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Assessment Forms

Click the name of the form below to display more information. Most entries include links for more information or to download a sample of the form.

Assessment Forms

Addiction Severity Index (ASI)

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Source
McLellan AT, Kushner H, Metzger D, Peters R, Smith I, Grissom G, Pettinati H, Argerious M. The fifth edition of the Addiction Severity Index. Journal of Substance Abuse Treatment. 1992;9:199-213.

Balloon analog Risk Task (BART)

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Source
Lejuez, C.W., Read, J.P., Kahler, C.W., Richards, J.B., Ramsey, S.E., Stuart, G.L., Strong, D.R., Brown, R.A.. (2002). Evaluation of a behavioral measure of risk taking: the Balloon Analogue Risk Task (BART). J Exp Psychol Appl. 2002 Jun;8(2):75-84

Barratt Impulsiveness Scale

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Source
Patton, J.H., Stanford, M.S., Barratt E.S. (1995). Factor structure of the Barratt impulsiveness scale. J Clin Psychol. Nov;51(6):768-74.

Baseline Screening

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Developed based on study needs.

BIS BAS (Behavioral Inhibition System/Behavioral Approach System)

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Source
Carver, C. S., & White, T. L. (1994). Behavioral inhibition, behavioral activation, and affective responses to impending reward and punishment: The BIS/BAS scales. Journal of Personality and Social Psychology, 67, 319–333.

Brief Symptom Inventory (BSI)

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Source
Derogatis, L. R. & Melisaratos, N. (1983) The Brief Symptom Index: An introductory report, Psychological Medicine, 13, 595-605.

Cambridge Cognition CANTAB

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Source
Robbins TW, James M, Owen AM, Sahakian BJ, Lawrence AD, McInnes L, Rabbitt PM. A study of performance on tests from the CANTAB battery sensitive to frontal lobe dysfunction in a large sample of normal volunteers: implications for theories of executive functioning and cognitive aging. Cambridge Neuropsychological Test Automated Battery. J Int Neuropsychol Soc. Sep 1998;4(5):474-490

Change Strategies Inventory (CSI)

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Source
Litt MD, Kadden RM, Cooney NL, Kabela E. Coping skills and treatment outcomes in cognitive-behavioral and interactional group therapy for alcoholism. J Consult Clin Psychol. 2003;71:118–28. 

Distress Tolerance Scale

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Source
Simons SS, Racluca MG. The Distress Tolerance Scale: Development and Validation of a Self-Report Measure. Motivation and Emotion, Vol. 29, No. 2, June 2005

FMRI Screening

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Developed based on study needs.

Inclusion and Exclusion Criteria

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Developed based on study needs.

Informed Consent Quiz

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Developed based on study needs.

Perceived Stress Scale (PSS)

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Source
Cohen, S., Kamarck, T., & Mermelstein, R., "A Global Measure of Perceived Stress," in Journal of Health and Social Behavior, 24 (1983), 385-396.

Program and Client Costs Substance Abuse Treatment (PACC SAT)

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Source
Jofre-Bonet M, Sindelar JL, Petrakis IL, Nich C, Frankforter T, Rounsaville BJ, Carroll KM. Cost effectiveness of disulfiram: treating cocaine use in methadone-maintained patients. J Subst Abuse Treat. Apr 2004;26(3):225-232

QDOT

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Source
Johnson MW. An efficient operant choice procedure for assessing delay discounting in humans: Initial validation in cocaine-dependent and control individuals. Exp Clin Psychopharmacol. 2012;20(3):191-204

Quality of Life Scale

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Source
World Health Organization Quality of Life Group. Development of the World Health Organization WHOQOL-BREF quality of life instrument. Psychol Med. 1998;28(3):551-558

Risk Assessment Battery (RAB)

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Source
Navaline HA, Snider EC, Petro CJ, Tobin D, Metzger D, Alterman AI, Woody GE. An automated version of the Risk Assessment Battery (RAB): Enhancing the assessment of risk behaviors. AIDS Research and Human Retroviruses. 1994;10 (supplement 2):281-283.

Serious Adverse Event Form (SAE)

Serious Adverse Event Entry Form - Download the form

Serious Adverse Event Reporting Form Addendum - Download the form

Developed based on study needs.

Shipley-2

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Source
Zachary RA. The Manual of the Shipley Institute of Living Scale. Los Angeles: Western Psychological Services; 1991.

State-Trait Anxiety Scale

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Source
Kendall PC, Finch AJ, Jr., Auerbach SM, Hooke JF, Mikulka PJ. The State-Trait Anxiety Inventory: a systematic evaluation. J Consult Clin Psychol. Jun 1976;44(3):406-412

Structured Clinical Interview for the DSM (SCID)

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Source
First, M. B., Spitzer, R. L., Gibbon, M. & Williams, J. B. W. (1995) Structured Clinical Interview for DSM-IV, Patient Edition. (Washington, D.C., American Psychiatric Press).

Substance Use Calendar

Substance Use for Pretreatment Phase - Download the form

Substance Use for Active Study Phase - Download the form

Substance Use for Follow-up - Download the form

Source
Robinson SM, Sobell LC, Sobell MB, Leo GI. Reliability of the Timeline Followback for Cocaine, Cannabis, and Cigarette Use. Psychol Addict Behav. Dec 31 2012.

Urine Toxicology and Breath Screen
Yale Psychotherapy Development Center
Photo by Jerry Domian (Yale)

Psychotherapy Development Center core battery of assessments.