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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