1)] los cigarrillos
que fumó, el alcohol que bebió y las drogas que usó.
H-1
[CIG30DAY = 2 AND ALC12MON = 4 AND (MAR12MON = 1 OR 2 OR 3 OR
COC12MON = 1 OR CRK12MON =1 OR HER12MON = 1 OR HAL12MON =
1 OR INH12MON = 1 OR MET12MON = 1 OR PAI12MON = 1 OR
TRA12MON = 1 OR STI12MON = 1 OR SED12MON = 1)] las drogas que usó.
Presione [ENTER] para continuar.
DRCIG
[IF CIG30DAY = 1] Piense en su uso de cigarrillos en los últimos 30 días al
responder las siguientes preguntas..
Presione [ENTER] para continuar.
PROGRAMMER: SHOW 30 DAY CALENDAR
DRCGE01
[IF CIG30DAY = 1] Por favor piense en lo cierto que es para usted cada
declaración.
Después de no fumar por un rato, usted necesita fumar para sentirse menos
inquieto o irritable.
1
No es nada cierto de mí
2
Es algo cierto de mí
3
Es más o menos cierto de mí
4
Es muy cierto de mí
5
Es sumamente cierto de mí
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
DRCGE02
[IF CIG30DAY = 1] Usted empieza a desear un cigarrillo después de no fumar
por varias horas.
1
No es nada cierto de mí
2
Es algo cierto de mí
3
Es más o menos cierto de mí
4
Es muy cierto de mí
5
Es sumamente cierto de mí
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
H-2
DRCGE03
[IF CIG30DAY = 1] A veces el deseo de fumar un cigarrillo es tan fuerte, que
usted siente como si estuviera bajo el control de alguna fuerza que no puede
dominar.
1
No es nada cierto de mí
2
Es algo cierto de mí
3
Es más o menos cierto de mí
4
Es muy cierto de mí
5
Es sumamente cierto de mí
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
DRCGE04
[IF CIG30DAY = 1] Usted siente que está en pleno control de la frecuencia con
que fuma, es decir, fuma cuando quiere pero igualmente si desea, puede dejar de
fumar en cualquier momento.
1
No es nada cierto de mí
2
Es algo cierto de mí
3
Es más o menos cierto de mí
4
Es muy cierto de mí
5
Es sumamente cierto de mí
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
DRCGE05
[IF CIG30DAY = 1] Usted trata de evitar lugares donde no se permite fumar, aún
cuando usted sabe que hubiera disfrutado de estar en aquellos lugares.
1
No es nada cierto de mí
2
Es algo cierto de mí
3
Es más o menos cierto de mí
4
Es muy cierto de mí
5
Es sumamente cierto de mí
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
DRCGE06a [IF CIG30DAY = 1] ¿Tiene amigos que no fuman cigarrillos?
1
Sí
2
No
DK/REF
H-3
DRCGE06b [IF CGE6A = 1] Piense en su uso de cigarrillos en los últimos 30 días al
responder las siguientes preguntas. Hay veces en que usted prefiere no andar con
amigos que no fuman porque a ellos les molestaría que usted fume en su
presencia.
DRCGE07
1
No es nada cierto de mí
2
Es algo cierto de mí
3
Es más o menos cierto de mí
4
Es muy cierto de mí
5
Es sumamente cierto de mí
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
[IF CIG30DAY = 1]
[ADD IF DRCGE06b = BLANK] Piense en su uso de cigarrillos en los últimos
30 días al responder las siguientes preguntas.
Aunque el viaje le sea más largo, usted preferiría no viajar en avión porque no le
permitirían fumar.
1
No es nada cierto de mí
2
Es algo cierto de mí
3
Es más o menos cierto de mí
4
Es muy cierto de mí
5
Es sumamente cierto de mí
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
DRCGE08
[IF CIG30DAY = 1] A veces usted se preocupa de que se le van a terminar los
cigarrillos.
1
No es nada cierto de mí
2
Es algo cierto de mí
3
Es más o menos cierto de mí
4
Es muy cierto de mí
5
Es sumamente cierto de mí
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
H-4
DRCGE09
[IF CIG30DAY = 1] Usted fuma cigarrillos regularmente durante el día.
1
No es nada cierto de mí
2
Es algo cierto de mí
3
Es más o menos cierto de mí
4
Es muy cierto de mí
5
Es sumamente cierto de mí
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
DRCGE10
[IF CIG30DAY = 1] Durante los fines de semana, usted fuma la misma cantidad
que fuma durante los días de semana.
1
No es nada cierto de mí
2
Es algo cierto de mí
3
Es más o menos cierto de mí
4
Es muy cierto de mí
5
Es sumamente cierto de mí
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
DRCGE11
[IF CIG30DAY = 1] Usted fuma casi el mismo número de cigarrillos todos los
días.
1
No es nada cierto de mí
2
Es algo cierto de mí
3
Es más o menos cierto de mí
4
Es muy cierto de mí
5
Es sumamente cierto de mí
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
DRCGE12
[IF CIG30DAY = 1] Es difícil decir cuántos cigarrillos usted fuma al día porque
el número varía con frecuencia.
1
No es nada cierto de mí
2
Es algo cierto de mí
3
Es más o menos cierto de mí
4
Es muy cierto de mí
5
Es sumamente cierto de mí
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
H-5
DRCGE13
[IF CIG30DAY = 1] Para usted es normal fumar varios cigarrillos en una sola
hora, y luego no fumar más por varias horas.
1
No es nada cierto de mí
2
Es algo cierto de mí
3
Es más o menos cierto de mí
4
Es muy cierto de mí
5
Es sumamente cierto de mí
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
DRCGE14
[IF CIG30DAY = 1] El número de cigarrillos que fuma al día cambia con
frecuencia, porque depende de otras
cosas, como por ejemplo, lo que está haciendo en ese momento o cómo se siente.
1
No es nada cierto de mí
2
Es algo cierto de mí
3
Es más o menos cierto de mí
4
Es muy cierto de mí
5
Es sumamente cierto de mí
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
DRCGE15
[IF CIG30DAY = 1] Su costumbre de fumar no cambia debido a ciertas
situaciones. Por ejemplo, usted fuma
casi lo mismo, sin importar si está relajándose o trabajando, o si se siente felíz o
triste, o si está solo
o acompañado.
1
No es nada cierto de mí
2
Es algo cierto de mí
3
Es más o menos cierto de mí
4
Es muy cierto de mí
5
Es sumamente cierto de mí
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
H-6
DRCGE16
[IF CIG30DAY = 1] Hoy en día, usted fuma más de lo que fumaba cuando
empezó a fumar.
1
No es nada cierto de mí
2
Es algo cierto de mí
3
Es más o menos cierto de mí
4
Es muy cierto de mí
5
Es sumamente cierto de mí
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
DRCGE17
[IF CIG30DAY = 1] Hoy en día, para quedar satisfecho usted necesita fumar más
de lo que fumaba cuando empezó a fumar.
1
No es nada cierto de mí
2
Es algo cierto de mí
3
Es más o menos cierto de mí
4
Es muy cierto de mí
5
Es sumamente cierto de mí
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
DRCGE18
[IF CIG30DAY = 1] Hoy en día, para sentir los efectos de fumar, usted necesita
fumar más de lo que fumaba cuando empezó a fumar.
1
No es nada cierto de mí
2
Es algo cierto de mí
3
Es más o menos cierto de mí
4
Es muy cierto de mí
5
Es sumamente cierto de mí
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
DRCGE19a [IF CIG30DAY = 1 AND (CG07 = 30 OR CG07DKRE = 6 ¿Qué tan pronto
después de despertarse fuma su primer cigarrillo?
1
En los primeros 5 minutos después de despertarse
2
Entre 6 y 30 minutos después de despertarse
3
Entre 31 y 60 minutos después de despertarse
4
Más de 60 minutos después de despertarse
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
H-7
DRCGE19b [IF DRCGE19a = BLANK AND CIG30DAY = 1 AND (CG07 = 1 - 29 OR
CG07DKRE - 1-5 Los días que usted fuma, ¿qué tan pronto después de
despertarse fuma su primer cigarrillo?
1
En los primeros 5 minutos después de despertarse
2
Entre 6 y 30 minutos después de despertarse
3
Entre 31 y 60 minutos después de despertarse
4
Más de 60 minutos después de despertarse
DK/REF
PROGRAMMER: SHOW 30 DAY CALENDAR
DRALC
[IF ALC12MON = 1 - 3] Piense en su consumo de alcohol en los últimos 12
meses, al responder las siguientes preguntas.
Presione [ENTER] para continuar.
DRALC01
[IF ALC12MON = 1 - 3] En los últimos 12 meses, ¿hubo un mes o más en que
usted dedicó mucho tiempo para conseguir o beber alcohol?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC02
[IF DRALC01 = 2 OR DK/REF] En los últimos 12 meses, ¿hubo un mes o más
en que usted pasó mucho tiempo recuperándose de los efectos del alcohol que
había tomado?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC04
[IF ALC12MON = 1 - 3] En los últimos 12 meses, ¿trató de ponerse límites en la
frecuencia o la cantidad de alcohol que bebería?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC05
[IF DRALC04 = 1] ¿Logró mantener los límites que estableció, o bebió con
frecuencia más de lo que había planeado?
1
Por lo general mantuvo los límites establecidos
2
Por lo general bebió más de lo planeado
DK/REF
H-8
DRALC06
[IF ALC12MON = 1 - 3] En los últimos 12 meses, ¿tuvo que beber más alcohol
de lo que acostumbraba beber, para poder conseguir el efecto que deseaba?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC07
[IF DRALCO6 = 2 OR DK/REF] En los últimos 12 meses, ¿notó que beber la
misma cantidad de alcohol le causaba menos efecto que antes?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC08
[IF ALC12MON = 1 - 3] En los últimos 12 meses, ¿quiso o trató de reducir la
cantidad o de dejar de beber alcohol?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC09
[IF DRALC08 = 1] En los últimos 12 meses, ¿logró reducir la cantidad de
alcohol o dejar de beber todas las veces que quiso o trató de hacerlo?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC10
[IF DRALC08 = 2 OR DK/REF OR DRALC09 = 2 OR DK/REF] En los últimos
12 meses, ¿redujo la cantidad o dejó de beber por lo menos una vez?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
H-9
DRALC11
[IF DRALC09 = 1 OR DRALC10 = 1] Por favor mire la siguiente lista de
síntomas. En los últimos 12 meses, ¿tuvo 2 o más de estos síntomas después de
reducir la cantidad o dejar de beber alcohol?
•
•
•
•
•
•
•
•
Sudó o sintió que su corazón latía muy rápido
Le temblaron las manos
Tuvo problemas para dormir
Vomitó o sintió náuseas
Vio, escuchó o sintió cosas que no estaban realmente ahí
Se sintió inquieto
Se sintió ansioso
Tuvo convulsiones o ataques
1
Sí
2
No
DK/REF
DRALC12
[IF DRALC11 = 1] Por favor mire la siguiente lista de síntomas. En los últimos
12 meses, ¿tuvo 2 o más de estos síntomas a la vez, que hayan durado más de un
día, después de beber menos o dejar de beber alcohol?
•
•
•
•
•
•
•
•
Sudó o sintió que su corazón latía muy rápido
Le temblaron las manos
Tuvo problemas para dormir
Vomitó o sintió náuseas
Vio, escuchó o sintió cosas que no estaban realmente ahí
Se sintió inquieto
Se sintió ansioso
Tuvo convulsiones o ataques
1
Sí
2
No
DK/REF
DRALC12a [IF DRALC11 = 1] Usted acaba de mencionar que tuvo síntomas después de
reducir la cantidad o dejar de beber alcohol. ¿Bebió alcohol otra vez, usó sedantes
o tranquilizantes que normalmente se venden con una receta médica, o alguna
sustancia ilícita para evitar o recuperarse de estos síntomas?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Presione F2 para ver estos síntomas otra vez
H-10
DRALC12b [IF DRALC11=2 OR DK/REF] Después que usted redujo la cantidad o dejó de
beber alcohol, ¿bebió alcohol otra vez, usó sedantes o tranquilizantes que
normalmente se venden con una receta médica, o alguna sustancia ilícita para
prevenir estos síntomas?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Presione F2 para ver estos síntomas otra vez
DRALC13
[IF ALC12MON = 1 - 3] En los últimos 12 meses, ¿tuvo algún problema
emocional, de nervios o de la salud mental que quizá haya sido causado o
empeorado por beber alcohol?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC14
[IF DRALC13 = 1] ¿Continuó bebiendo alcohol aún cuando pensaba que beber le
estaba causando problemas emocionales, de nervios o de la salud mental?
1
Sí
2
No
DK/REF
DRALC15
[IF DRALC13 = 2 OR DK/REF OR DRALC14 = 2 OR DK/REF] En los últimos
12 meses, ¿tuvo algún problema de salud física que quizá haya sido causado o
empeorado por beber alcohol?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC16
[IF DRALC15 = 1] ¿Continuó bebiendo alcohol aún cuando pensaba que beber le
estaba causando problemas de salud física?
1
Sí
2
No
DK/REF
DRALC17
[IF ALC12MON = 1 - 3] Esta pregunta se trata de actividades importantes como
H-11
trabajar, ir a estudiar, cuidar niños o hacer cosas divertidas como pasatiempos,
jugar deportes y pasar tiempo con los amigos y la familia.
En los últimos 12 meses, ¿su consumo de alcohol le hizo abandonar o dedicar
menos tiempo a hacer ese tipo de actividades importantes?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC18
[IF ALC12MON = 1 - 3] A veces las personas que beben alcohol tienen
problemas serios en su hogar, en el trabajo o en la escuela, como:
- descuidar de sus hijos
- faltar al trabajo o a la escuela
- desempeñarse mal en el trabajo o en los estudios
- perder su trabajo o abandonar los estudios
En los últimos 12 meses, ¿su consumo de alcohol le causó problemas serios como
estos en su hogar, en el trabajo o en la escuela?
1
Sí
2
No
DK/REF
DRALC19
[IF ALC12MON = 1 - 3] En los últimos 12 meses, ¿bebía alcohol en forma
regular y luego hacía algo que lo hubiera expuesto al peligro físico porque estaba
borracho?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC20
[IF ALC12MON = 1 - 3] En los últimos 12 meses, ¿su consumo de alcohol le
causó hacer cosas que lo metieron en problemas con la ley una y otra vez?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
H-12
DRALC21
[IF ALC12MON = 1 - 3] En los últimos 12 meses, ¿tuvo algún problema con su
familia o sus amigos, que probablemente fue causado por su consumo de alcohol?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC22
[IF DRALC21 = 1] ¿Continuó bebiendo alcohol aún cuando usted pensaba que
beber le causaba problemas con la familia o los amigos?
1
Sí
2
No
DK/REF
DRALC23a
Alguna vez en los últimos 12 meses, ¿tuvo tantas ganas de beber alcohol que no
podía pensar en nada más?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC23b [If DRALC23a = 2, DK/REF] Alguna vez en los últimos 12 meses, ¿tuvo usted
un deseo fuerte o la necesidad de beber alcohol?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ
[IF MAR12MON = 1 - 3] Piense en su uso de marihuana o hachís en los últimos 12
meses, al responder las siguientes preguntas.
Presione [ENTER] para continuar.
DRMJ01 [IF MAR12MON = 1 - 3] En los últimos 12 meses, ¿hubo un mes o más en que usted
dedicó mucho tiempo para conseguir o usar marihuana o hachís?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
H-13
DRMJ02 [IF DRMJ01 = 2 OR DK/REF] En los últimos 12 meses, ¿hubo un mes o más en que
usted pasó mucho tiempo recuperándose de los efectos de la marihuana o hachís que
había usado?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ04 [IF MAR12MON = 1 - 3] En los últimos 12 meses, ¿trató de ponerse límites en la
frecuencia o cantidad de marihuana o hachís que usaría?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ05 [IF DRMJ04 = 1] ¿Logró mantener los límites que estableció, o usó con frecuencia
más marihuana o hachís de lo que había planeado?
1
Por lo general mantuvo los límites establecidos
2
Por lo general usó más de lo planeado
DK/REF
DRMJ06 [IF MAR12MON = 1 - 3] En los últimos 12 meses, ¿tuvo que usar más marihuana o
hachís de lo que acostumbraba usar, para poder conseguir el efecto que deseaba?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ07 [IF DRMJ06 = 2 OR DK/REF] En los últimos 12 meses, ¿notó que usar la misma
cantidad de marihuana o hachís le causaba menos efecto que antes?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ08 [IF MAR12MON = 1 - 3] En los últimos 12 meses, ¿quiso o trató de reducir el uso o
dejar de usar marihuana o hachís?
1
Sí
2
No
DK/REF
H-14
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ09 [IF DRMJ08 = 1] En los últimos 12 meses, ¿logró reducir el uso o dejar de usar
marihuana o hachís todas las veces que quiso o trató de hacerlo?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ10
[IF DRMJC08 = 2 OR DK/REF OR DRMJC09 = 2 OR DK/REF] En los últimos
12 meses, ¿redujo el uso o dejó de usar marihuana o hachís por lo menos una
vez?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ11a
[IF DRMJ09 = 1 OR DRMJ10 = 1] Por favor mire la siguiente lista de síntomas.
En los últimos 12 meses, ¿tuvo alguno de estos síntomas después de reducir el uso
o dejar de usar marihuana o hachís?
Dolor de estómago
Agitación o temblores en el cuerpo
Sudor
Fiebre
Escalofríos
Dolor de cabeza
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ11b
[IF DRMJ09 = 1 OR DRMJ10 = 1] En los últimos 12 meses, ¿tuvo [IF DRMJ11a
= 1 then fill 2, IF DRMJ11a = 2, DK/REF then fill 3] o más de estos síntomas
después que reducir el uso o dejó de usar marihuana o hachís?
Se sintió irritable o enojado
Se sintió ansioso o nervioso
Tuvo problemas para dormir
Perdió el apetito o bajó de peso sin tratar de hacerlo
Se sintió inquieto
Se sintió deprimido
H-15
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ12a
[IF DRMJ11a = 1 OR DRMJ11b = 1] Usted acaba de mencionar que tuvo
síntomas después de reducir el uso o dejar de usar marihuana o hachís. ¿Usó
marihuana o hachís otra vez, o alguna sustancia ilícita para evitar o recuperarse
de estos síntomas?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Presione F2 para ver estos síntomas otra vez
DRMJ12b
[IF (DRMJ11a = 2 OR DK/REF) AND (DRMJ11b = 2 OR DK/REF)] Después
que usted redujo el uso o dejó de usar marihuana o hachís, ¿usó marihuana o
hachís otra vez, o alguna sustancia ilícita para prevenir estos síntomas?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Presione F2 para ver estos síntomas otra vez
DRMJ13 [IF MAR12MON = 1 - 3] En los últimos 12 meses, ¿tuvo algún problema emocional,
de nervios o de la salud mental que quizá haya sido causado o empeorado por usar
marihuana o hachís?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ14 [IF DRMJ13 = 1] ¿Continuó usando marihuana o hachís aún cuando pensaba que le
estaba causando problemas emocionales, de nervios o de la salud mental?
1
Sí
2
No
DK/REF
H-16
DRMJ15 [IF DRMJ13 = 2 OR DK/REF OR DRMJ14 = 2 OR DK/REF] En los últimos 12
meses, ¿tuvo algún problema de salud física que quizá haya sido causado o
empeorado por usar marihuana o hachís?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ16 [IF DRMJ15 = 1] ¿Continuó usando marihuana o hachís aún cuando pensaba que le
estaba causando problemas de salud física?
1
Sí
2
No
DK/REF
DRMJ17 [IF MAR12MON = 1 - 3] Esta pregunta se trata de actividades importantes como
trabajar, ir a estudiar, cuidar niños o hacer cosas divertidas como pasatiempos, jugar
deportes y pasar tiempo con los amigos y la familia.
En los últimos 12 meses, ¿el usar marihuana o hachís le hizo abandonar o dedicar
menos tiempo a hacer estos tipos de actividades importantes?.
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ18 [IF MAR12MON = 1 - 3] A veces las personas que usan marihuana o hachís tienen
problemas serios en su hogar, en el trabajo o en la escuela, como:
- descuidar de sus hijos
- faltar al trabajo o a la escuela
- desempeñarse mal en el trabajo o en los estudios
- perder su trabajo o abandonar los estudios
En los últimos 12 meses, ¿su uso de marihuana o hachís le causó problemas serios
como esos en su hogar, en el trabajo o en la escuela?
1
Sí
2
No
DK/REF
H-17
DRMJ19 [IF MAR12MON = 1 - 3] En los últimos 12 meses, ¿usaba marihuana o hachís en
forma regular y luego hacía algo que lo hubiera expuesto al peligro físico porque
estaba usando marihuana o hachís?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ20 [IF MAR12MON = 1 - 3] En los últimos 12 meses, ¿el usar marihuana o hachís le
causó hacer cosas que lo metieron en problemas con la ley una y otra vez?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ21 [IF MAR12MON = 1 - 3] En los últimos 12 meses, ¿tuvo algún problema con la
familia o los amigos que probablemente fue causado por su uso de marihuana o
hachís?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ22 [IF DRMJ21 = 1] ¿Continuó usando marihuana o hachís aún cuando usted pensaba
que le causaba problemas con la familia o los amigos?
1
Sí
2
No
DK/REF
DRMJ23a Alguna vez en los últimos 12 meses, ¿tuvo tantas ganas de usar marihuana o hachís
que no podía pensar en nada más?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
H-18
DRMJ23b [IF DRMJ23a = 2, DK/REF] Alguna vez en los últimos 12 meses, ¿tuvo usted un
deseo fuerte o la necesidad de usar marihuana o hachís?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC
[IF COC12MON = 1 OR CRK12MON = 1] Piense en su uso de cocaína [IF
CRK12MON = 1] , incluyendo la forma de cocaína que se conoce como ''crack''
en los últimos 12 meses, al responder las siguientes preguntas.
Presione [ENTER] para continuar.
DEFINE COKEFILL:
IF COC12MON = 1 AND CRK12MON NE 1, THEN COKEFILL = ‘cocaína’
IF COC12MON = 1 AND CRK12MON = 1 THEN COKEFILL = ‘cocaína o ‘crack’
IF COC12MON NE 1 AND CRK12MON = 1 THEN COKEFILL = ‘crack’
ELSE COKEFILL = BLANK
DRCC01 [IF COC12MON = 1 OR CRK12MON = 1] En los últimos 12 meses, ¿hubo un mes o
más en que usted dedicó mucho tiempo para conseguir o usar [COKEFILL]?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC02 [IF DRCC01 = 2 OR DK/REF] En los últimos 12 meses, ¿hubo un mes o más en que
usted pasó mucho tiempo recuperándose de los efectos de [COKEFILL] que había
usado?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC04 [IF COC12MON = 1 OR CRK12MON = 1] En los últimos 12 meses, ¿trató de
ponerse límites en la frecuencia o cantidad de [COKEFILL] que usaría?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
H-19
DRCC05 [IF DRCC04 = 1] ¿Logró mantener los límites que estableció, o usó con frecuencia
más [COKEFILL] de lo que había planeado?
1
Por lo general mantuvo los límites establecidos
2
Por lo general usó más de lo planeado
DK/REF
DRCC06 [IF COC12MON = 1 OR CRK12MON = 1] En los últimos 12 meses, ¿tuvo que usar
más [COKEFILL] de lo que acostumbraba usar, para poder conseguir el efecto que
deseaba?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC07 [IF DRCC06 = 2 OR DK/REF] En los últimos 12 meses, ¿notó que usar la misma
cantidad de [COKEFILL] le causaba menos efecto que antes?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC08 [IF COC12MON = 1 OR CRK12MON = 1] En los últimos 12 meses, ¿quiso o trató
de reducir el uso o dejar de usar [COKEFILL]?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC09 [IF DRCC08 = 1] En los últimos 12 meses, ¿logró reducir el uso o dejar de usar
[COKEFILL] todas las veces que quiso o trató de hacerlo?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC10 [IF DRCC8 = 2 OR DK/REF OR DRCC9 = 2 OR DK/REF] En los últimos 12 meses,
¿redujo el uso o dejó de usar [COKEFILL] por lo menos una vez?
1
Sí
2
No
DK/REF
H-20
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC10a [IF DRCC09 = 1 OR DRCC10 = 1] En los últimos 12 meses, ¿se sintió algo
deprimido o decaído cuando redujo el uso o dejó de usar [COKEFILL]?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC10b
[IF DRCC10a = 2] Esta pregunta es también acerca de las ocasiones después que
usted redujo el uso o dejó de usar cocaína.
Durante alguna de esas ocasiones, ¿usó cocaína o “crack” otra vez,
metanfetamina, estimulantes que normalmente se venden con una receta médica o
alguna sustancia ilícita para prevenir sentirse deprimido o decaído?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC11 [IF DRCC10a = 1] Por favor mire la siguiente lista de síntomas. En los últimos 12
meses, ¿tuvo 2 o más de estos síntomas después de reducir el uso o dejar de usar
[COKEFILL]?
•
•
•
•
•
Se sintió cansado o agotado
Tuvo sueños malos
Tuvo problemas para dormir o durmió más de lo que acostumbra
Sintió hambre con más frecuencia
Sintió que todo lo hacía más lento o se sintió inquieto
1
Sí
2
No
DK/REF
DRCC12
[IF DRCC11 = 1] Por favor mire la siguiente lista de síntomas. En los últimos 12
meses, ¿tuvo 2 o más de estos síntomas a la vez, que hayan durado más de un
día, después de usar menos o dejar de usar [COKEFILL]?
•
•
•
•
•
Se sintió cansado o agotado
Tuvo sueños malos
Tuvo problemas para dormir o durmió más de lo que acostumbra
Sintió hambre con más frecuencia
Sintió que todo lo hacía más lento o se sintió inquieto
H-21
1
Sí
2
No
DK/REF
DRCC12a
[IF DRCC11 = 1] Usted acaba de mencionar que tuvo síntomas después de
reducir el uso o dejar de usar [COKEFILL]. ¿Usó usted cocaína o “crack” otra
vez, metanfetamina, estimulantes que normalmente se venden con una receta
médica o alguna sustancia ilícita para evitar o recuperarse de estos síntomas?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Presione F2 para ver estos síntomas otra vez
DRCC12b
[IF DRCC11 = 2 OR DK/REF] Después que usted redujo el uso o dejó de usar
[COKEFILL], ¿usó cocaína o “crack” otra vez, metanfetamina, estimulantes que
normalmente se venden con una receta médica o alguna sustancia ilícita para
prevenir esos síntomas?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Presione F2 para ver estos síntomas otra vez
DRCC13 [IF COC12MON = 1 OR CRK12MON = 1] En los últimos 12 meses, ¿tuvo algún
problema emocional, de nervios o de la salud mental que quizá haya sido causado o
empeorado por su uso de [COKEFILL]?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC14 [IF DRCC13 = 1] ¿Continuó usando [COKEFILL] aún cuando pensaba que le
estaba causando problemas emocionales, de nervios o de la salud mental?
1
Sí
2
No
DK/REF
DRCC15 [IF DRCC13 = 2 OR DK/REF OR DRCC14 = 2 OR DK/REF] En los últimos 12
H-22
meses, ¿tuvo algún problema de la salud física que quizá haya sido causado o
empeorado por su uso de [COKEFILL]?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC16 [IF DRCC15 = 1] ¿Continuó usando [COKEFILL] aún cuando pensaba que le
estaba causando problemas de salud física?
1
Sí
2
No
DK/REF
DRCC17 [IF COC12MON = 1 OR CRK12MON = 1] Esta pregunta se trata de actividades
importantes como trabajar, ir a estudiar, cuidar niños o hacer cosas divertidas como
pasatiempos, jugar deportes y pasar tiempo con los amigos y la familia.
En los últimos 12 meses, ¿el usar [COKEFILL] le hizo abandonar o dedicar menos
tiempo a hacer estos tipos de actividades importantes?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC18 [IF COC12MON = 1 OR CRK12MON = 1] A veces las personas que usan
[COKEFILL] tienen problemas serios en su hogar, en el trabajo o en la escuela,
como:
- descuidar de sus hijos
- faltar al trabajo o a la escuela
- desempeñarse mal en el trabajo o en los estudios
- perder su trabajo o abandonar los estudios
En los últimos 12 meses, ¿su uso de [COKEFILL] le causó problemas serios como
esos en su hogar, en el trabajo o en la escuela?
1
Sí
2
No
DK/REF
DRCC19 [IF COC12MON = 1 OR CRK12MON = 1] En los últimos 12 meses, ¿usaba
[COKEFILL] en forma regular y luego hacía algo que lo hubiera expuesto al peligro
físico porque estaba usando [COKEFILL]?
H-23
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC20 [IF COC12MON = 1 OR CRK12MON = 1] En los últimos 12 meses, ¿el usar
[COKEFILL] le causó hacer cosas que lo metieron en problemas con la ley una y
otra vez?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC21 [IF COC12MON = 1 OR CRK12MON = 1] En los últimos 12 meses, ¿tuvo algún
problema con la familia o los amigos que probablemente fue causado por su uso de
[COKEFILL]?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC22 [IF DRCC21 = 1] ¿Continuó usando [COKEFILL] aún cuando usted pensaba que le
causaba problemas con la familia o los amigos?
1
Sí
2
No
DK/REF
DRCC23a Alguna vez en los últimos 12 meses, ¿tuvo tantas ganas de usar [COKEFILL] que
no podía pensar en nada más?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC23b [IF DRCC23a = 2, DK/REF] Alguna vez en los últimos 12 meses, ¿tuvo usted un
deseo fuerte o la necesidad de usar [COKEFILL]?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
H-24
Heroin
DRHE
[IF HER12MON = 1] Piense en su uso de heroína en los últimos 12 meses al
responder las siguientes preguntas.
Press [ENTER] to continue.
DRHE01 [IF HER12MON = 1] En los últimos 12 meses, ¿hubo un mes o más en que usted
dedicó mucho tiempo para conseguir o usar heroína?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE02 [IF DRHE01 = 2 OR DK/REF] En los últimos 12 meses, ¿hubo un mes o más en que
usted pasó mucho tiempo recuperándose de los efectos de la heroína que había
usado?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE04 [IF HER12MON = 1] En los últimos 12 meses, ¿trató de ponerse límites en la
frecuencia o la cantidad de heroína que usaría?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE05 [IF DRHE04 = 1] ¿Logró mantener los límites que estableció, o usó con frecuencia
más heroína de lo que había planeado?
1 Por lo general mantuvo los límites establecidos
2 Por lo general usó más de lo planeado
DK/REF
DRHE06 [IF HER12MON = 1] En los últimos 12 meses, ¿tuvo que usar más heroína de lo que
acostumbraba usar, para poder conseguir el efecto que deseaba?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE07 [IF DRHE06 = 2 OR DK/REF] En los últimos 12 meses, ¿notó que usar la misma
H-25
cantidad de heroína le causaba menos efecto que antes?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE08 [IF HER12MON = 1] En los últimos 12 meses, ¿quiso o trató de reducir el uso o
dejar de usar heroína?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE09 [IF DRHE08 = 1] En los últimos 12 meses, ¿logró reducir el uso o dejar de usar
heroína todas las veces que quiso o trató de hacerlo?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE10 [IF DRHE08 = 2 OR DK/REF OR DRHE09 = 2 OR DK/REF] En los últimos 12
meses, ¿redujo el uso o dejó de usar heroína por lo menos una vez?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE11 [IF DRHE09 = 1 OR DRHE10 = 1] Por favor mire la siguiente lista de síntomas. En
los últimos 12 meses, ¿tuvo 3 o más de estos síntomas después de reducir el uso o
dejar de usar heroína?
•
•
•
•
•
•
•
•
•
1
Se sintió algo deprimido o decaído
Vomitó o sintió náuseas
Tuvo calambres o dolores musculares
Tuvo los ojos lagrimosos o le goteaba la nariz
Sudó o tenía las pupilas dilatadas, o se le erizaban los pelos
Tuvo diarrea
Bostezaba
Tuvo fiebre
Tuvo problemas para dormir
Sí
H-26
2
No
DK/REF
DRHE12 [IF DRHE11 = 1] Por favor mire la siguiente lista de síntomas. En los últimos 12
meses, ¿tuvo 3 o más de estos síntomas a la vez que hayan durado más de un día,
después de usar menos o dejar de usar heroína?
•
•
•
•
•
•
•
•
•
Se sintió algo deprimido o decaído
Vomitó o sintió náuseas
Tuvo calambres o dolores musculares
Tuvo los ojos lagrimosos o le goteaba la nariz
Sudó o tenía las pupilas dilatadas, o se le erizaban los pelos
Tuvo diarrea
Bostezaba
Tuvo fiebre
Tuvo problemas para dormir
1
Sí
2
No
DK/REF
DRHE12a [IF DRHE11 = 1] Usted acaba de mencionar que tuvo síntomas después de reducir el
uso o dejar de usar heroína. ¿Usó heroína otra vez o analgésicos que normalmente se
venden con una receta médica, o alguna sustancia ilícita para evitar o recuperarse de
estos síntomas?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Presione F2 para ver estos síntomas otra vez
DRHE12b[IF DRHE11 = 2 OR DK/REF] Después que usted redujo el uso o dejó de usar
heroína, ¿usó heroína otra vez o analgésicos que normalmente se venden con una
receta médica, o alguna sustancia ilícita para prevenir estos síntomas?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Presione F2 para ver estos síntomas otra vez
DRHE13 [IF HER12MON = 1] En los últimos 12 meses, ¿tuvo algún problema emocional, de
nervios o de la salud mental que quizá haya sido causado o empeorado por su uso de
H-27
heroína?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE14 [IF DRHE13 = 1] ¿Continuó usando heroína aún cuando pensaba que le estaba
causando problemas emocionales, de nervios o de la salud mental?
1
Sí
2
No
DK/REF
DRHE15 [IF DRHE13 = 2 OR DK/REF OR DRHE14 = 2 OR DK/REF] En los últimos 12
meses, ¿tuvo algún problema de salud física que quizá haya sido causado o
empeorado por su uso de heroína?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE16 [IF DRHE15 = 1] ¿Continuó usando heroína aún cuando pensaba que le estaba
causando problemas de salud física?
1
Sí
2
No
DK/REF
DRHE17 [IF HER12MON = 1] Esta pregunta se trata de actividades importantes como trabajar,
ir a estudiar, cuidar niños o hacer cosas divertidas como pasatiempos, jugar deportes
y pasar el tiempo con amigos y con la familia.
En los últimos 12 meses, ¿el usar heroína le hizo abandonar o dedicar menos tiempo
a hacer estos tipos de actividades importantes?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE18 [IF HER12MON = 1] A veces las personas que usan heroína tienen problemas serios
en su hogar, en el trabajo o en la escuela, como:
H-28
- descuidar de sus hijos
- faltar al trabajo o a la escuela
- desempeñarse mal en el trabajo o en los estudios
- perder su trabajo o abandonar los estudios
En los últimos 12 meses, ¿el usar heroína le causó problemas serios como esos, en su
hogar, en el trabajo o en la escuela?
1
Sí
2
No
DK/REF
DRHE19 [IF HER12MON = 1] En los últimos 12 meses, ¿ usaba heroína en forma regular y
luego hacía algo que lo hubiera expuesto al peligro físico porque la estaba usando?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE20 [IF HER12MON = 1] En los últimos 12 meses, ¿el usar heroína le causó hacer cosas
que lo metieron en problemas con la ley una y otra vez?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE21 [IF HER12MON = 1] En los últimos 12 meses, ¿tuvo algún problema con la familia o
los amigos que probablemente fue causado por su uso de heroína?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE22 [IF DRHE21 = 1] ¿Continuó usando heroína aún cuando usted pensaba que le
causaba problemas con la familia o los amigos?
1
Sí
2
No
DK/REF
H-29
DRHE23a Alguna vez en los últimos 12 meses, ¿tuvo tantas ganas de usar heroína que no podía
pensar en nada más?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE23b [If DRHE23a = 2, DK/REF] Alguna vez en los últimos 12 meses, ¿tuvo usted un
deseo fuerte o la necesidad de usar heroína?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS
[IF HAL12MON = 1] Piense en su uso de alucinógenos, como LSD, 'ácido', PCP,
'Éxtasis' o ‘Molly’ , psilocibina u hongos, mescalina o peyote en los últimos 12 meses
al contestar a las siguientes preguntas.
Presione [ENTER] para continuar.
DRLS01 [IF HAL12MON = 1] En los últimos 12 meses, ¿hubo un mes o más en que usted
dedicó mucho tiempo para conseguir o usar alucinógenos?
1 Sí
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS02 [IF DRLS01 = 2 OR DK/REF] En los últimos 12 meses, ¿hubo un mes o más en que
usted pasó mucho tiempo recuperándose de los efectos de los alucinógenos que había
usado?
1 Sí
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS04 [IF HAL12MON = 1] En los últimos 12 meses, ¿trató de ponerse límites en la
frecuencia o la cantidad de alucinógenos que usaría?
1 Sí
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
H-30
DRLS05 [IF DRLS04 = 1] ¿Logró mantener los límites que estableció o usó con frecuencia
más alucinógenos de lo que había planeado?
1 Por lo general mantuvo los límites establecidos
2 Por lo general los usó más de lo planeado
DK/REF
DRLS06 [IF HAL12MON = 1] En los últimos 12 meses, ¿tuvo que usar más alucinógenos de
lo que acostumbraba usar para poder conseguir el efecto que deseaba?
1 Sí
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS07 IF DRLS06 = 2 OR DK/REF] En los últimos 12 meses, ¿notó que usar la misma
cantidad de alucinógenos le causaba menos efecto que antes?
1 Sí
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS08 [IF HAL12MON = 1] En los últimos 12 meses, ¿quiso o trató de usar menos
alucinógenos o de dejar de usarlos?
1 Sí
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS09 [IF DRLS08 = 1] En los últimos 12 meses, ¿logró usar menos alucinógenos o dejar
de usarlos todas las veces que quiso o trató de hacerlo?
1 Sí
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
H-31
DRLS13 [IF HAL12MON = 1] En los últimos 12 meses, ¿tuvo algún problema emocional, de
nervios o de la salud mental que quizá haya sido causado o empeorado por su uso de
alucinógenos?
1 Sí
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS14 [IF DRLS13 = 1] ¿Continuó usando alucinógenos aún cuando pensaba que le estaba
causando problemas emocionales, de nervios o de la salud mental?
1 Sí
2 No
DK/REF
DRLS15 [IF DRLS13 = 2 OR DK/REF OR DRLS14 = 2 OR DK/REF] En los últimos 12
meses, ¿tuvo algún problema de salud física que quizá haya sido causado o
empeorado por su uso de alucinógenos?
1 Sí
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS16 [IF DRLS15 = 1] ¿Continuó usando alucinógenos aún cuando pensaba que le estaba
causando problemas de salud física?
1 Sí
2 No
DK/REF
DRLS17 [IF HAL12MON = 1] Esta pregunta se trata de actividades importantes como
trabajar, ir a estudiar, cuidar niños o hacer cosas entretenidas como pasatiempos,
jugar deportes y pasar tiempo con los amigos y la familia.
En los últimos 12 meses, ¿el usar alucinógenos le hizo abandonar o dedicar menos
tiempo a hacer estos tipos de actividades importantes?
1 Sí
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
H-32
DRLS18 [IF HAL12MON = 1] A veces las personas que usan alucinógenos tienen problemas
serios en su hogar, en el trabajo o en la escuela, como:
- descuidar de sus hijos
- faltar al trabajo o a la escuela
- desempeñarse mal en el trabajo o en los estudios
- perder su trabajo o abandonar los estudios
En los últimos 12 meses, ¿el usar alucinógenos le causó problemas serios como esos
en su hogar, en el trabajo o en la escuela?
1 Sí
2 No
DK/REF
DRLS19 [IF HAL12MON = 1] En los últimos 12 meses, ¿usaba alucinógenos en forma
regular y luego hacía algo que lo hubiera expuesto al peligro porque estaba usando
alucinógenos?
1 Sí
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS20 [IF HAL12MON = 1] En los últimos 12 meses, ¿el usar alucinógenos le causó hacer
cosas que lo metieron en problemas con la ley una y otra vez?
1 Sí
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS21 [IF HAL12MON = 1] En los últimos 12 meses, ¿tuvo algún problema con la familia o
con los amigos que probablemente fue causado por su uso de alucinógenos?
1 Sí
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS22 [IF DRLS21 = 1] ¿Continuó usando alucinógenos aún cuando pensaba que le
causaba problemas con la familia o los amigos?
1 Sí
2 No
DK/REF
H-33
DRLS23a Alguna vez en los últimos 12 meses, ¿tuvo tantas ganas de usar alucinógenos que no
podía pensar en nada más?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS23b [If DRLS23a = 2, DK/REF] Alguna vez en los últimos 12 meses, ¿tuvo usted un
deseo fuerte o la necesidad de usar alucinógenos?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN
[IF INH12MON = 1] Piense en su uso de inhalantes, como nitrato de amilo o
'bombitas', óxido nitroso, gasolina o líquidos para encendedores, pegamento, pinturas
en aerosol o líquido de corrección, en los últimos 12 meses, al contestar las siguientes
preguntas.
Presione [ENTER] para continuar.
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN01 [IF INH12MON = 1] En los últimos 12 meses, ¿hubo un mes o más en que usted
dedicó mucho tiempo para conseguir o usar inhalantes?
1 Sí
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN02 [IF DRIN01 = 2 OR DK/REF] En los últimos 12 meses, ¿hubo un mes o más en que
usted pasó mucho tiempo recuperándose de los efectos de los inhalantes que había
usado?
1 Sí
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
H-34
DRIN04 [IF INH12MON = 1] En los últimos 12 meses, ¿trató de ponerse límites en la
frecuencia o la cantidad de inhalantes que usaría?
1 Sí
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN05 [IF DRIN04 = 1] ¿Logró mantener los límites que estableció, o usó con frecuencia
más inhalantes de lo que había planeado?
1 Por lo general mantuvo los límites establecidos
2 Por lo general los usó más de lo planeado
DK/REF
DRIN06 [IF INH12MON = 1] En los últimos 12 meses, ¿tuvo que usar más inhalantes de lo
que acostumbraba usar, para poder conseguir el efecto que deseaba?
1 Sí
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN07 [IF DRIN06 = 2 OR DK/REF] En los últimos 12 meses, ¿notó que usar la misma
cantidad de inhalantes le causaba menos efecto que antes?
1 Sí
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN08 [IF INH12MON = 1] En los últimos 12 meses, ¿quiso o trató de usar menos
inhalantes o de dejar de usarlos?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN09 [IF DRIN08 = 1] En los últimos 12 meses, ¿logró usar menos inhalantes o dejar de
usarlos todas las veces que quiso o trató de hacerlo?
1 Sí
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
H-35
DRIN13 [IF INH12MON = 1] En los últimos 12 meses, ¿tuvo algún problema emocional, de
nervios o de la salud mental que quizá haya sido causado o empeorado por su uso de
inhalantes?
1 Sí
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN14 [IF DRIN13 = 1] ¿Continuó usando inhalantes aún cuando pensaba que le estaba
causando problemas emocionales, de nervios o de la salud mental?
1 Sí
2 No
DK/REF
DRIN15 [IF DRIN13 = 2 OR DK/REF OR DRIN14 = 2 OR DK/REF] En los últimos 12
meses, ¿tuvo algún problema de salud física que quizá haya sido causado o
empeorado por su uso de inhalantes?
1 Sí
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN16 [IF DRIN15 = 1] ¿Continuó usando inhalantes aún cuando pensaba que le estaba
causando problemas de salud física?
1 Sí
2 No
DK/REF
DRIN17 [IF INH12MON = 1] Esta pregunta se trata de actividades importantes como trabajar,
ir a estudiar, cuidar niños o hacer cosas entretenidas como pasatiempos, jugar
deportes y pasar tiempo con los amigos y la familia.
En los últimos 12 meses, ¿el usar inhalantes le hizo abandonar o dedicar menos
tiempo a hacer ese tipo de actividades importantes?
1 Sí
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
H-36
DRIN18 [IF INH12MON = 1] A veces las personas que usan inhalantes tienen problemas
serios en su hogar, en el trabajo o en la escuela, como:
- descuidar de sus hijos
- faltar al trabajo o a la escuela
- desempeñarse mal en el trabajo o en los estudios
- perder su trabajo o abandonar los estudios
En los últimos 12 meses, ¿el usar inhalantes le causó problemas serios como esos en
su hogar, en el trabajo o en la escuela?
1 Sí
2 No
DK/REF
DRIN19 [IF INH12MON = 1] En los últimos 12 meses, ¿usaba inhalantes en forma regular y
luego hacía algo que lo hubiera expuesto al peligro físico porque estaba usando
inhalantes?
1 Sí
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN20 [IF INH12MON = 1] En los últimos 12 meses, ¿el usar inhalantes le hizo hacer cosas
que lo metieron en problemas con la ley una y otra vez?
1 Sí
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN21 [IF INH12MON = 1] En los últimos 12 meses, ¿tuvo algún problema con la familia o
los amigos que quizá haya sido causado por su uso de inhalantes?
1 Sí
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN22 [IF DRIN21 = 1] ¿Continuó usando inhalantes aún cuando pensaba que le causaba
problemas con la familia o los amigos?
1 Sí
2 No
DK/REF
H-37
DRIN23a Alguna vez en los últimos 12 meses, ¿tuvo tantas ganas de usar inhalantes que no
podía pensar en nada más?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN23b [If DRIN23a = 2, DK/REF] Alguna vez en los últimos 12 meses, ¿tuvo usted un deseo
fuerte o la necesidad de usar inhalantes?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME
[IF MET12MON = 1] Piense en su uso de metanfetamina en los últimos 12 meses al
contestar las siguientes preguntas.
Presione [ENTER] para continuar.
DRME01 [IF MET12MON = 1] En los últimos 12 meses, ¿hubo un mes o más en que usted
dedicó mucho tiempo para conseguir o usar metanfetamina?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME02 [IF DRME01 = 2 OR DK/REF] En los últimos 12 meses, ¿hubo un mes o más en que
usted pasó mucho tiempo recuperándose de los efectos de la metanfetamina que
había usado?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME04 [IF MET12MON = 1] En los últimos 12 meses, ¿trató de ponerse límites en la
frecuencia o la cantidad de metanfetamina que usaría?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
H-38
DRME05 [IF DRME04 = 1] ¿Logró mantener los límites que estableció, o usó con frecuencia
más metanfetamina de lo que había planeado?
1 Por lo general mantuvo los límites establecidos
2 Por lo general usó más de lo planeado
DK/REF
DRME06 [IF MET12MON = 1] En los últimos 12 meses, ¿tuvo que usar más metanfetamina
de lo que acostumbraba usar, para poder conseguir el efecto que deseaba?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME07 [IF DRME06 = 2 OR DK/REF] En los últimos 12 meses, ¿notó que usar la misma
cantidad de metanfetamina le causaba menos efecto que antes?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME08 [IF MET12MON = 1] En los últimos 12 meses, ¿quiso o trató de reducir el uso o
dejar de usar metanfetamina?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME09 [IF DRME08 = 1] En los últimos 12 meses, ¿logró reducir el uso o dejar de usar
metanfetamina todas las veces que quiso o trató de hacerlo?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME10 [IF DRME08 = 2 OR DK/REF OR DRME09 = 2 OR DK/REF] En los últimos 12
meses, ¿redujo el uso o dejó de usar metanfetamina por lo menos una vez?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
H-39
DRME10a
[IF DRME09 = 1 OR DRME10 = 1] En los últimos 12 meses, ¿se ha sentido algo
deprimido o decaído al reducir el uso de metanfetamina o dejar de usarla?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME10b
[IF DRME10a = 2] Esta pregunta es también acerca de las ocasiones después que
usted redujo el uso o dejó de usar metanfetamina.
Durante alguna de esas ocasiones, ¿uso metanfetamina otra vez, cocaína o
“crack”, estimulantes que normalmente se venden con una receta médica o alguna
sustancia ilícita para prevenir sentirse deprimido o decaído?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME11 [IF DRME10a = 1] Por favor mire la siguiente lista de síntomas. En los últimos 12
meses, ¿tuvo 2 o más de estos síntomas después de reducir el uso o dejar de usar
metanfetamina?
•
•
•
•
•
Se sintió cansado o agotado
Tuvo sueños malos
Tuvo problemas para dormir o durmió más de lo que acostumbra
Sintió hambre con más frecuencia
Se sentía muy lento o que no podía estar tranquilo
1
Sí
2
No
DK/REF
DRME12 [IF DRME11 = 1] Por favor mire la siguiente lista de síntomas. En los últimos 12
meses, ¿tuvo 2 o más de estos síntomas a la vez que hayan durado más de un día,
después de usar menos o dejar de usar metanfetamina?
•
•
•
•
•
Se sintió cansado o agotado
Tuvo sueños malos
Tuvo problemas para dormir o durmió más de lo que acostumbra
Sintió hambre con más frecuencia
Se sentía muy lento o que no podía estar tranquilo
1
Sí
H-40
2
No
DK/REF
DRME12a
[IF DRME11 = 1] Usted acaba de mencionar que tuvo síntomas después de
reducir el uso o dejar de usar metanfetamina. ¿Usó metanfetamina otra vez,
cocaína o “crack”, o estimulantes que normalmente se venden con una receta
médica o alguna sustancia ilícita para evitar o recuperarse de estos síntomas?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Presione F2 para ver estos síntomas otra vez
DRME12b [IF DRME11 = 2 OR DK/REF] Después que usted redujo el uso o dejó de usar
metanfetamina, ¿usó metanfetamina otra vez, cocaína o “crack”, estimulantes que
normalmente se venden con una receta médica o alguna sustancia ilícita para
prevenir estos síntomas?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Presione F2 para ver estos síntomas otra vez
DRME13 [IF MET12MON = 1] En los últimos 12 meses, ¿tuvo algún problema emocional, de
nervios o de la salud mental que quizá haya sido causado o empeorado por su uso de
metanfetamina?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME14 [IF DRME13 = 1] ¿Continuó usando metanfetamina aún cuando pensaba que le
estaba causando problemas emocionales, de nervios o de la salud mental?
1
Sí
2
No
DK/REF
H-41
DRME15 [IF DRME13 = 2 OR DK/REF OR DRME14 = 2 OR DK/REF] En los últimos 12
meses, ¿tuvo algún problema de salud física que quizá haya sido causado o
empeorado por su uso de metanfetamina?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME16 [IF DRME15 = 1] ¿Continuó usando metanfetamina aún cuando pensaba que le
estaba causando tener problemas de salud física?
1
Sí
2
No
DK/REF
DRME17 [IF MET12MON = 1] Esta pregunta se trata de actividades importantes como
trabajar, ir a estudiar, cuidar niños o hacer cosas divertidas como pasatiempos, jugar
deportes y pasar el tiempo con amigos y con la familia.
En los últimos 12 meses, ¿el usar metanfetamina le hizo abandonar o dedicar menos
tiempo a hacer estos tipos de actividades importantes?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME18 [IF MET12MON = 1] A veces las personas que usan metanfetamina tienen
problemas serios en su casa, en el trabajo o en la escuela, como:
•
•
•
•
descuidar de sus hijos
faltar al trabajo o a la escuela
desempeñarse mal en el trabajo o en los estudios
perder su trabajo o abandonar los estudios
En los últimos 12 meses, ¿el usar metanfetamina le causó problemas serios como
esos en su hogar, en el trabajo o en la escuela?
1
Sí
2
No
DK/REF
H-42
DRME19 [IF MET12MON = 1] En los últimos 12 meses, ¿ usaba metanfetamina en forma
regular y luego hacía algo que lo hubiera expuesto al peligro físico porque estaba
usando metanfetamina?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME20 [IF MET12MON = 1] En los últimos 12 meses, ¿el usar metanfetamina le causó
hacer cosas que lo metieron en problemas con la ley una y otra vez?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME21 [IF MET12MON = 1] En los últimos 12 meses, ¿tuvo algún problema con la familia
o los amigos que probablemente fue causado por su uso de metanfetamina?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME22 [IF DRME21 = 1] ¿Continuó usando metanfetamina aún cuando pensaba que le
causaba problemas con la familia o los amigos?
1
Sí
2
No
DK/REF
DRME23a Alguna vez en los últimos 12 meses, ¿tuvo tantas ganas de usar metanfetamina que
no podía pensar en nada más?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
H-43
DRME23b [If DRME23a = 2, DK/REF] Alguna vez en los últimos 12 meses, ¿tuvo usted un
deseo fuerte o la necesidad de usar metanfetamina?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Rx Pain Relievers
DRPR [IF PAI12MON = 1] Piense en su uso de analgésicos que normalmente se venden
con una receta médica en los últimos 12 meses al contestar las siguientes preguntas.
Recuerde que solamente estamos interesados en analgésicos que normalmente se
venden con una receta médica que haya usado de alguna manera que un doctor no le
haya indicado.
Anteriormente, la computadora registró que en los últimos 12 meses usted usó [IF
PRMISCOUNT = 1 FILL PRFILL2][IF PRMISCOUNT ≥ 2 FILL WITH “los
analgésicos que se muestran a continuación”] de una manera que un doctor no le
había indicado.
[IF PRMISCOUNT ≥ 2 FILL WITH DRUG NAMES FROM PRY01-PRY36
BELOW. USE MULTIPLE COLUMNS AS NEEDED. IF PRYOTH = 1, ADD "
Algún otro analgésico que normalmente se vende con una receta médica".]
Las siguientes preguntas se refieren a [IF PRYOTH NE 1 AND PRMISCOUNT = 1
FILL PRFILL2 como un analgésico que normalmente se vende con una receta médica;
IF PRYOTH = 1 AND PRMISCOUNT = 1 FILL WITH “este otro analgésico que
normalmente se vende con una receta médica”; IF PRMISCOUNT ≥ 2 FILL WITH
“estos como analgésicos que normalmente se venden con una receta médica”].
Presione [ENTER] para continuar.
DRPR01 [IF PAI12MON = 1] En los últimos 12 meses, ¿hubo un mes o más en que usted
dedicó mucho tiempo para conseguir o usar analgésicos que normalmente se
venden con una receta médica?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
H-44
DRPR02 [IF DRPR01 = 2 OR DK/REF] En los últimos 12 meses, ¿hubo un mes o más en que
usted pasó mucho tiempo recuperándose de los efectos de los analgésicos que
normalmente se venden con una receta médica que había usado?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR04 [IF PAI12MON = 1] En los últimos 12 meses, ¿trató de ponerse límites en la
frecuencia o en la cantidad de analgésicos que normalmente se venden con una
receta médica que usaría?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR05 [IF DRPR04 = 1] ¿Logró mantener los límites que estableció, o usó con frecuencia
más analgésicos que normalmente se venden con una receta médica de lo que
había planeado?
1 Por lo general mantuvo los límites establecidos
2 Por lo general los usó más de lo planeado
DK/REF
DRPR06 [IF PAI12MON = 1] En los últimos 12 meses, ¿tuvo que usar más analgésicos que
normalmente se venden con una receta médica de lo que acostumbraba usar, para
poder conseguir el efecto que deseaba?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR07 [IF DRPR06 = 2 OR DK/REF] En los últimos 12 meses, ¿notó que usar la misma
cantidad de analgésicos que normalmente se venden con una receta médica le
causaba menos efecto que antes?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
H-45
DRPR08 [IF PAI12MON = 1] En los últimos 12 meses, ¿quiso o trató de reducir el uso o
dejar de usar analgésicos que normalmente se venden con una receta médica?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR09 [IF DRPR08 = 1] En los últimos 12 meses, ¿logró reducir el uso o dejar de usar
analgésicos que normalmente se venden con una receta médica todas las veces
que quiso o trató de hacerlo?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR10 [IF DRPR08 = 2 OR DK/REF OR DRPR09 = 2 OR DK/REF] En los últimos 12
meses, ¿redujo el uso o dejó de usar analgésicos que normalmente se venden con
una receta médica por lo menos una vez?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR11 [IF DRPR09 = 1 OR DRPR10 = 1] Por favor mire la siguiente lista de síntomas. En
los últimos 12 meses, ¿tuvo 3 o más de estos síntomas después de reducir el uso o
dejar de usar analgésicos que normalmente se venden con una receta médica?
•
•
•
•
•
•
•
•
•
Se sintió algo deprimido o decaído
Vomitó o sintió náuseas
Tuvo calambres o dolores musculares
Tuvo los ojos lagrimosos o le goteaba la nariz
Sudó o tenía las pupilas dilatadas, o se le erizaban los pelos
Tuvo diarrea
Bostezaba
Tuvo fiebre
Tuvo problemas para dormir
1
Sí
2
No
DK/REF
H-46
DRPR12 [IF DRPR11 = 1] Por favor mire la siguiente lista de síntomas. En los últimos 12
meses, ¿tuvo 3 o más de estos síntomas a la vez, que hayan durado más de un día,
después de usar menos o dejar de usar analgésicos que normalmente se venden con
una receta médica?
•
•
•
•
•
•
•
•
•
Se sintió algo deprimido o decaído
Vomitó o sintió náuseas
Tuvo calambres o dolores musculares
Tuvo los ojos lagrimosos o le goteaba la nariz
Sudó o tenía las pupilas dilatadas, o se le erizaban los pelos
Tuvo diarrea
Bostezaba
Tuvo fiebre
Tuvo problemas para dormir
1
Sí
2
No
DK/REF
DRPR12a [IF DRPR11 = 1] Usted acaba de mencionar que tuvo síntomas después de reducir el
uso o dejar de usar analgésicos que normalmente se venden con una receta
médica. ¿Usó analgésicos que normalmente se venden con una receta médica otra
vez, heroína o alguna sustancia ilícita para evitar o recuperarse de estos síntomas?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Presione F2 para ver estos síntomas otra vez
DRPR12b [IF DRPR11 = 2 OR DK/REF] Después que usted redujo el uso o dejó de usar
analgésicos que normalmente se venden con una receta médica, ¿usó analgésicos
que normalmente se venden con una receta médica otra vez, heroína o alguna
sustancia ilícita para prevenir estos síntomas?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Presione F2 para ver estos síntomas otra vez
DRPR13 [IF PAI12MON = 1] En los últimos 12 meses, ¿tuvo algún problema emocional, de
H-47
nervios o de la salud mental que quizá haya sido causado o empeorado por su uso de
analgésicos que normalmente se venden con una receta médica?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR14 [IF DRPR13 = 1] ¿Continuó usando analgésicos que normalmente se venden con
una receta médica aún cuando pensaba que le estaba causando problemas
emocionales, de nervios o de la salud mental?
1
Sí
2
No
DK/REF
DRPR15 [IF DRPR13 = 2 OR DK/REF OR DRPR14 = 2 OR DK/REF] En los últimos 12
meses, ¿tuvo algún problema de salud física que quizá haya sido causado o
empeorado por su uso de analgésicos que normalmente se venden con una receta
médica?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR16 [IF DRPR15 = 1] ¿Continuó usando analgésicos que normalmente se venden con
una receta médica aún cuando pensaba que le estaba causando problemas de salud
física?
1
Sí
2
No
DK/REF
H-48
DRPR17 [IF PAI12MON = 1] Esta pregunta se trata de actividades importantes como trabajar,
ir a estudiar, cuidar niños o hacer cosas divertidas como pasatiempos, jugar deportes
y pasar el tiempo con amigos y con la familia.
En los últimos 12 meses, ¿el usar analgésicos que normalmente se venden con una
receta médica le hizo abandonar o dedicar menos tiempo a hacer estos tipos de
actividades importantes?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR18 [IF PAI12MON = 1] A veces las personas que usan analgésicos que normalmente
se venden con una receta médica tienen problemas serios en su hogar, en el trabajo
o en la escuela, como:
- descuidar de sus hijos
- faltar al trabajo o a la escuela
- desempeñarse mal en el trabajo o en los estudios
- perder su trabajo o abandonar los estudios
En los últimos 12 meses, ¿el usar analgésicos que normalmente se venden con una
receta médica le causó problemas serios como esos, en su hogar, en el trabajo o en la
escuela?
1
Sí
2
No
DK/REF
DRPR19 [IF PAI12MON = 1] En los últimos 12 meses, ¿usaba analgésicos que normalmente
se venden con una receta médica en forma regular y luego hacía algo que lo hubiera
expuesto al peligro físico porque estaba usando analgésicos?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR20 [IF PAI12MON = 1] En los últimos 12 meses, ¿el usar analgésicos que
normalmente se venden con una receta médica le causó hacer cosas que lo
metieron en problemas con la ley una y otra vez?
1
Sí
2
No
DK/REF
H-49
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR21 [IF PAI12MON = 1] En los últimos 12 meses, ¿tuvo algún problema con la familia o
los amigos que probablemente fue causado por su uso de analgésicos que
normalmente se venden con una receta médica?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR22 [IF DRPR21 = 1] ¿Continuó usando analgésicos que normalmente se venden con
una receta médica aún cuando pensaba que le causaba problemas con la familia o los
amigos?
1
Sí
2
No
DK/REF
DRPR23a Alguna vez en los últimos 12 meses, ¿tuvo tantas ganas de usar analgésicos que
normalmente se venden con una receta médica que no podía pensar en nada más?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR23b [IF DRPR23a = 2, DK/REF] Alguna vez en los últimos 12 meses, ¿tuvo usted un
deseo fuerte o la necesidad de usar analgésicos que normalmente se venden con
una receta médica?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Rx Tranquilizers
DRTR [IF TRA12MON = 1] Piense en su uso de tranquilizantes que normalmente se
venden con una receta médica en los últimos 12 meses, al contestar las siguientes
preguntas. Recuerde que solamente estamos interesados en tranquilizantes que
normalmente se venden con una receta médica que haya usado de alguna manera
que un doctor no le haya indicado.
Anteriormente, la computadora registró que en los últimos 12 meses usted usó [IF
TRMISCOUNT = 1 FILL TRFILL2][IF TRMISCOUNT ≥ 2 FILL WITH “los
H-50
tranquilizantes que se muestran a continuación”] de una manera que un doctor no le
había indicado.
[IF TRMISCOUNT ≥ 2 FILL WITH DRUG NAMES FROM TRY01- TRY12
BELOW. USE MULTIPLE COLUMNS AS NEEDED. IF TRYOTH = 1, ADD
"Algún otro tranquilizante que normalmente se vende con una receta médica".]
Las siguientes preguntas se refieren a [IF TRYOTH NE 1 AND TRMISCOUNT = 1
FILL TRFILL2 como un tranquilizante que normalmente se vende con una receta
médica; IF TRYOTH = 1 AND TRMISCOUNT = 1 FILL WITH “este otro
tranquilizante que normalmente se vende con una receta médica”; IF TRMISCOUNT
≥ 2 FILL WITH “estos como tranquilizantes que normalmente se venden con una
receta médica”].
Presione [ENTER] para continuar.
DRTR01 [IF TRA12MON = 1] En los últimos 12 meses, ¿hubo un mes o más en que usted
dedicó mucho tiempo para conseguir o usar tranquilizantes que normalmente se
venden con una receta médica?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR02 [IF DRTR01 = 2 OR DK/REF] En los últimos 12 meses, ¿hubo un mes o más en que
usted pasó mucho tiempo recuperándose de los efectos de los tranquilizantes que
normalmente se venden con una receta médica que había usado?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR04 [IF TRA12MON = 1] En los últimos 12 meses, ¿trató de ponerse límites en la
frecuencia o en la cantidad de tranquilizantes que normalmente se venden con una
receta médica que usaría?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR05 [IF DRTR04 = 1] ¿Logró mantener los límites que estableció, o usó con frecuencia
H-51
más tranquilizantes que normalmente se venden con una receta médica de lo que
había planeado?
1 Por lo general mantuvo los límites establecidos
2 Por lo general los usó más de lo planeado
DK/REF
DRTR06 [IF TRA12MON = 1] En los últimos 12 meses, ¿tuvo que usar más tranquilizantes
que normalmente se venden con una receta médica de lo que acostumbraba usar,
para poder conseguir el efecto que deseaba?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR07 [IF DRTR06 = 2 OR DK/REF] En los últimos 12 meses, ¿notó que usar la misma
cantidad de tranquilizantes que normalmente se venden con una receta médica le
causaba menos efecto que antes?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR08 [IF TRA12MON = 1] En los últimos 12 meses, ¿quiso o trató de reducir el uso o
dejar de usar tranquilizantes que normalmente se venden con una receta médica?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR09 [IF DRTR08 = 1] En los últimos 12 meses, ¿logró reducir el uso o dejar de usar
tranquilizantes que normalmente se venden con una receta médica todas las
veces que quiso o trató de hacerlo?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR10 [IF DRTR08 = 2 OR DK/REF OR DRTR09 = 2 OR DK/REF] En los últimos 12
meses, ¿redujo el uso o dejó de usar tranquilizantes que normalmente se venden
con una receta médica por lo menos una vez?
H-52
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR11 [IF DRTR09 = 1 OR DRTR10 = 1] Por favor mire la siguiente lista de síntomas. En
los últimos 12 meses, ¿tuvo 2 o más de estos síntomas después de reducir el uso o
dejar de usar tranquilizantes que normalmente se venden con una receta médica?
•
•
•
•
•
•
•
•
Sudó o sintió que su corazón latía muy rápido
Le temblaron las manos
Tuvo problemas para dormir
Vomitó o sintió náuseas
Vio, escuchó o sintió cosas que no estaban realmente ahí
Se sintió inquieto
Se sintió ansioso
Tuvo convulsiones o ataques
1
Sí
2
No
DK/REF
DRTR12a [IF DRTR11 = 1] Usted acaba de mencionar que tuvo síntomas después de reducir el
uso o dejar de usar tranquilizantes que normalmente se venden con una receta
médica. ¿Usó tranquilizantes que normalmente se venden con una receta médica otra
vez, bebió alcohol, usó sedantes que normalmente se venden con una receta médica o
alguna sustancia ilícita para evitar o recuperarse de estos síntomas?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Presione F2 para ver estos síntomas otra vez
DRTR12b [IF DRTR11 = 2 OR DK/REF] Después que usted redujo el uso o dejó de usar
tranquilizantes que normalmente se venden con una receta médica, ¿usó
tranquilizantes que normalmente se venden con una receta médica otra vez, bebió
alcohol, usó sedantes que normalmente se venden con una receta médica o alguna
sustancia ilícita para prevenir estos síntomas?
1
Sí
2
No
DK/REF
H-53
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Presione F2 para ver estos síntomas otra vez
DRTR13 [IF TRA12MON = 1] En los últimos 12 meses, ¿tuvo algún problema emocional, de
nervios o de la salud mental que quizá haya sido causado o empeorado por su uso de
tranquilizantes que normalmente se venden con una receta médica?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR14 [IF DRTR13 = 1] ¿Continuó usando tranquilizantes que normalmente se venden
con una receta médica aún cuando pensaba que le estaba causando problemas
emocionales, de nervios o de la salud mental?
1
Sí
2
No
DK/REF
DRTR15 [IF DRTR13 = 2 OR DK/REF OR DRTR14 = 2 OR DK/REF] En los últimos 12
meses, ¿tuvo algún problema de salud física que quizá haya sido causado o
empeorado por su uso de tranquilizantes que normalmente se venden con una
receta médica?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR16 [IF DRTR15 = 1] ¿Continuó usando tranquilizantes que normalmente se venden
con una receta médica aún cuando pensaba que le estaba causando problemas de
salud física?
1
Sí
2
No
DK/REF
H-54
DRTR17 [IF TRA12MON = 1] Esta pregunta se trata de actividades importantes como trabajar,
ir a estudiar, cuidar niños o hacer cosas divertidas como pasatiempos, jugar deportes
y pasar el tiempo con amigos y con la familia.
En los últimos 12 meses, ¿el usar tranquilizantes que normalmente se venden con
una receta médica le hizo abandonar o dedicar menos tiempo a hacer ese tipo de
actividades importantes?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR18 [IF TRA12MON = 1] A veces las personas que usan tranquilizantes que
normalmente se venden con una receta médica tienen problemas serios en su
hogar, en el trabajo o en la escuela, como:
- descuidar de sus hijos
- faltar al trabajo o a la escuela
- desempeñarse mal en el trabajo o en los estudios
- perder su trabajo o abandonar los estudios
En los últimos 12 meses, ¿el usar tranquilizantes que normalmente se venden con
una receta médica le causó problemas serios como esos en su hogar, en el trabajo o
en la escuela?
1
Sí
2
No
DK/REF
DRTR19 [IF TRA12MON = 1] En los últimos 12 meses, ¿ usaba tranquilizantes que
normalmente se venden con una receta médica en forma regular y luego hacía algo
que lo hubiera expuesto al peligro físico porque estaba usando tranquilizantes?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR20 [IF TRA12MON = 1] En los últimos 12 meses, ¿el usar tranquilizantes que
normalmente se venden con una receta médica le causó hacer cosas que lo
metieron en problemas con la ley una y otra vez?
1
Sí
2
No
DK/REF
H-55
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR21 [IF TRA12MON = 1] En los últimos 12 meses, ¿tuvo algún problema con la familia o
los amigos que probablemente fue causado por su uso de tranquilizantes que
normalmente se venden con una receta médica?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR22 [IF DRTR21 = 1] ¿Continuó usando tranquilizantes que normalmente se venden
con una receta médica aún cuando pensaba que le causaba problemas con la familia
o amigos?
1
Sí
2
No
DK/REF
DRTR23a Alguna vez en los últimos 12 meses, ¿tuvo tantas ganas de usar tranquilizantes que
normalmente se venden con una receta médica que no podía pensar en nada más?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR23b [If DRTR23a = 2, DK/REF] Alguna vez en los últimos 12 meses, ¿tuvo usted un
deseo fuerte o la necesidad de usar tranquilizantes que normalmente se venden con
una receta médica?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Rx Stimulants
DRST
[IF STI12MON = 1] Piense en su uso de estimulantes que normalmente se venden
con una receta médica en los últimos 12 meses al contestar las siguientes preguntas.
Recuerde que solamente estamos interesados en estimulantes que normalmente se
venden con una receta médica que haya usado de alguna manera que un doctor no
le haya indicado.
H-56
Anteriormente, la computadora registró que en los últimos 12 meses usted usó [IF
STMISCOUNT = 1 FILL STFILL2][IF STMISCOUNT ≥ 2 FILL WITH “los
estimulantes que se muestran a continuación”] de una manera que un doctor no le
había indicado.
[IF STMISCOUNT ≥ 2 FILL WITH DRUG NAMES FROM STY01-STY26
BELOW. USE MULTIPLE COLUMNS AS NEEDED. IF STYOTH = 1, ADD
"Algún otro estimulante que normalmente se vende con una receta médica".]
Las siguientes preguntas se refieren a [IF STYOTH NE 1 AND STMISCOUNT = 1
FILL STFILL2 como un estimulante que normalmente se vende con una receta
médica; IF STYOTH = 1 AND STMISCOUNT = 1 FILL WITH “este otro
estimulante que normalmente se vende con una receta médica”; IF STMISCOUNT ≥ 2
FILL WITH “estos como estimulantes que normalmente se venden con una receta
médica”].
Presione [ENTER] para continuar.
DRST01 [IF STI12MON = 1] En los últimos 12 meses, ¿hubo un mes o más en que usted
dedicó mucho tiempo para conseguir o usar estimulantes que normalmente se
venden con una receta médica?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST02 [IF DRST01 = 2 OR DK/REF] En los últimos 12 meses, ¿hubo un mes o más en que
usted pasó mucho tiempo recuperándose de los efectos de los estimulantes que
normalmente se venden con una receta médica que había usado?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST04 [IF STI12MON = 1] En los últimos 12 meses, ¿trató de ponerse límites en la
frecuencia o la cantidad de estimulantes que normalmente se venden con una
receta médica que usaría?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
H-57
DRST05 [IF DRST04 = 1] ¿Logró mantener los límites que estableció, o usó con frecuencia
más estimulantes que normalmente se venden con una receta médica de lo que
había planeado?
1 Por lo general mantuvo los límites establecidos
2 Por lo general los usó más de lo planeado
DK/REF
DRST06 [IF STI12MON = 1] En los últimos 12 meses, ¿tuvo que usar más estimulantes que
normalmente se venden con una receta médica de lo que acostumbraba usar para
poder conseguir el efecto que deseaba?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST07 [IF DRST06 = 2 OR DK/REF] En los últimos 12 meses, ¿notó que usar la misma
cantidad de estimulantes que normalmente se venden con una receta médica le
causaba menos efecto que antes?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST08 [IF STI12MON = 1] En los últimos 12 meses, ¿quiso o trató de reducir el uso o dejar
de usar estimulantes que normalmente se venden con una receta médica?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST09 [IF DRST08 = 1] En los últimos 12 meses, ¿logró reducir el uso o dejar de usar
estimulantes que normalmente se venden con una receta médica todas las veces
que quiso o trató de hacerlo?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
H-58
DRST10 [IF DRST08 = 2 OR DK/REF OR DRST09 = 2 OR DK/REF] En los últimos 12
meses, ¿redujo el uso o dejó de usar estimulantes que normalmente se venden con
una receta médica por lo menos una vez?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST10a [IF DRST09 = 1 OR DRST10 = 1] En los últimos 12 meses, ¿se sintió algo deprimido
o decaído cuando redujo el uso de estimulantes que normalmente se venden con
una receta médica o cuando dejó de usarlos?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST10b [IF DRST10a = 2] Esta pregunta es también acerca de las ocasiones después que
usted redujo el uso o dejó de usar estimulantes que normalmente se venden con
una receta médica.
Durante alguna de esas ocasiones, ¿usó estimulantes que normalmente se venden con
una receta médica otra vez, metanfetamina, cocaína o “crack”, o alguna sustancia
ilícita para prevenir sentirse deprimido o decaído?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST11 [IF DRST10a = 1] Por favor mire la siguiente lista de síntomas. En los últimos 12
meses, ¿tuvo 2 o más de estos síntomas después de reducir el uso o dejar de usar
estimulantes que normalmente se venden con una receta médica?
•
•
•
•
•
Se sintió cansado o agotado
Tuvo sueños malos
Tuvo problemas para dormir o durmió más de lo que acostumbra
Sintió hambre con más frecuencia
Sintió que todo lo hacía más lento o se sintió inquieto
1
Sí
2
No
DK/REF
H-59
DRST12 [IF DRST11 = 1] Por favor mire la siguiente lista de síntomas. En los últimos 12
meses, ¿tuvo 2 o más de estos síntomas a la vez, que hayan durado por más de un
día, después de usar menos o dejar de usar estimulantes que normalmente se
venden con una receta médica?
•
•
•
•
•
Se sintió cansado o agotado
Tuvo sueños malos
Tuvo problemas para dormir o durmió más de lo que acostumbra
Sintió hambre con más frecuencia
Sintió que todo lo hacía más lento o se sintió inquieto
1
Sí
2
No
DK/REF
DRST12a [IF DRST11 = 1] Usted acaba de mencionar que tuvo síntomas después de reducir el
uso o dejar de usar estimulantes que normalmente se venden con una receta
médica. ¿Usó estimulantes que normalmente se venden con una receta médica otra
vez, metanfetamina, cocaína o “crack”, o alguna sustancia ilícita para evitar o
recuperarse de estos síntomas?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Presione F2 para ver estos síntomas otra vez
DRST12b [IF DRST11 = 2 OR DK/REF] Después que usted redujo el uso o dejó de usar
estimulantes que normalmente se venden con una receta médica, ¿usó
estimulantes que normalmente se venden con una receta médica otra vez,
metanfetamina, cocaína o “crack”, o alguna sustancia ilícita para prevenir estos
síntomas?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Presione F2 para ver estos síntomas otra vez
H-60
DRST13 [IF STI12MON = 1] En los últimos 12 meses, ¿tuvo algún problema emocional, de
nervios o de la salud mental que quizá haya sido causado o empeorado por su uso de
estimulantes que normalmente se venden con una receta médica?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST14 [IF DRST13 = 1] ¿Continuó usando estimulantes que normalmente se venden con
una receta médica aún cuando pensaba que le estaba causando problemas
emocionales, de nervios o de la salud mental?
1
Sí
2
No
DK/REF
DRST15 [IF DRST13 = 2 OR DK/REF OR DRST14 = 2 OR DK/REF] En los últimos 12
meses, ¿tuvo algún problema de salud física que quizá haya sido causado o
empeorado por su uso de estimulantes que normalmente se venden con una receta
médica?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST16 [IF DRST15 = 1] ¿Continuó usando estimulantes que normalmente se venden con
una receta médica aún cuando pensaba que le estaban causando problemas de salud
física?
1
Sí
2
No
DK/REF
H-61
DRST17 [IF STI12MON = 1] Esta pregunta se trata de actividades importantes como trabajar,
ir a estudiar, cuidar niños o hacer cosas divertidas como pasatiempos, jugar deportes
y pasar el tiempo con amigos y con la familia.
En los últimos 12 meses, ¿el usar estimulantes que normalmente se venden con
una receta médica le hizo abandonar o dedicar menos tiempo a hacer estos tipos de
actividades importantes?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST18 [IF STI12MON = 1] A veces las personas que usan estimulantes que normalmente
se venden con una receta médica tienen problemas serios en su hogar, en el trabajo
o en la escuela, como:
- descuidar de sus hijos
- faltar al trabajo o a la escuela
- desempeñarse mal en el trabajo o en los estudios
- perder su trabajo o abandonar los estudios
En los últimos 12 meses, ¿el usar estimulantes que normalmente se venden con
una receta médica le causó problemas serios como esos en su hogar, en el trabajo o
en la escuela?
1
Sí
2
No
DK/REF
DRST19 [IF STI12MON = 1] En los últimos 12 meses, ¿usaba estimulantes que
normalmente se venden con una receta médica en forma regular y luego hacía algo
que lo hubiera expuesto al peligro físico porque estaba usando estimulantes?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST20 [IF STI12MON = 1] En los últimos 12 meses, ¿el usar estimulantes que
normalmente se venden con una receta médica le causó hacer cosas que lo
metieron en problemas con la ley una y otra vez?
1
Sí
2
No
DK/REF
H-62
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST21 [IF STI12MON = 1] En los últimos 12 meses, ¿tuvo algún problema con la familia o
los amigos que probablemente fue causado por su uso de estimulantes que
normalmente se venden con una receta médica?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST22 [IF DRST21 = 1] ¿Continuó usando estimulantes que normalmente se venden con
una receta médica aún cuando usted pensaba que le causaba problemas con la
familia o los amigos?
1
Sí
2
No
DK/REF
DRST23a Alguna vez en los últimos 12 meses, ¿tuvo tantas ganas de usar estimulantes que
normalmente se venden con una receta médica que no podía pensar en nada más?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST23b [IF DRST23a = 2, DK/REF] Alguna vez en los últimos 12 meses, ¿tuvo usted un
deseo fuerte o la necesidad de usar estimulantes que normalmente se venden con
una receta médica?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Rx Sedatives
DRSV [IF SV12MON = 1] Piense en su uso de sedantes que normalmente se venden con
una receta médica en los últimos 12 meses al contestar las siguientes preguntas.
Recuerde que solamente estamos interesados en sedantes que normalmente se
venden con una receta médica que haya usado de alguna manera que un doctor no le
haya indicado.
Anteriormente, la computadora registró que en los últimos 12 meses usted usó [IF
SVMISCOUNT = 1 FILL SVFILL2][IF SVMISCOUNT ≥ 2 FILL WITH “los
H-63
sedantes que se muestran a continuación”] de una manera que un doctor no le había
indicado.
[IF SVMISCOUNT ≥ 2 FILL WITH DRUG NAMES FROM SVY01-SVY14
BELOW. USE MULTIPLE COLUMNS AS NEEDED. IF SVYOTH = 1, ADD
"Algún otro sedante que normalmente se vende con una receta médica".]
Las siguientes preguntas se refieren a [IF SVYOTH NE 1 AND SVMISCOUNT = 1
FILL SVFILL2 com un sedante que normalmente se vende con una receta médica; IF
SVY17 = 1 AND SVMISCOUNT = 1 FILL WITH “este otro sedante que
normalmente se vende con una receta médica”; IF SVMISCOUNT ≥ 2 FILL WITH
“como sedantes que normalmente se venden con una receta médica”].
Presione [ENTER] para continuar.
DRSV01 [IF SED12MON = 1] En los últimos 12 meses, ¿hubo un mes o más en que usted
dedicó mucho tiempo para conseguir o usar sedantes que normalmente se venden
con una receta médica?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV02 [IF DRSV01 = 2 OR DK/REF] En los últimos 12 meses, ¿hubo un mes o más en que
usted pasó mucho tiempo recuperándose de los efectos de los sedantes que
normalmente se venden con una receta médica que había usado?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV04 [IF SED12MON = 1] En los últimos 12 meses, ¿trató de ponerse límites en la
frecuencia o la cantidad de sedantes que normalmente se venden con una receta
médica que usaría?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
H-64
DRSV05 [IF DRSV04 = 1] ¿Logró mantener los límites que estableció, o usó con frecuencia
más sedantes que normalmente se venden con una receta médica de lo que había
planeado?
1 Por lo general mantuvo los límites establecidos
2 Por lo general los usó más de lo planeado
DK/REF
DRSV06 [IF SED12MON = 1] En los últimos 12 meses, ¿tuvo que usar más sedantes que
normalmente se venden con una receta médica de lo que acostumbraba usar para
poder conseguir el efecto que deseaba?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV07 [IF DRSV06 = 2 OR DK/REF] En los últimos 12 meses, ¿notó que usar la misma
cantidad de sedantes que normalmente se venden con una receta médica le
causaba menos efecto que antes?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV08 [IF SED12MON = 1] En los últimos 12 meses, ¿quiso o trató de reducir el uso o
dejar de usar sedantes que normalmente se venden con una receta médica?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV09 [IF DRSV08 = 1] En los últimos 12 meses, ¿logró reducir el uso o dejar de usar
sedantes que normalmente se venden con una receta médica todas las veces que
quiso o trató de hacerlo?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
H-65
DRSV10 [IF DRSV08 = 2 OR DK/REF OR DRSV09 = 2 OR DK/REF] En los últimos 12
meses, ¿redujo el uso o dejó de usar sedantes que normalmente se venden con una
receta médica por lo menos una vez?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV11 [IF DRSV09 = 1 OR DRSV10 = 1] Por favor mire la siguiente lista de síntomas. En
los últimos 12 meses, ¿tuvo 2 o más de estos síntomas después de reducir el uso o
dejar de usar sedantes que normalmente se venden con una receta médica?
•
•
•
•
•
•
•
•
Sudó o sintió que su corazón latía muy rápido
Le temblaron las manos
Tuvo problemas para dormir
Vomitó o sintió náuseas
Vio, escuchó o sintió cosas que no estaban realmente ahí
Se sintió inquieto
Se sintió ansioso
Tuvo convulsiones o ataques
1
Sí
2
No
DK/REF
DRSV12 [IF DRSV11 = 1] Por favor mire la siguiente lista de síntomas. En los últimos 12
meses, ¿tuvo 2 o más de estos síntomas a la vez, que hayan durado por más de un
día, después de usar menos o dejar de usar sedantes que normalmente se venden
con una receta médica?
•
•
•
•
•
•
•
•
Sudó o sintió que su corazón latía muy rápido
Le temblaron las manos
Tuvo problemas para dormir o durmió más de lo que acostumbra
Vomitó o sintió náuseas
Vio, escuchó o sintió cosas que no estaban realmente ahí
Se sintió inquieto
Se sintió ansioso
Tuvo convulsiones o ataques
1
Sí
2
No
DK/REF
H-66
DRSV12a [IF DRSV11 = 1] Usted acaba de mencionar que tuvo síntomas después de reducir el
uso o dejar de usar sedantes que normalmente se venden con una receta médica.
¿Usó sedantes que normalmente se venden con una receta médica otra vez, bebió
alcohol, usó tranquilizantes que normalmente se venden con una receta médica o
alguna sustancia ilícita para evitar o recuperarse de estos síntomas?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Presione F2 para ver estos síntomas otra vez
DRSV12b [IF DRSV11 = 2 OR DK/REF] Después que usted redujo el uso o dejó de usar
sedantes que normalmente se venden con una receta médica, ¿usó sedantes que
normalmente se venden con una receta médica otra vez, bebió alcohol, usó
tranquilizantes que normalmente se venden con una receta médica o alguna sustancia
ilícita para prevenir estos síntomas?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Presione F2 para ver estos síntomas otra vez
DRSV13 [IF SED12MON = 1] En los últimos 12 meses, ¿tuvo algún problema emocional, de
nervios o de la salud mental que quizá haya sido causado o empeorado por su uso de
sedantes que normalmente se venden con una receta médica?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV14 [IF DRSV13 = 1] ¿Continuó usando sedantes que normalmente se venden con una
receta médica aún cuando pensaba que le estaba causando problemas emocionales,
de nervios o de la salud mental?
1
Sí
2
No
DK/REF
H-67
DRSV15 [IF DRSV13 = 2 OR DK/REF OR DRSV14 = 2 OR DK/REF] En los últimos 12
meses, ¿tuvo algún problema de salud física que quizá haya sido causado o
empeorado por su uso de sedantes que normalmente se venden con una receta
médica?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV16 [IF DRSV15 = 1] ¿Continuó usando sedantes que normalmente se venden con una
receta médica aún cuando pensaba que le estaban causando problemas de salud
física?
1
Sí
2
No
DK/REF
DRSV17 [IF SED12MON = 1] Esta pregunta se trata de actividades importantes como trabajar,
ir a estudiar, cuidar niños o hacer cosas divertidas como pasatiempos, jugar deportes
y pasar el tiempo con amigos y con la familia.
En los últimos 12 meses, ¿el usar sedantes que normalmente se venden con una
receta médica le hizo abandonar o dedicar menos tiempo a hacer estos tipos de
actividades importantes?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV18 [IF SED12MON = 1] A veces las personas que usan sedantes que normalmente se
venden con una receta médica tienen problemas serios en su hogar, en el trabajo o
en la escuela, como:
- descuidar de sus hijos
- faltar al trabajo o a la escuela
- desempeñarse mal en el trabajo o en los estudios
- perder su trabajo o abandonar los estudios
En los últimos 12 meses, ¿el usar sedantes que normalmente se venden con una
receta médica le causó problemas serios como esos en su hogar, en el trabajo o en la
escuela?
1
Sí
2
No
DK/REF
H-68
DRSV19 [IF SED12MON = 1] En los últimos 12 meses, ¿usaba sedantes que normalmente
se venden con una receta médica en forma regular y luego hacía algo que lo hubiera
expuesto al peligro físico porque estaba usando sedantes?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV20 [IF SED12MON = 1] En los últimos 12 meses, ¿el usar sedantes que normalmente
se venden con una receta médica le causó hacer cosas que lo metieron en problemas
con la ley una y otra vez?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV21 [IF SED12MON = 1] En los últimos 12 meses, ¿tuvo algún problema con la familia o
los amigos que probablemente fue causado por su uso de sedantes que normalmente
se venden con una receta médica?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV22 [IF DRSV21 = 1] ¿Continuó usando sedantes que normalmente se venden con una
receta médica aún cuando pensaba que le causaba problemas con la familia o los
amigos?
1
Sí
2
No
DK/REF
DRSV23a Alguna vez en los últimos 12 meses, ¿tuvo tantas ganas de usar sedantes que
normalmente se venden con una receta médica que no podía pensar en nada más?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
H-69
DRSV23b [IF DRSV23a = 2, DK/REF] Alguna vez en los últimos 12 meses, ¿tuvo usted un
deseo fuerte o la necesidad de usar sedantes que normalmente se venden con una
receta médica?
1
Sí
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
H-70
| File Type | application/pdf |
| Author | gmchenry |
| File Modified | 2017-01-11 |
| File Created | 2017-01-11 |