ITEM | WOMEN | MEN |
---|---|---|
1. Family history of substance abuse: | ||
• alcohol | [ ] 1 point | [ ] 3 points |
• illegal drugs | [ ] 2 points | [ ] 3 points |
• prescription drugs | [ ] 4 points | [ ] 4 points |
2. Personal history of substance abuse: | ||
• alcohol | [ ] 3 points | [ ] 3 points |
• illegal drugs | [ ] 4 points | [ ] 4 points |
• prescription drugs | [ ] 5 points | [ ] 5 points |
3. Age between 16 and 45 y | [ ] 1 point | [ ] 1 point |
4. History of preadolescent sexual abuse | [ ] 3 points | [ ] 0 points |
5. Psychological disease | ||
• attention deficit disorder, obsessive-compulsive disorder, bipolar disorder, or schizophrenia | [ ] 2 points | [ ] 2 points |
• depression | [ ] 1 point | [ ] 1 point |
Total |
Adapted from Webster and Webster.11