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Source: U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. Substance Abuse Relapse Prevention for Older Adults: A Group Treatment Approach 2005 Substance Abuse Profile for the Elderly (SAPE) Interview Client’s Name: Date of Admission: Date of Interview: Interviewer: (Read the following to the client before beginning the interview.)
This interview focuses on certain aspects of your use of substances. Your answers will help in developing your treatment plan. Please answer the questions honestly. Whenever possible, please provide the best answer or estimate. Do you have any questions before we start?
The interview takes approximately 1 hour per part. Following the interview and after the client has left the room, transcribe the client’s responses into Table A "Table for Client Responses."
Also draw up the client’s antecedents list and consequences list. Part I: Substance Use and Treatment History Substance Use 1. To your knowledge, did any members of your immediate family have a substance use problem? (Read the following choices; check those that apply) (1) Father (4) Brother (6) Son (2) Mother (5) Sister (7) Daughter (3) Spouse 2. Has anyone ever told you that you have or had a substance use problem? (1) Yes (2) No (If no, skip to question 6) 3. At approximately what age were you told that? Age 4. Who told you, at that time, that you had a problem? (Check all appropriate categories) (01) Parent(s) (06) Physician (02) Spouse (07) Substance abuse treatment professional (03) Brother/sister (08) Mental health professional (04) Friend(s) (09) Member of clergy (05) Children (10) Other (identify) 5. Did you agree with him or her that the problem existed at that time? (1) Yes (2) No (If yes, skip question 6, and go to question 7) 6. Do you believe that you have or had a substance use problem? (1) Yes (2) No (If no, skip to question 9) 7. At about what age do you think your problem began? Age 8. What substances did you use the most at the time your problem began?
(If necessary, read the choices) (1) Beer/malt liquor (6) Crack (2) Wine/wine cooler (7) Heroin (3) Hard liquor (8) Prescription drugs (4) Marijuana (9) Over-the-counter drugs (5) Cocaine (powder) (10) Other 9. During the last 6 months, what is the longest period during which you went without
using a substance? (Enter a number in the appropriate category below, or check
“never,” if appropriate) Days Weeks Months Never went without substances (If the answer is never, go to question 11) 10. Next, I will show you a list of situations. Which one item might describe why you
started using substances again after having stopped? (Show List A "Why Did You Start Using a Substance Again?", and record the answer by placing a checkmark next to the item) (01) I was lonely (11) I had been having nightmares (02) I didn’t feel needed (12) I was bored (03) My friends pressured me (13) I was a victim of violence, crime to use (14) I wanted to forget my physical (04) I had marital problems problems or pain (05) I had problems with (15) I had strong urges to use children/relatives substances (06) My spouse died (16) I felt depressed (07) A family member died (17) I was at a party or other (08) I lost my sense of purpose celebration (09) I was overconfident and (18) I had financial problems thought I could control my (19) I can’t remember/don’t know substance use (20) Other (specify) (10) I was angry and frustrated 11. Have you ever, on your own, and without any help, taken steps to stop substance use? (1) Yes (2) No (If no, skip to question 14) 12. If yes, what was the approximate month and year of your first attempt? / 13. What did you do to try to stop? Treatment History I would like to focus on your previous treatment history, that is, formal programs you have
been admitted to or counseling you have received because of a substance use problem. 14. Have you ever entered detoxification (detox) or substance abuse treatment before,
not including the program you are in now? (1) Yes (2) No (If no, skip to question 25) 15. Estimate the month and year of that very first admission (or when you began
that therapy). / 16. Was this first admission (1) A detox program only? (2) An inpatient treatment/residential program? (3) An outpatient program with groups or individual counseling sessions? 17. Did you (1) Complete that first treatment? (2) Drop out of that program? 18. Estimate the month and year of discharge from that first treatment. / 19. Over your life, how many treatment programs have you been admitted to before the
one you are in now? (Enter a number for each category below. If the response in any
category is “none,” enter zero) # of detox admissions # of inpatient/residential treatment programs # of outpatient treatment programs Now, I would like you to think about the last substance abuse treatment program (or therapy) you were treated in before the program you are in now. (Probe for best estimates. Do not leave blanks) 20. What were the approximate month and year of that last admission? / 21. What were the approximate month and year of your discharge? / About how long after leaving that last treatment program did you slip and first start to use a substance again? (Enter a number in the category below that best describes the reported length of time before that first slip occurred) Days Weeks Months Years 23. Looking at the list we used earlier, which situation best describes why you had that
first slip? (Show List A used in question 10, and record the client’s answer below; then
take away List A) Code Number Reason for Slip 24. Did you continue to use the substance on that same day you slipped? (1) Yes (2) No 25. Did you continue to use the substance on that same day you slipped? (1) Yes (2) No (If no, stop here) 26. When was this? From: To: 27. Do you now regularly attend these meetings? (1) Yes (2) No (If no, stop here) 28. How long have you been attending these meetings? Months Years (Enter the number of months or years.) Part II: The Substance Use and Behavior Chain Recent Substance Use Pattern 1. When did you last use a substance? / / (Ask for the best estimate. The interviewer can calculate the date based on a response, such as “2 weeks ago.” Write the beginning and ending dates for the 30-day period just before this last use on a card or piece of paper, and place it in front of the client) 2. The next series of questions focuses on the 30 days just before your last use. To help you remember that period, I have written down the beginning and ending dates of that 30-day period. Over that period, what substance or substances did you use the most?
(If necessary, read the list aloud. Check all substances that apply) (1) Beer/malt liquor (5) Cocaine (powder) (9) Over-the-counter drugs (2) Wine/wine cooler (6) Crack (10) Other (3) Hard liquor (7) Heroin (4) Marijuana (8) Prescription drugs 3. Which one substance caused you the most problems during that 30-day period? (Enter the name of the substance from the list above) From this point on, we will refer to your use of (problem substance named in question 3). (State the name of the substance whenever the blank line is used in the question you are reading). 4. How many days would you estimate that you used (problem substance) during those 30 days? 5. During those 30 days, how often were you intoxicated or under the influence? 6. How would you describe your pattern of use during that time? I will read some choices, and I would like you to tell me which pattern best describes your substance use during that 30-day period. (1) Steady or almost every day (3) Weekends only (2) Occasional or binges (4) Other (describe) 7. Now, think about the days you did not use (problem substance) during that 30-day period. Using this list, can you point to a reason why you did not use it? (Hand the client List B. Record the answer below; then put away List B) (01) Pressure from spouse/family (07) Religious influences (02) Concern about my health (08) Able to control it (03) Mental problems (09) Substance not available (04) Worried about losing job (10) Felt too sick to use a lot (05) Couldn’t afford it (11) Wanted to stop (06) Afraid my children would see me (12) Other intoxicated or under the influence 8. Were there any days you used (problem substance) without becoming intoxicated or under the influence? (1) Yes (2) No List A (Use for questions 10 and 23 of Part I) Why Did You Start Using a Substance Again? (01) I was lonely (02) I didn’t feel needed (03) My friends pressured me to use (04) I had marital problems (05) I had problems with children/relatives (06) My spouse died (07) A family member died (08) I lost my sense of purpose (09) I was overconfident and thought I could control my substance use (10) I was angry and frustrated (11) I had been having nightmares (12) I was bored (13) I was a victim of violence, crime (14) I wanted to forget my physical problems or pain (15) I had strong urges to use substances (16) I felt depressed (17) I was at a party or other celebration (18) I had financial problems (19) I can’t remember/don’t know (20) Other (specify) List B (Use for Question 7 of Part II) What Prevented You From Substance Use on Those Days? (01) Pressure from spouse/family (02) Concern about my health (03) Mental problems (04) Worried about losing job (05) Couldn’t afford it (06) Afraid my children would see me intoxicated or under the influence (07) Religious influences (08) Able to control it (09) Substance not available (10) Felt too sick to use a lot (11) Wanted to stop (12) Other (specify) List C (Use for Question 17 of Part II) Locations Where Substance Use Might Occur for You on a Typical Day (01) My home (02) A friend’s home (03) Bar or lounge (04) Restaurant (05) While driving (06) Outdoors, such as a park, the woods, or on a boat (07) Sporting event (08) Crack house (09) Neighborhood drug hangout (20) Other (specify) List D (Use for Question 18 of Part II) Activities in Which You Were Involved Just Before Substance Use (01) Nothing (02) Watching TV (03) Listening to music (04) Driving (05) At work/job (06) Socializing (07) Entertaining (08) On a date (09) Having sex (10) Arguing or fighting (12) Other (specify) List E (Use for Question 19 of Part II) People With Whom You Used a Substance (01) No one (alone) (02) My spouse (03) My girlfriend/boyfriend (04) A particular friend (05) A few friends (06) A large group of people (07) Strangers (08) Members of a club (09) My son or daughter (10) Drug dealer/pusher (11) Other (specify) List F (Use for Questions 20 and 21 of Part II) Feelings Associated With Substance Use (01) Happy (11) Afraid (21) Insecure (02) Relaxed (12) Nervous (22) Inferior (03) Peaceful (13) Tense (23) Withdrawn (04) Calm (14) Excited (24) Unfriendly (05) Unafraid (15) Restless (25) Weak (06) Angry (16) Secure (26) Guilty (07) Sad (17) Superior (27) Failure (08) Depressed (18) Outgoing (28) Shy (09) Lonely (19) Friendly (29) Powerful (10) Frustrated (20) Strong (30) Other List G (Use for Question 27 of Part II) Problems I Have Experienced as a Result of Substance Use (01) Legal problems (02) Employment problems (03) Family problems (04) Social problems (05) Health problems (06) Financial problems (07) Psychological/mental disorders (08) No problems Table A (For Counselor's Use Only) Table for Client Responses Instructions: Following the SAPE interview and after the client has left the room, the counselor should immediately transcribe the information gathered from SAPE into this formatted table. Situation/Thoughts Feelings Cues Urges 9. On a typical day you used (problem substance) during that 30-day period, how much would you use? (Indicate a quantity, such as 6 12-ounce beers, 4
shots of whiskey, 1 pint of vodka, 2 marijuana joints, 4 tranquilizers or pain pills) 10. Did you usually buy the (problem substance)? (1) Yes (2) No If yes, where did you buy it? 11. If yes, about how much did you spend on it each week? $ per week 12. If you usually did not buy it, who gave it to you? (Check one) (1) Friend (4) Other family (2) Spouse (5) Dealer/pusher (3) Son/daughter (6) Other Did you keep substances in a particular place in your home? (1) Yes (2) No If yes, where did you keep it? 14. Was there a special time of day or certain day of the week you would start using a substance? (1) Yes (2) No If yes, when? (Specify time or day) 15. Was there any particular reason why you used (problem substance) then? 16. How would you compare this 30-day period of use we’ve been talking about with previous substance use in the past? Would you say you used (1) More in the past? (3) About the same as before? (2) Less in the past? Antecedents to Substance Use Now we will focus on events that often occurred on a typical day, just before you used (problem substance) 17. Locations I will show you a list of locations where substance use might occur. Please look at this list, and tell me where you most often used (problem substance) on a typical day during the 30 days just before your last use. (Hand the client List C)
I’ll place a number “1” next to the correct response below. (01) My home (06) Outdoors, such as a park or on a boat (02) A friend’s home (07) Sporting event (03) Bar or lounge (08) Crack house (04) Restaurant (09) Neighborhood drug hangout (05) While driving (10) Other Now, look at the list again, and tell me which place might be the next most frequent place of use. (Enter the number “2” next to the appropriate response) And, where is the next most frequent? (Enter a “3” in that space. Put away List C) 18. Activities Let’s focus on some typical things you did just before you used (problem substance). Using List D, what activity were you involved in just before using (problem substance)? (Hand the client List D) Record a “1” next to the correct response below. Is there any other activity? (Place a
“2” next to that response. Remove List D.) (01) Nothing (07) Entertaining (02) Watching TV (08) On a date (03) Listening to music (09) Having sex (04) Driving (10) Arguing or fighting (05) At work/job (11) Other (06) Socializing 19. People Next, please look at List E. Which of these best describes with whom you most often used (problem substance)? (Hand the client List E) (01) No one (alone) (07) Strangers (02) My spouse (08) Members of a club (03) My girlfriend/boyfriend (09) My son or daughter (04) A particular friend (10) Drug dealer/pusher (05) A few friends (11) Other (06) A large group of people 20. Feelings Just Before Substance Use Let’s talk about how you felt just before your first use on the last occasion you recall using (problem substance). Here is a list of words; each describes feelings or emotions. Which three best describe emotions that you experienced during a typical day? (Hand the client List F) (01) Happy (11) Afraid (21) Insecure (02) Relaxed (12) Nervous (22) Inferior (03) Peaceful (13) Tense (23) Withdrawn (04) Calm (14) Excited (24) Unfriendly (05) Unafraid (15) Restless (25) Weak (06) Angry (16) Secure (26) Guilty (07) Sad (17) Superior (27) Failure (08) Depressed (18) Outgoing (28) Shy (09) Lonely (19) Friendly (29) Powerful (10) Frustrated (20) Strong (30) Other Feelings Just Before Substance Use (Continued) (Probe for situations that lead to client’s feelings. For example, if the response is “sad,”
ask, “What were you sad about?” Record the code number, feeling, and definition below.
Then repeat the process for the next two choices. Ask, “Which would be your next most
frequent feeling?”) 1. 2. 3. Code Feeling Client’s definition or description (Keep List F close at hand, and use it for the next section) Consequences of Substance Use Now, I would like to ask you a few questions about what you experienced just after your first use of a substance on a typical day of substance use. 21. People’s feelings often change shortly after they start using a substance. Using the same list we just used, please select which best describes how you typically felt immediately after you started using (problem substance). (Hand List F back to the client. Record the corresponding code and feeling; then probe
for situations that led to that feeling. For example, if the client says “guilty,” ask, “What
did you feel guilty about?” Record the answer next to the feeling. Complete for the
second and third most frequent feelings.) 1. 2. 3. Code Feeling Client’s definition or description 22. Can you describe a situation or something that would make you feel like not giving into an urge for a substance? 23. Other than just getting intoxicated or being under the influence, what did you like about using (problem substance)? 24. What did you dislike about using (problem substance)? 25. Have you ever experienced any of the following after you stopped using (problem substance)? (Read each answer aloud, and place a checkmark next to every client’s “yes” response) (1) Withdrawal symptoms (4) The shakes (2) The DTs (5) Don’t remember any symptoms (3) Hallucinations 26. In your own words, what is the main reason you used substances? (Summarize client’s response on the line below) 27. Next, I will show you a list of problems. As I read each one, please answer yes or no
to experiencing any of these as a result of substance use. (Hand the client List G. Read each response, and place a checkmark next to every “yes” answer) (1) Legal problems (5) Health problems (2) Employment problems (6) Financial problems (3) Family problems (7) Psychological/mental disorders (4) Social problems (8) No problems Motivation for Treatment 28. What are the main reasons for seeking help for your problem at this particular time?
(Read the items below and check any that apply. If none apply, use response number 11,
and fill in blank) (01) Worried about my health (02) Trying to save my marriage (03) Emotional/mental disorders (04) Pressure from my family (05) Worried about my job (06) Fear of legal consequences (07) Just wanted to stop using (08) Substance not available (09) No money/costs too much (10) Religious influences (11) Other (Read the following, and record any questions or comments)
Thank you. That completes the interview. Your answers will be very helpful in the upcoming
sessions. I will provide you with a copy of your answers for your notebook. Do you have any
questions or comments at this time? Cognitive–Behavioral