Signs and Symptons Scale

Section I: Qualities of a Parent or Sponsor

Have you had experience with substance abusers?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Have you read literature on substance abuse?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Are you familiar with the psychological effects of the common substances of abuse?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Are you familiar with the physical effects of the common substances of abuse?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Are you familiar with the social effects of the common substances of abuse?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Are you familiar with the most common forms of treatment for substance abuse?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Have you discussed drug abuse with your children?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Have you condemned drug abuse?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Have you expressed your dislike for your children's friends who you know or suspect are using drugs?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Have you told your family that drug use will not be accepted in your home?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Have you asked for their help in keeping drugs out of the home?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Have you been careful not to use drugs in front of your children?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Have you been careful not to let your children see you high or drunk?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Have you told your children that you love them?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Do you set time aside to listen and discuss problems with your children?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Do you spend time together as a family?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Do you spend time with your spouse?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Do you listen to your spouses problems?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Are you supportive of your spouse's interests and problems?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Do they know that you care for them?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Do you provide for your family?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Do you make sacrifices for your children?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Do you make sacrifices for your spouse?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Section II: Qualities of the Home

Do people in the home have trouble getting along?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Are there arguments in the home between parents?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Are there arguments in the home between other family members?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Is there negative tension in the home?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Is there physical violence in the home?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Are there people in the family who use drugs?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Are there family members who sell drugs?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Are there family members who have drug abuser friends calling or coming by the house?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Is there verbal abuse and cursing in the home?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Are there healthy adults in the house who are not working?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Have children in the family dropped out of school?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Have family members been allowed to get high in the house?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Have family members been allowed to sell or purchase drugs in the house?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Have minors been out past 9:00 pm without calling or an adult knowing where they are?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Are minors allowed to associate with whoever they want?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Are children made to feel uncomfortable at home?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Are adults in the family made to feel uncomfortable at home?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Is there disrespect among family members?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Is there little support for each other among family members?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Are relationships between family members weak?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Section III: General Indicators - For Subject

Medical Problems

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Psychological Problems

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Social Problems

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Emotional Problems

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Educational Problems

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Legal Problems

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Section IV: Qualities of Mental Health - For Subject

Problems Eating

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Problems Losing Weight

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Problems Getting to Sleep

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Has Mood Swings

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Has Sad Moods

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Is Nervous

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Is Irritable

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Has a Quick Temper

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Laugh a Great Deal

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Cry a Great Deal

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Talks about Suicide

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Is Verbally Threatening to Others

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Disrespectful towards Authority

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Thinks Everyone is Against Him/Her

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Believes Things That Are Not True

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Been Treated for a Mental Problem

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Has a Bad Attitude about Life

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Not Care About School or Work

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Has Trouble Remembering Things

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Problems with Memory

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Has Shakes and Tremors

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Has Headaches

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Has Dizziness

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Has Blackouts

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Has Seizures

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

See Things that are Not There

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Talks to self

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Talks to People that No one Else Sees

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Is Very Sensitive or Easily Offended

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Is Fidgety or Restless

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Is Slow and Listless

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Section V: Qualities of Personal Relationship - For Subject

Is Detached and Withdrawn

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Comes Home Late from Work or School

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Comes Home After 10:00 PM

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Hangs Out with Friends Until Very Late

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Oversleeps in the Morning

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Is Late for School or Work

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Is Absent from School or Work

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Has Disagreements with Teachers and Supervisors

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Has Difficulty Maintaining a Job, staying in school

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Comes Home Late on Payday

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Comes Home Intoxicated

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Spends Large Amounts from Paycheck

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Does Not Bring Paycheck Home

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Associates with Undesirable Friends

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Has Relationship with Another Man Or Woman

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Is Verbally Abusive

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Is Physically Abusive

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Is Sexually Inactive with Spouse

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Friends Call or Come by Late at Night Without Being Introduced

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Does Not Come Home on Pay day

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Section VI: Qualities of Addictive Behavior - For Subject

Is Unfriendly Toward Others

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Avoids Conversations

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Sweats a Great Deal When Talking

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Seems Manipulated by Others

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Is Sexually Seductive

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Attempts to Take Control

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Is Evasive When Asked Direct Questions about Drugs

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Is Suspicious of Others

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Rarely Makes Sense

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Has unclear Thoughts

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Exercises Poor Judgment

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Rarely Gives Clear Answers to Questions

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Has Short Attention Span

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Is Fearful or Scared

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Is Easily Influenced by Friends

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Has Lost Interest in personal Appearance

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Has Lost Interest in their Work or School

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Talks about Drugs

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Has History of Using Drugs

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Believes he/she can Associate with Addicts and Not Use Drugs

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Believes he/she can Use Drugs and can Stop when he/she Wants

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Claims to want to use drugs to help:

Overcome Emotional Pain

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Overcome Physical Pain

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Lose Weight

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Sleep

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

the Way he/she Looks

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

the Way he/shes treated by others

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

work or school environment

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

the marriage

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

the relationship

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Has Lost Interest in:

work

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

school

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

family

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

friends

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

other interests

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Lies or is Evasive about Outside Activities

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Steals Money or Misuses Money

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Neglects Responsibilities Toward:

Brothers or Sisters

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Children

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Other Family

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Are Other Addicted Persons:

Living with Subject?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Working with Subject?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time

Going to School with Subject?

(0) not applicable n/a
(1) not at all, never
(2) very little, slightly seldom
(3) significantly, often, frequent occasions
(4) a great deal, very much, most of the time