Days Without Writing

January 12, 2014

This is an excellent blog for anyone of any age aspiring to be a writer. Remember this, when you define yourself at least in part by your writing, you are a writer whether you call yourself that it not.

Write on my friends, write on

Best Regards To All
Terry Gorski

Waiting Outside of Parnassus

At what point is one allowed to call oneself a writer is a question that I’ve spent far too much time contemplating. When I was younger, I would shy away from calling myself a writer because my writing wasn’t serious, wasn’t good, wasn’t published, wasn’t published in a paying magazine, and myriad of other reasons. I now say that the only thing that makes a person a writer is that they write (something I’ve heard a lot of other people say for a long time before I accepted its obvious truth). As long as I spend a good portion of my time getting words on the page, I am a writer. Maybe not a good one, a successful one or any other qualifier, but I am inarguably a writer, though there is always a little (or huge) part of me that doesn’t think I can call myself one. Part of the…

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PTSD and Addiction: A Cognitive Restructuring Approach

January 11, 2014
By Terence T. Gorski, Author
June 22, 2013
Unknown

Recovery Is Possible With
Cognitive Restructuring

 WHEN  TREATING PTSD AND ADDICTION, I don’t use a single approach – I use a consistent set of principles and practices. I strive to be sensitive and adaptive to the emerging needs of patients in the moment. The key seems to be a balance of flexibility and consistency.  Everyone responds in a uniquely personal way in learning to understand and manage PTSD. I like the idea that and the PTSD recovery process results in Post Traumatic Growth. People don’t just overcome their symptoms. They grow and change in positive ways.

PTSD ASSESSSMENT – A CRITICAL FIRST STEP

First I do a comprehensive assessment of PTSD. This includes an analysis of presenting problems, a life history, and a history of treatment and recovery. I include efforts at self-help to be important. Most people try everything they know to get a handle on their PTSD before seeking any formal or professional help.

ADDICTION ASSESSMENT – NOT A LUXURY, A NECESSITY

If the assessment provides confirmation of active PTSD symptoms, I do a comprehensive addiction assessment because addiction is so common in patients with PTSD. If the addiction is not identified and treated concurrently, the PTSD treatment can make the addiction symptoms worse, and the addiction symptoms can prevent patients from benefiting from the treatment/recovery of PTSD.

PSYCHO-EDUCATION – TEACHING A LANGUAGE OF RECOVERY

Then I use psycho-education to give people a new cognitive frame of reference about PTSD. This is extremely important because, although most people are familiar with the general idea of PTSD, most lack accurate information or a useful way of understanding the symptoms and the pathways to recovery.

SURVIVORS – NOT VICTIMS

The most important thing I want to teach is that patients are trauma survivors, not trauma victims. I also want to be sure that the trauma is over. You work differently with PTSD if the trauma is still ongoing It makes a difference if: a soldier needs to return to combat or is home from the war; if a battered child is still living under the control of violent parent and will have to go home; if the abused spouse is out of the marriage or still involved due to children or financial issues; if the person is in prison and going back to the cell block or if they have been released. If they are actively involved in an ongoing trauma teach survival and coping skills, safety plans, and ways to responsible get out and get safe.

GET PATIENTS SOME INITIAL RELIEF FROM PAIN

The first goal is to provide relief for the most painful mediate symptoms. This often involves referral for EMDR. I am not skilled with this method, but many patients find it helpful. This also involves basic training in relaxation, diet, and exercise as a part of overall stress management.

THE LIFE AND SYMPTOMS HISTORY – A COLLABORATIVE APPROACH

Then I do a guided life and symptom history so people can see how symptoms have affected their life negatively through pain, problems, and losses; and positively through a process of making decisions that lead to positive change, growth, and development. This is a positive psychology intervention called Post Traumatic Growth (PSG).

THE COMPREHENSIVE SYMPTOM LIST

I develop a comprehensive list of the PTSD symptoms that patients are struggling with. This often involves showing them a list of symptoms because they lack the words or language to describe what they are experiencing. It is easy for me to forget how important it is to give patients a language of recovery so they can identify and communicate their experiences.

Once I have a comprehensive symptom list, I ask patients to evaluate the frequency (how often) and severity (how disruptive) the symptoms tend to be.  Then explore each symptom. First I want them to tell me real-life stories about what happened when they experienced each symptoms. I like to get at least two stories about each – one story in which they managed it pretty well, and one story in which they managed it poorly. This helps them to take ownership of their symptoms and get a feel for the new language they are learning. I get stress enough how important I feel this process by relating symptoms to actual lived experiences is for most patients.

I look for patterns of symptoms. Many symptoms appear in clusters that are activated by the same trigger event and once they appear, they mutual reinforce and intensify each other. I treat these symptom clusters as a single symptom and help patients to find a meaningful name it.

STRENGTH-BASED – WHAT ARE YOU DOING RIGHT

I make it a point to discuss how patients have managed to survive up to this point. I want to find periods of time when they have successfully managed their symptoms or been symptoms free. What were they doing at those times. What was going on or not going in their lives. What thoughts, feelings, behaviors, and social styles are associated with successfully coping with the symptoms?

THE IDEA OF PTSD SYMPTOM EPISODES

I also like to introduce the concept of PTSD symptoms episodes – moments in time when the symptoms get turned on by triggers and turned off by things like rest and safe environments. The idea is that the symptoms are not always there. Most patients believe that they are, but they are usually wrong. The symptoms are usually turned on some of the time and turned off at other times. Once a symptoms episode is activated by a trigger, it starts, runs a cycle, and then ends or significantly diminishes in intensity. Know that it will end gives strength in facing the symptoms. Naming the symptoms identifies the enemies or the monsters to be dealt with. At the very least, at some times the symptoms are less severe and more manageable than at other times.

SYMPTOM SELF-MONITORING

I encourage patients to do conscious self-monitoring o their symptoms at least four times per day (breakfast, lunch, dinner, and before bed) and note the specific symptoms experienced, how severe the symptom is, what is happening that is making it more severe, and what could be done to make it a little bit less severe. This starts patients on a journey of Post Traumatic Growth by showing them they are not totally at the mercy of these symptoms — that they can choose to do things to make their symptoms a little bit better or a little worse.

FLASHBACKS – TEACHING PATIENT TO GET OUT SAFELY

I find that many patients are fearful of the flashback and dissociative states that they get into that are often a part of PTSD. They fear that if they get into these states they will fall into a bottomless black pit and never be able to crawl out again. This is why a believe so many people are afraid to start talking about past experiences or the triggers that activate symptoms. They are afraid that once the symptoms start they won’t stop.

FINDING A SAFE PLACE INSIDE YOURSELF

To counter this, I like to have patients find a safe-memory or fantasy that they can go to and practice going there when they are feeling pretty good. I want them to learn and practice relaxation exercises that work for them. I give them a smorgasbord of relaxation methods to choose from. Giving choices, it seems, reduces resistance. I also avoid “one size fits all” methods of relaxation — but no methods really do work for everyone. I avoid using guided imagery at first because I find it unpredictable. Once patients relax and engage their imagery processes, they often are vulnerable to intrusive thoughts, feelings, and flashbacks.

IMMEDIATE RELAXATION METHODS – CHOICE AND SAFETY

I like to teach centering, deep-breathing, and mindful (detached) awareness, I want to be sure that patients learn how to get back into the here and now and stop intrusive symptoms as soon as they start.

I avoid what I call “big bang catharsis techniques” which take the patients quickly into deeply re-experiencing the memories of trauma. I have just had too many b ad experiences with patients regressing and getting worse as a result of these techniques. I personally don’t find using them worth the risk.

I would rather take patients into the memories as they emerge in the assessment and recovery skills training process. I want to be sure that patients have the ability to stop and crawl out of the experience and get back into a tight anchor with here-and-now-reality.

SUPPORT NETWORKS 0 CRITICALLY IMPORTANT

I also focus on building support networks of people, places, and things that can be used when things get tough. Simple things like: Who can you call if you need to talk? Who should you avoid if your symptoms are bad in the moment? What can you do that will help? What should you avoid doing because it will make things worse? I am especially concerned about having a support systems that can be used during the night. This is when the symptoms tend to be more intense and the support less available.

COGNITIVE RESTRUCTURING – TFUAR MANAGEMENT

The general structure I wrap these general principles of cognitive restructuring. I use the word cognitive to mean total information processing with the brain and the mind. This involves Thoughts (T), Feelings (F), Urges (U), actions (A), and relationships. It also involves subtle intuitions and openness to spiritual experiences which seem to be very common in people who survive trauma. using a cognitive restructuring process. I ask patients to complete these sentence stems, or I turn them into open-ended questions. Using active listing is critical. Patients must feel listened to, understood, taken seriously and affirmed as a person. This process turns a sterile and “objective” assessment into a highly personalized and collaborative self-assessment.

COGNITIVE RESTRUCTURING FOR PTSD

Here is a general structure for the process:

1.  The symptom that I am experiencing is …

2.  When I experience this symptom I tend to think …

  • A more helpful way of thinking might be ….

3.   When I experience this symptom I tend to feel …

  • A more helpful way of managing those feelings might be ….

4.  When I experience this symptom I tend to manage it by doing the following things …

  • A more helpful behavioral strategy for managing this symptom might be ….

5.  When I experience this symptom what I do to try to get help from other important people in my life is …

  • A more helpful strategy for getting the help and support if others in managing this symptom might be ….

6.   he overall daily plan I have for managing my PTSD recovery is …

  • Some ways of making my recovery plan more helpful for me might be …

A SIMPLISTIC SKELETON OF A COMPLEX PROCESS 

This is a simplistic skeleton of the basic principles and practices of a cognitive restructuring approach for PTSD. This sketch, of course, just covers some of the steps on the critical path to recovery and relapse prevention. It also presents my preferences as a therapist based upon my past experiences with clients. I am sharing this as a personal report on lessons learned.

 Gorski Books


The New Opiate Addict

January 11, 2014

By Terence T. Gorski, Author
January 11, 2014

images

Men Get Addicted

A Profile of the New Opiate Addict

There is an old stereotype of opiate addicts painting them as old-school street junkies who over-dose in alleys with needles in their arms. This stereotype is not only wrong – it is dangerous. It deters people from recognizing the new opiates, especially prescription pain-killers and their non-medical use, and the new opiate addicts who are thirty-something in age, largely employed even in this faltering economy, and spending one-third of their annual income of about $53,000 per year supporting their opiate addiction.

siobhan-morse

Siobhan A. Morse, Researcher

I developed this snapshot of the new opiate addict from a research study by Siobhan A. Morse who is the Director of Research for Foundations Recovery Network

Detailed Information On The New Opiate Addict

Here is a summary of the data upon which this profile of the new opiate addict is based: Of the 1,972 patients who agreed to participate in research between January 2008 and June 2010:

– 49.8% reported opiate use within the 30 days prior to admission:

– 11.8% reported heroin use,

– 5.4% reported non-medical use of methadone, and

images

Women Get Addicted

– 32.4% reported using “other opiates,” which includes nonmedical prescription opiate use.

– 8.4% of the opiate users reported using more than one type of opiate.

– The average age was 32.5 years, 59% were males and 49% were females.

– Over half (52%) reported being employed in the 30 days prior to admission; however, they also reported only working an average of 10.7 days.

– 95.8% reported receiving money from illegal activity in the month prior to treatment.

– Their average monthly income was $1,465 in the month prior, earning about $53,000 per year.

– Most spent an average of 35% of their earned monthly income on opiate drugs.

– Six months post-treatment, 73.2% of opiate users remained alcohol-free and 80.5% of were drug-free.

Opiate Use Fact Sheet

– There was a 400% increase in prescription painkillers from 1999 to 2010 (National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, 2012).

– In 2011, prescription painkillers are the largest single category of illicit drug use other than marijuana (Substance Abuse and Mental Health Services Administration, 2012).

– The USA and Canada combined account for 6%, 22 tons, of the world’s heroin consumption in 2010 (United Nations Office on Drugs and Crime , 2010).

– In 2011, 4.5 million Americans over the age of 12 were current nonmedical users of painkillers and an additional 620,000 were past year users of heroin (Substance Abuse and Mental Health Services Administration, 2012).

– 1.8 million persons suffered from a pain reliever abuse or dependence in 2011 (Substance Abuse and Mental Health Services Administration, 2012).

– Opioid pain relievers accounted for 14,800 drug overdose deaths in 2008 (Centers for Disease Control and Prevention, 2011).

– The societal costs of opioid abuse, dependence and misuse including health care consumption, lost productivity and criminal justice costs and were estimated at $55.7 billion (Birnbaum, 2011).

Read the entire study on the internet.

OPIATE ADDICTION CAN BE SUCCESSFULLY TREATED

LIVE SOBER – BE RESPONSIBLE – LIFE FREE

GORSKI BOOKSGORSKI TRAINING/CONSULTATION

Read Straight Talk About Addiction
By Terence T. Gorski


Solitary Confinement: Research and Experiences

January 10, 2014
Has anyone following this blog been in prison and served time in solitary confinement. Dr. Grassian, a trusted colleague, is interested in interviewing people to further his research on the impact of solitary confinement. Please review the correspondence below.  If you can help Dr. Grassian find people willing to be interviewed please contact him.
Stuart Grassian  M.D.

401 Beacon Street
Chestnut Hill, MA 02467
(617) 244-3315
stgrassian@gmail.com 

Please read our correspondence below for more information.
Dear Mr. Gorski,
Thanks for your words of support.  As you know, addictions and imprisonment are so tightly connected;  I am pleased to learn of your work reaching out to those who have experienced both.
Earlier this year I made a commitment to try to collect stories of individuals who, now released back into the community, had spent a great deal of time in solitary confinement.  I would greatly appreciate any referrals you might have of individuals who have experienced this and might be willing to share their experience (of course, confidentiality would be maintained).
I hope the new year finds you well and that your work continues to make a difference.
Stuart Grassian  M.D.

401 Beacon Street
Chestnut Hill, MA 02467
(617) 244-3315
stgrassian@gmail.com

On Tue, Dec 24, 2013 at 12:46 PM, <stgrassian@aol.com> wrote:
—- original Message—–
From: ttgorski <ttgorski@gmail.com>
To: stgrassian <stgrassian@aol.com>
Cc: Tresa Watson <tresa@cenaps.com>; Terence T. Gorski <ttgorski@gmail.com>; Dr. Stephen Grinstead <sgrinstead@cenaps.com>
Sent: Mon, Dec 23, 2013 2:30 pm
Subject: Thank You For You Work

Dear Dr. Grassian,

I have been delinquent in expressing my gratitude and and telling you about how useful your work has been to me. As a means f introduction I am an author and a trainer/consultant specializing in addiction and related mental health problems. I have developed a popular model of Relapse Prevention Therapy (RPT).  and through me uncountable addiction professionals trying to understand the unusual and difficult to deal problem they have in treating http://salvationist.ca/2011/11/an-ounce-of-prevention/ patients who have been incarcerated. When I started trying to meet the needs of these counselors, I constructed a concept called Post Incarceration Syndrome (PICS). Initially it was very popular, until of course, the economy and climate of addiction treatment radically changed through the influence of Government Policy.
Here are links to several internet resources that show how your work has influenced me:
1. My blog republishing a basic article that has been reference and reposted many times:https://terrygorski.wordpress.com/2013/10/26/the-post-incarceration-syndrome-pics/
6. Relapse Prevention In The Salvation Army programs: http://salvationist.ca/2011/11/an-ounce-of-prevention/
This is just a sample of the many people who have spread your ideas which are contained in the concept of Post Incarceration Syndrome.
I wanted you to know that your has, is, and will continue to make a difference to me and countless lives that your research and writing have changed for the better. Thank you for your contributions and you career work.
Terence T. Gorski

Suicide and Addiction (Substance Use Disorders)

January 9, 2014

Here are some facts about suicide and addiction (substance use disorders) that we all need to be aware of.

1. Suicide is a leading cause of death among people who abuse alcohol and drugs (Wilcox, Conner, & Caine, 2004).

2. Compared to the general population, individuals treated for alcohol abuse or dependence are at about 10 times greater risk to eventually die by suicide compared with the general population, and people who inject drugs are at about 14 times greater risk for eventual suicide (Wilcox et al., 2004).

3. Individuals with substance use disorders are also at elevated risk for suicidal ideation and suicide attempts (Kessler, Borges, & Walters, 1999).

4. People with substance use disorders who are in treatment are at especially high risk of suicidal behavior for many reasons, including:

–  They enter treatment at a point when their substance abuse is out of control, increasing a variety of risk factors for suicide.

–  They enter treatment when a number of co­ occurring life crises may be occurring (e.g., marital, legal, job)

–  They enter treatment at peaks in depressive symptoms.

–  Mental health problems (e.g., depression, post­ traumatic stress disorder [PTSD], anxiety dis­ orders, some personality disorders) associated with suicidality often co-occur among people who have been treated for substance use disorders.

–  Crises that are known to increase suicide risk sometimes occur during treatment (e.g., relapse and treatment transitions).

SUICIDE IS A PERMANENT SOLUTION
TO A TEMPORARY PROBLEM

GORSKI’S BLOG
Straight Talk About Suicide

GORSKI BOOKSGORSKI TRAINING/CONSULTING


Dark Thoughts: Personal and Collective

January 8, 2014
1508552_705489946150179_333021707_nBy Terence T. Gorski, Author
January 8, 2014

Dark thoughts can envelop our soul. We create some of these thoughts from personal experience, but not all of them.  Real but hidden threats cause some of these thoughts. Historical memory of devastating wars, poverty, and disease are the source of others. Many dark thoughts come from the collective unconscious of the group mind reflected in the deep rumblings of  the core violence of human culture.

There are bigger currents of humanity that move through our minds – a collective current that touches us all but is acknowledged by few. Our troubled violent history and current problems disturb us to the core of our being. It is easier to deny, to self-medicate, to distract with destructive pursuits. To look away is tempting. Denial, however, does not work very well in changing reality.

Human civilization is dark and violent. Human beings have a long history of collective and personal violence. War and violent crime have plagued humanity since before the beginning of written history.  The first recorded war occurred over 5,000 years ago and human beings have been systematically slaughtering each other with the best available technology ever since. War is the primary driver of technology and economic development.

Violence may have created and certainly sustains human culture. Read the Bible or the Koran and take note of the wide-spread murders, wars, plundering of cities, the women raped and murdered, and children put to the sword. Much of this slaughter was done in the name of God. It was also done to get new lands and steal the wealth of others. It is too often rationalized as the will of god.

The violence that permeates culture creates chronic pain called ANGST – the universal pain of the human condition. Living with the conscious knowledge that we will die causes us fear. To know that we need to love and the violence causes more violence causes shame and guilt when we live a world where life must feed upon life in order to survive. Addiction may well be a universal cross-cultural mechanism for managing this primal fear. There seems to be a strong relationship between fear of violence and both addiction and mental health problems. There is strong evidence that primitive religion emerged as a result of ritual practices to stop collective mob violence in primitive communities.

As long as we deny the violence all around us and pretend that it doesn’t exist, we ware part of the problem. We silently enable the violence and refuse to see what we are doing. The dark thoughts that we push deep into our mind, however, haunt us and often emerge at unexpected times. We are all guilty of perpetrated or enabling violence.

While hanging on the cross Jesus said: “Father, forgive them for they know not what they do.” This statement tells us why we are all culpable for the violence that surrounds us. If we don’t continue to improve our violence control mechanisms based on human empathy, individual societies and the world can lapse again into world war and domestic riots.

Tremendous resources are invested in national and international violence control mechanisms. War is expensive. So is crime.  Many of us prefer to deny this fact. It is easier to pretend that civilization is based upon a foundation of peace and love. It’s not! History has taught us that denial of violence does not work. Denial results in more violence. The social processing of violence, in a peaceful way, is necessary to establish any solid foundation for future peace.

It is hard to accept the truth and then stand for something better – a higher truth that we are also a part if something better. The problem is that power structure of the world has a solid foundation and a need for perpetual violence. To develop a peacetime economy that is not preparation for war is a goal that has yet to be achieved.

LIVE SOBER – BE RESPONSIBLE – LIVE FREE

GORSKI BOOKS GORSKI TRAINING/CONSULTATION


The AWARE Questionnaire: For Monitoring Relapse Warning Signs

January 8, 2014

AWARE_RWS_LogoBy Terence T. Gorski, Author
January 6, 2014

The risk of relapse is an important factor in determining the type and level of care for addiction treatment. A useful tool called The AWARE Questionnaire has been developed been developed and is in its third revision based upon ongoing use (Miller et al 1996). This questionnaire provides an evidenced based approach for measuring the risk of relapse.

The AWARE Questionnaire (Advance WArning of RElapse) was designed as a measure of the warning signs of relapse, as described by Gorski (Gorski & Miller, 1982).

Gorski’s thirty-seven warning signs of relapse was originally developed as a result of clinical interviews with 117 patient conducted by Gorski.  The patients were chronic stage gamma alcoholics who had completed at least one 28-day residential rehabilitation program for alcoholism and subsequently entered treatment again for alcoholism.

The AWARE Questionnaire (Advance WArning of RElapse) was designed as a measure of the warning signs of relapse, as described by Gorski (Gorski & Miller, 1982). In a prospective study of relapse following outpatient treatment for alcohol abuse or dependence (Miller et al., 1996) the researchers found the AWARE score to be a good predictor of the occurrence of relapse (r = .42, p < .001). With subsequent analyses, the researchers refined the scale from its 37-item original version to the current 28-item scale (version 3.0) (Miller & Harris, 2000).

The items are arranged in the order of occurrence of warning signs, as hypothesized by Gorski. In our prospective study, however, we found no evidence that the warning signs actually occur in this order in real-time (Miller & Harris, 2000). Rather, the total score was the best predictor of impending relapse.

This is a self-report questionnaire that can be filled out by the client. Be sure that the client understands the 1-7 rating scale. When the client has finished, make sure that all items have been answered and none omitted.

Scoring is completed by adding up  the total the numbers circled for all items, but reversing the scoring for the following five items: 8, 14, 20, 24, 26. For these five items only. In other words, if the client circles this number: 1 2 3 4 5 6 7 Add this number to the total score: 7 6 5 4 3 2 1

INTERPRETATION: The higher the score, the more warning signs of relapse are being reported by the client. The range of scores is from 28 (lowest possible score) to 196 (highest possible score). The following table shows the probability of heavy drinking (not just a slip) during the next two months, based on our prospective study of relapse in the first year after treatment (Miller & Harris, 2000).

Probability of Heavy Drinking During the Next Two Months

AWARE
Score

If already drinking
in the prior 2 months

If abstinent during
the prior 2 months

28-55

37%

11%

56-69

62%

21%

70-83

72%

24%

84-97

82%

25%

98-111

86%

28%

112-125

77%

37%

126-168

90%

43%

169-196

>95%

53%

This instrument was developed through research funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA, contract ADM 281-91-0006). It is in the public domain, and may be used without specific permission provided that proper acknowledgment is given to its source. The appropriate citation is Miller & Harris (2000).

References

Gorski, T. F., & Miller, M. (1982). Counseling for relapse prevention. Independence, MO: Herald House – Independence Press.

Miller, W. R., & Harris, R. J. (2000). A simple scale of Gorski’s warning signs for relapse. Journal of Studies on Alcohol, 61, 759-765.

Miller, W. R., Westerberg, V. S., Harris, R. J., & Tonigan, J. S. (1996). What predicts relapse? Prospective testing of antecedent models. Addiction, 91 (Supplement), S155-S171.

AWARE Questionnaire 3.0

Please read the following statements and for each one circle a number, from 1 to 7, to indicate how much this has been true for you recently. Please circle one and only one number for every statement.

Never

Rarely

Some-
times

Fairly
often

Often

Almost
always

Always

1. I feel nervous or unsure of my ability to stay sober.

1

2

3

4

5

6

7

2. I have many problems in my life.

1

2

3

4

5

6

7

3. I tend to overreact or act impulsively.

1

2

3

4

5

6

7

4. I keep to myself and feel lonely.

1

2

3

4

5

6

7

5. I get too focused on one area of my life.

1

2

3

4

5

6

7

6. I feel blue, down, listless, or depressed.

1

2

3

4

5

6

7

7. I engage in wishful thinking.

1

2

3

4

5

6

7

8. The plans that I make succeed.

1

2

3

4

5

6

7

9. I have trouble concentrating and prefer to dream about
how things could be.

1

2

3

4

5

6

7

10. Things don’t work out well for me.

1

2

3

4

5

6

7

11. I feel confused.

1

2

3

4

5

6

7

12. I get irritated or annoyed with my friends.

1

2

3

4

5

6

7

13. I feel angry or frustrated.

1

2

3

4

5

6

7

14. I have good eating habits.

1

2

3

4

5

6

7

Never

Rarely

Some-
times

Fairly
often

Often

Almost
always

Always

15. I feel trapped and stuck, like there is no way out.

1

2

3

4

5

6

7

16. I have trouble sleeping.

1

2

3

4

5

6

7

17. I have long periods of serious depression.

1

2

3

4

5

6

7

18. I don’t really care what happens.

1

2

3

4

5

6

7

19. I feel like things are so bad that I might as well drink.

1

2

3

4

5

6

7

20. I am able to think clearly.

1

2

3

4

5

6

7

21. I feel sorry for myself.

1

2

3

4

5

6

7

22. I think about drinking.

1

2

3

4

5

6

7

23. I lie to other people.

1

2

3

4

5

6

7

24. I feel hopeful and confident.

1

2

3

4

5

6

7

25. I feel angry at the world in general.

1

2

3

4

5

6

7

26. I am doing things to stay sober.

1

2

3

4

5

6

7

27. I am afraid that I am losing my mind.

1

2

3

4

5

6

7

28. I am drinking out of control.

1

2

3

4

5

6

7

SCORING FOR THE AWARE 3.0

For these items, record the number circled

1. ___ 2. ___  3. ___ 4. ___ 5. ___ 6. ____7. ___ 9. ___ 10.__ 11.____ 12.___ 13.___ 15.___ 16.___ 17.___
18.___ 19.___ 21.___ 22.___ 23.___ 25.___ 27.__ 28.___

Subtotal #1: _________

For these 5 items,
reverse the scale
1 = 7; 2=6; 3=5; 4=4; 5=3; 6=2; 7=1;

8. ___ 14. ____ 20. ____ 24. ____ 26 .____

Subtotal #2: _________

Subtotal #1: ______ + Subtotal #2: ______ = AWARE Score:  ______


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