PRISM SECTION 1 OVERVIEW. Number of times divorced. Number of times widowed

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1 START TIME : PRISM SECTION 1 OVERVIEW Statement A.1: I would like to begin by asking you some questions about your background > Sex 1 MALE 2 FEMALE 2. How old are you? Age AGE 3. What is your date of birth? Birthdate / / (MO/DAY/YR) ASK IF NOT KNOWN: 4. What is your race? (Are you of Hispanic origin?) Race/ethnicity 1 WHITE, NOT OF HISPANIC IGIN 2 BLACK, NOT OF HISPANIC IGIN 3 HISPANIC 4 AMERICAN INDIAN ALASKAN NATIVE 5 ASIAN 6 OTHER (SPECIFY) 5. What is your current legal marital status? Are you living with someone as if you were married? Have you ever been married? Current marital status 1 NEVER MARRIED - SKIP TO Q.8 2 MARRIED 3 DIVCED 4 SEPARATED 5 LIVING WITH SOMEONE AS IF MARRIED ( COMMON-LAW) 6 WIDOWED ASK IF NOT KNOWN: 6. Have you ever been divorced? How many times? Number of times divorced NUMBER OF TIMES DIVCED ASK IF NOT KNOWN: 7. Have you ever been widowed? How many times? Number of times widowed NUMBER OF TIMES WIDOWED 8. Have you had any children? How about adopted or foster children? Ever had children - stepchildren who have not been adopted = "1" - legally-arranged adoptions or foster care arrangements = "3" 1 NO - SKIP TO Q How many children have you had altogether (including adopted or foster children)? (How old are they?) Number of children - refer to coding guidelines for Q.8 NUMBER OF CHILDREN 10. Did you ever have primary responsibility for a child who was not your own? Did you take care of him or her for as long as a month? Primary caretaker of a child - must have primary responsibility for at least 1 month - children covered in Q.8 and Q.9 = "1" - stepchildren who have not been adopted = "3" 1 NO 1

2 11. How far did you get in school? (Did you finish (SCHOOL MENTIONED)? Did you get a diploma/degree?) Highest level of education attained - correspondence school = "1" - training program lasting one year or less = 8 1 NO FMAL SCHOOLING 2 SOME GRAMMAR SCHOOL (LESS THAN 8TH GRADE) 3 COMPLETED GRAMMAR SCHOOL 4 SOME HIGH SCHOOL 5 COMPLETED HIGH SCHOOL 6 HIGH SCHOOL EQUIVALENCY (GED) 7 SOME COLLEGE (NO DEGREE) 8 SOME TECHNICAL PROGRAM (NO CERTIFICATE) 9 COMPLETED ASSOCIATE OTHER TECHNICAL 2-YEAR DEGREE 10 COMPLETED COLLEGE (BACHEL'S DEGREE) 11 SOME GRADUATE/PROFESSIONAL STUDIES (BACHEL'S, BUT NO POST-BACHEL'S DEGREE) 12 COMPLETED GRADUATE/ PROFESSIONAL DEGREE (MASTER'S DEGREE HIGHER) 12. Did you ever start a school or training program you didn't finish? Was that because of your alcohol or drug use or because of a mental or emotional problem you were having? Educational program interrupted - probe for possible psychopathology, e.g., conflict with others or performance clearly below subject s abilities - if coded "3," probe further in applicable sections SPECIFY REASON(S) 1 NO - ALL PROGRAMS COMPLETED 2 YES - NO PSYCHOPATHOLOGY - POSSIBLE PSYCHO- PATHOLOGY _ 13. Have you ever served in the armed forces? Served on active duty in the armed services - reserves only = 1 - merchant marines = 1 1 NO - SKIP TO Q.16, PAGE 3 ASK IF NOT KNOWN: 14. Are you still serving in the armed forces? Currently on active duty in the armed forces 1 NO - SKIP TO Q.16, PAGE What were the circumstances that led to your discharge? Circumstances of discharge - if coded "3," probe further in applicable sections SPECIFY CIRCUMSTANCES 1 - NO PSYCHOPATHOLOGY 3 - POSSIBLE PSYCHOPATHOLOGY _ 2

3 16. Have you ever been in jail or prison overnight or longer? Why were you in (jail/prison/soe)? Incarceration - jail, prison, held at police station overnight or longer = "3 - if juvenile detention or reform school only, code "3" and check box SPECIFY REASON(S) 1 NO - SKIP TO Q. 18 JUVENILE DETENTION REFM SCHOOL ONLY 17. What was the longest time you spent in (jail/prison/soe)? Duration of longest incarceration DAYS YEARS (IF ME WEEKS THAN 12 MONTHS) MONTHS 18. Who do you live with? All occupants of the household SPECIFY OTHER 1 LIVES ALONE 2 SPOUSE 3 CHILD/CHILDREN 4 PARENT(S) 5 SIBLING(S) 6 BOY/GIRLFRIEND (OPPOSITE-SEX PARTNER) 7 SAME-SEX PARTNER 8 OTHER FRIEND 9 ROOMMATE(S), NON-FRIEND 10 HIRED HOUSEHOLD HELP 11 LODGER(S) 12 AUNT(S)/UNCLE(S) 13 IN-LAW(S) 14 GRANDPARENT(S) 15 OTHER BLOOD RELATIVE(S) 16 SHELTER/GROUP HOME 17 OTHER (SPECIFY) 3

4 19. Are you working? Do you work full-time, that is, 35 hours or more a week? What do you do? IF NO: Are you on disability? Are you in school now? (What are you studying? Is that full-time or part-time?) Current employment status - code status as of the date of the interview - if hospitalized, code status just prior to admission - temporarily disabled : unemployed due to temporary illness/disability - "permanently disabled": includes being supported by SSD (Social Security Disability), SSI (Supplemental Security Income), or others - illegal activities only = 5 SPECIFY CURRENT EMPLOYMENT 1 EMPLOYED FULL-TIME, 35 + HOURS 2 EMPLOYED PART-TIME, < 35 HOURS 3 EMPLOYED, BUT ABSENT DUE TO ILLNESS 4 EMPLOYED, BUT TEMPARILY SUSPENDED 5 UNEMPLOYED LAID OFF 6 UNEMPLOYED, TEMPARILY DISABLED 7 UNEMPLOYED, PERMANENTLY DISABLED 8 RETIRED 9 IN SCHOOL, FULL-TIME 10 IN SCHOOL, PART-TIME 11 FULL TIME HOMEMAKER 20. What was the longest time you worked at any one job? Longest time working at single place of employment - if never employed, code 99 years DAYS YEARS (IF ME WEEKS THAN 12 MONTHS) MONTHS CHECK ITEM IS SUBJECT CURRENTLY EMPLOYED 35 HOURS A WEEK ME? NO 1.1 (IS "1" CODED IN Q.19?) YES - SKIP TO STATEMENT A.2, PAGE What are the reason(s) you are not working (more hours) now? Reason(s) for current unemployment or part-time employment - if coded "3", probe further in applicable sections SPECIFY REASON(S) 1 - NO PSYCHOPATHOLOGY 3 - POSSIBLE PSYCHOPATHOLOGY 4

5 Statement A.2. Now I'm going to ask you some questions about treatment you might have had. 22. Did you ever have a serious medical problem or injury? Did you or anyone else think your (illness/injury) was related to alcohol or drugs, or to a mental or emotional problem? Serious medical problem or injury - HIV+ = "3" - suicide attempt requiring medical treatment = "3" SPECIFY PROBLEM(S) 1 NO - SKIP TO Q. 25a CHECK ALL THAT APPLY: ALCOHOL-RELATED DRUG-RELATED PSYCHIATRIC-RELATED 23. Were you ever in the hospital overnight or longer for a medical problem? Medical hospitalization 1 NO - SKIP TO Q. 25a 24. What was the longest time you were in the hospital for medical treatment? Duration of longest medical hospitalization DAYS WEEKS MONTHS 25a. Did you ever talk to a psychiatrist, psychologist or social worker because of a mental or emotional problem? Were you ever hospitalized for a mental or emotional problem? Did you ever see a psychiatrist, psychologist, or social worker when you weren t in the hospital? What kinds of mental or emotional problems were you having? Did you or anyone else think that was related to alcohol or drugs? (What did they say?) Treatment for psychiatric or psychological problems - code psychiatric treatment in detox, rehab, or therapeutic community in Q. 27a - counseling specifically for alcohol or drug problems, e.g., methadone counseling = "1" - guidance or vocational counseling = "1" - psychiatric treatment at shelter or residence = 2 - emergency room or day hospital treatment = 2 - alcohol- or drug-related psychiatric problem, code 2 or 3 and check box SPECIFY PROBLEM(S) 1 NO - SKIP TO Q. 26a, PAGE 6 2 YES - OUTPATIENT - INPATIENT CHECK ALL THAT APPLY: ALCOHOL-RELATED DRUG-RELATED 25b. When was the first time you got help for a mental or emotional problem? Initial psychiatric or psychological treatment - code first psychiatric or psychological treatment, regardless of patient's cooperation or participation (IF ME 5

6 25c. When was the most recent time that you talked to a psychiatrist, psychologist or social worker about a mental or emotional problem? IF PSYCHIATRIC HOSPITALIZATION: 25d. What was the longest time you were in the hospital for a mental or emotional problem? Most recent psychiatric or psychological treatment - if ongoing, code "1 DAY AGO" and check box Duration of longest psychiatric hospitalization (IF ME CURRENT TREATMENT DAYS WEEKS MONTHS 26a. Did a doctor ever give you medication for a mental or emotional problem? What medication did you take? What was that for? Psychotropic medication prescribed - if more than 5 medications, code those taken the longest SPECIFY MEDICATION(S) 1 NO - SKIP TO Q. 27a ENTER DRUG CODES: 26b. When was the first time you took medication for a mental or emotional problem? Initial treatment with psychotropic medication (IF ME 26c. When was the most recent time? Most recent treatment with psychotropic medication - if current, code "1 DAY AGO" and check box (IF ME CURRENT PSYCHOTROPIC 27a. Have you ever had alcohol or drug treatment or counseling? Were you ever in a detox, rehab, or therapeutic community? Did you see an alcohol or drug counselor when you were not in a detox, rehab, or therapeutic community? What substances did you have treatment for? Did you or anyone else think that your problems with (alcohol/drug) were related to a mental or emotional problem? Alcohol or drug treatment or counseling - 12-step group only = "1" - guidance or vocational counseling = "1" - outpatient treatment at alcohol or drug clinic = 2 - emergency room or day hospital treatment = 2 - detox, rehab, or therapeutic community = 3 - alcohol or drug treatment, code 2 or 3 and check box - code explicit dual diagnosis treatment coded in Q. 25a SPECIFY PROBLEM(S) 6 1 NO - SKIP TO Q. 28a, PAGE 7 2 YES - OUTPATIENT - INPATIENT CHECK ALL THAT APPLY: ALCOHOL DRUGS POSSIBLE PSYCHOPATHOLOGY

7 27b. When was the first time you got help for an alcohol or drug problem? Initial alcohol or drug treatment (IF ME 27c. When was the most recent time? Most recent alcohol or drug treatment - if ongoing, code "1 DAY AGO" and check box (IF ME CURRENT SUBSTANCE TREATMENT IF EVER IN INPATIENT ALCOHOL/ DRUG TREATMENT: 27d. What was the longest time you were in detox, rehab, or a t.c. for alcohol or drug problems? Duration of longest inpatient alcohol or drug treatment DAYS WEEKS MONTHS 28a. Did a doctor ever give you medication like Antabuse, naltrexone, Trexan, Narcan, or methadone to help you stop drinking or using drugs? What medication did you take? Medication to promote abstinence SPECIFY DRUG(S) 1 NO - SKIP TO Q. 29a, PAGE 8 ENTER DRUG CODES: 28b. When was the first time you took medication to help you stop drinking or using drugs? Initial treatment with medication to promote abstinence (IF ME 28c. When was the most recent time? Most recent treatment with medication to promote abstinence - if current, code "1 DAY AGO" and check box (IF ME CURRENT ABSTINENCE MEDICATION 7

8 29a. Did you ever attend meetings of any 12-step groups because of your own drinking or drug use, for instance Alcoholics Anonymous, Narcotics Anonymous, or Cocaine Anonymous? Did you go for your alcohol use, your drug use, or both? Attendance of 12-step group(s) - went only for reason other than own alcohol or drug use = 1 - meetings attended in inpatient settings = "2", "3", or "4" SPECIFY GROUP TYPE(S) 1 NO - SKIP TO CHECK ITEM YES - ATTENDED F ALCOHOL USE ONLY - ATTENDED F DRUG USE ONLY 4 YES - ATTENDED F BOTH ALCOHOL AND DRUG USE 29b. When was the first time you attended a meeting of a 12-step group? Initial attendance of 12-step group (IF ME 29c. When was the most recent time? Most recent attendance of 12-step group - if ongoing attendance, code "1 DAY AGO" and check box (IF ME CURRENT ATTENDANCE CHECK ITEM DID SUBJECT EVER RECEIVE TREATMENT F A SUBSTANCE NO 1.2 PSYCHIATRIC PROBLEM? (ARE ANY Q.'S 25-29, PAGES 5-8 CODED 2 HIGHER?) YES SKIP TO SECTION 2, STATEMENT B.1, PAGE Did you or anyone else ever think you should go for any kind of help for mental or emotional problems or for alcohol or drug problems? Who thought you should go? Why? Subject or someone else thought treatment was needed SPECIFY PERSON 1 NO 2 YES - ALCOHOL - DRUGS 4 YES - PSYCHIATRIC END TIME : 8

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