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guide pratique des outils de repérage

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1. a a a T M y a M a un y a T e z M 3 a fe g ol Q A gt 9 z un 9 DEN ON OT NN OOCOOCOCOO0000 Know cannabis test 8 When you smoke cannabis what people do you usually smoke with 1 Always with friends O 2 Usually with friends but sometimes alone O 3 Usually alone and sometimes with friends O 4 Always alone O 9 Could you stop smoking cannabis whenever you want 1 No couldn t O 2 Maybe but it would take me a lot of effort O 3 Probably but not without some effort O 4 Sure would have no trouble at all O 10 How often have you thought to yourself in the past year should cut down or stop O 1 Never 2 Afewtimes O 3 Once a month O 4 Once a week O 5 Almost every day O 11 In the past year how often has your use of cannabis affected your performance in your work or studies 1 Never O 2 Afewtimes O 3 Once a month O 4 Once a week O 5 Almost every day O 12 Do you sometimes put things off because you are stoned 1 No never 2 Yes sometimes O 3 Yes regularly O 4 Yes almost always O 13 Have you ever felt extremely frustrated because you couldn t smoke cannabis when you wanted to 1 No never O 2 Yes sometimes O 3 Yes regularly O 4 Yes almost always O 14 How often in the past year have you felt worried about your use of cannabis 1 Never O 2 Afewtimes during the year O 3
2. as a c d v v 5 W a a v D N S v v D i O a v v E 5 5 x 5 g v c T a N v v ice 5 k a v kz O Auteur s E mail Date de publication Type Objectifs Population cible P riode de temps sur laquelle porte l outil Cotations scores Dur e de passation Langues Bibliographie par ordre chronologique Site Internet DAST 10 Drug Abuse Screening Test in 10 Questions l Harvey A Skinner Addiction Research Foundation Department of Health Science Toronto Canada harvey skinner yorku ca 1982 Questionnaire d entretien structur en 10 items version courte du DAST lui m me inspir du Michigan Alcoholism Screening Test MAST Permettre un rep rage rapide des troubles li s l usage de drogues illicites d terminant le type de suivi indiqu Adultes et adolescents 12 derniers mois 0 Aucun risque gt Monitoring ducation la sant 1 2 Risque faible Conseil brief counselling 3 5 Risque possible Suivi ambulatoire outpatient selon les crit res du DSM orientation sp cialis e le cas ch ant 6 8 Risque substantiel Orientation sp cialis e et suivi intensif 9 10 Risque s v re Orientation sp cialis e et suivi intensif Vy Vy 2 minutes Anglais Skinner HA 1982 The Drug Abuse Screening Test Addictive Beha viors 7 4
3. e guide vise a offrir une aide pratique aux professionnels de sant de premi re ligne confront s aux adolescents pour rep rer un ventuel usage probl matique de cannabis Lutilit du rep rage de l usage probl matique de cannabis par les m decins de premi re ligne est largement reconnue Celui ci peut se faire lors d un entretien clinique focalis sur la fr quence et la quantit d usage la perte de contr le et les cons quences m dico psychosociales ou l aide d outils sp cifiques de rep rage facilement utilisables en m decine de premier recours IS Ce guide d crit les principaux questionnaires qui permettent un rep rage rapide et non stigmatisant de l usage probl matique de cannabis Il se limite pr senter les outils brefs et ou simples d utilisation sp cifiquement destin s au rep rage d un usage probl matique de cannabis sans voquer les questionnaires permettant de fournir une valua tion de la situation du patient ni les outils de diagnostic strictement parler Il s agit de dresser un inventaire des instruments de d tection de risques potentiellement associ s l usage de cannabis chez les adolescents de cannabi ique t ema Le recours a ces outils de rep rage ne saurait se substituer a un jugement clinique Ils sont un outil compl mentaire de l entretien clinique guidant le questionnement m dical La vocation de ces questionnaires est de fournir une indication pr lim
4. T 9 2 c a M un T S T 9 a a Q T M 9 a M a un 9 a T e z M 3 a fe g ol Q A 5 9 z un DETC Diminuer Entourage Trop Cannabis DETC est l acronyme fran ais propos pour Diminuer Entourage Trop Cannabis Il s agit d un quivalent du questionnaire CAGE cannabis Cut Annoyed Guilty Eye opener originellement labor et valid aux Etats Unis Voir CAGE cannabis p 12 13 a I v o T v 5 Lod 2 a a v lzy CU 3 v T v a i J a v v T oe 5 x 5 g v a n v T v 5 ka 5 k a v T DETC DIMINUER ENTOURAGE TROP CANNABIS Oui 1 Avez vous ressenti le besoin de Diminuer votre consommation de cannabis 2 Votre Entourage vous a t il d j fait des remarques au sujet de votre consommation 3 Avez vous d j eu l impression que vous fumiez Trop de cannabis 4 Avez vous d j eu besoin de fumer du Cannabis d s le matin pour vous sentir en forme Non 2 r ponses positives voquent une consommation nocive de cannabis DETC Diminuer Entourage Trop Cannabis a Q M T gw 2 c M a M a T gt 2 T gw x a a Q oO Lu T M g a M a o un g a oO T e z M 3 a fe g o Q M A w
5. 13 How do you feel about your use of alcohol or drugs 0 1 3 4 5 6 Circle allthat apply 14 How do others see you in relation to your alcohol or drug use 0 2 3 4 5 Guide pratique des pr Developed by D Paul Moberg Center for Health Policy and Program Evaluation University of Wisconsin Medical School Adap ted with permission from Mayer and Filstead s Adolescent Alcohol Involvement Scale Journal of Studies on Alcohol 40 291 300 1979 and Moberg and Hahn s Adolescent Drug Involvement Scale Journal of Chemical Dependency 2 75 88 1991 Guide pratique des principaux outils de rep rage de l usage pobl matique de cannabis 2 a I z v v T v 5 I 2 a v lzy CU 3 v T v a i J a v v T oe 5 x 5 g v a n v T v 5 ka 5 k a v T ADOSPA ADOlescents et Substances PsychoActives ADOSPA est l acronyme fran ais propos pour ADOlescents et Substances Psycho Actives mais gale ment pour Auto moto conduite d un v hicule sous influence ou par quelqu un sous influence d alcool ou d autres drogues D tente usage auto th rapeutique Oubli troubles mn siques sous produits Seul consommation solitaire Probl mes Amis famille reproches faits par les amis ou la famille Il s agit d un quivalent du questionnaire CRAFFT Relax alone forget fa
6. 6 Do you abuse drugs on a continuous basis 1 0 y 7 Do you try to limit your drug use to certain situations o 1 2 8 Have you had blackouts or flashbacks as a result of drug use 1 0 a 9 Do you ever feel bad about your drug abuse 1 0 10 Does your spouse or parents ever complain about your involvement with drugs 1 0 T 11 Do your friends or relatives know or suspect you abuse drugs 1 0 5 12 Has drug abuse ever created problems between you and your spouse 1 0 5 y 13 Has any family member ever sought help for problems related to your drug use 1 0 14 Have you ever lost friends because of your use of drugs 1 0 P 15 Have you ever neglected your family or missed work because of your use of drugs 1 0 16 Have you ever been in trouble at work because of drug abuse 1 0 2 17 Have you ever lost a job because of drug abuse 1 0 18 Have you gotten into fights when under the influence of drugs 1 0 19 Have you ever been arrested because of unusual behavior while under the influence of drugs 1 0 S 20 Have you ever been arrested for driving while under the influence of drugs 1 0 21 Have you engaged in illegal activities in order to obtain drug 1 0 e 22 Have you ever been arrested for possession of illegal drugs 1 0 23 Have you ever experienced withdrawal symptoms as a result of heavy drug intake 1 0 2 24 Have you had medical problems as a result of your drug use e g memory loss 1 0
7. v a N v v o 5 k a v kz 5 CPQ A et CPQ A S Cannabis Problems Questionnaire for Adolescents CPQ A 58 ITEMS m Below you will find a list of questions that relate to difficulties that other people who use cannabis sometimes complain of m Read each question carefully and answer either YES or NO by putting a tick in the appropriate box if you have experienced any of these difficulties m Some questions specifically ask about problems associated with using cannabis while others ask about general problems that may have occurred Please answer all the questions that apply to you All the questions apply to your experiences in the last 3 months Core 1ITEMS In the last 3 months Yes No Have you tended to smoke more on your own than you used to Have you worried about meeting people you don t know when you are stoned Have you spent more time with smoking friends than other kinds of friends Have your friends criticised you for smoking too much Have you had any debts as a result of needing to buy cannabis Have you pawned any of your belongings to buy cannabis Have you found yourself making excuses about money 8 Have you found yourself worried about the amount of money you have been spending on cannabis 9 Have you been caught out lying about money 10 Have you been in trouble with the police due to your smoking 11 Have you been in juvenile detention or pri
8. Seresta Dormicum Rohypno 0 3 Stilnox etc h Hallucinog nes LSD champignons PCP etc 0 i Opiac s h ro ne morphine m thadone cod ine bupr norphine etc j Autres sp cifiez 0 Si toutes les r ponses sont n gatives demandez m me lorsque vous tiez l cole Si non tous les items arr tez l entretien Si oui l un ou plusieurs de ces items posez la Question 2 concernant ces substances O Q o T 9 t 2 a M un T S T 9 Et a Q o x T M w la o 2 E A g Q T e z N 3 M 2 Q o fe o gt EU w a ASSIST Alcohol Smoking and Substance Involvement Screening Test Question 2 Au cours des 3 derniers mois combien de fois avez vous T E a consomm les substances que vous avez mentionn es 5 3 PREMIERE SUBSTANCE DEUXIEME SUBSTANCE etc g a E es alase g 3 2l all ZE LE RS E Siaa a Tabac cigarette cigare pipe narguil tabac chiquer etc 0 2 3 4 6 b Boissons alcooliques bi re alcopop vin spiritueux etc 0 2 5 4 6 c Cannabis marijuana joint herbe hash etc 0 2 5 4 6 n 5 d Cocaine coke crack etc 0 2 3 4 6 e Stimulants de type amph tamine speed pilules tha pilules 0 2 3 2 6 6S coupe faim ecstasy etc amp f Solvants colle essence diluant etc 0 2 3 4 6 vu g Calmants ou somnif res Val
9. 23 Do you believe that alcohol pot or other drug not one pres cribed for you by a doctor has some really important value to you in helping you with a building up your confidence around friends b in handling angry feelings c in helping you forget about your problems or d in helping you to overcome depression 24 Have you or your friends noted that you have stared to do more and more drugs or alcohol more and more frequently or that you have started to do stronger drugs to have fun and get as high as you like yourself to be 25 Has anyone friend parent teacher or counselor ever told you that they believe that you may have a drinking or drug problem 26 Do you usually feel blue or really sad on the inside as if hardly anything can really cheer you up 27 Have you ever had a suicide attempt even if you never told anyone about it Yes No Uncertain Guide pratique des principaux outils de rep rage de l usage pobl matique de cannabis a a c d v v 5 g W a a v D N S v v D 6 i oO a v v E 5 5 x 5 g J a N v v 5 k a v kz O Auteur s E mail Date de publication Type Objectifs Population cible P riode de temps sur laquelle porte l outil Cotations scores Dur e de passation Langues Bibliographie par ordre chronologique Sites Internet
10. DAST A Drug Abuse Screening Test Adolescents bed Dr Harvey A Skinner Centre for Addiction and Mental Health Faculty of Health York University Toronto Canada harvey skinner yorku ca 1982 Questionnaire d entretien structur adapt du MAST Michigan Alcoholism Screening Test 2 formats 20 items DAST 20 ou 10 items DAST 10 Il en existe galement une version sp cifique pour les adolescents voir DAST A Rep rer l abus ou la d pendance de drogues illicites Adultes l ves femmes enceintes 12 derniers mois Score total de 0 28 partir de 6 seuil d usage probl matique Environ 8 minutes Anglais Skinner HA 1982 The Drug Abuse Screening Test Addictive Behaviors 7 4 363 371 Gavin DR Ross HE Skinner HA 1989 Diagnostic validity of the Drug Abuse Screening Test in the assessment of DSM III drug disorders British Journal of Addiction 84 3 301 307 Saltstone R Halliwell S Hayslip MA 1994 A multivariate evaluation of the Michigan Alcoholism Screening Test and the Drug Abuse Screening Test ina female offender population Addictive Behaviors 19 5 455 462 Martino S Grilo CM Fehon DC 2000 Development of the Drug Abuse Screening Test for adolescents DAST A Addictive Behaviors 25 1 57 70 Maisto SA Carey MP Carey KB Gordon CM Gleason JR 2000 Use of the AUDIT and the DAST 10 to identify alcohol and drug use disorders among adults with a severe and per
11. F N g a o T e z M 3 r S a o le g g u 24 have woken up in an unexpected place after using marijuana 25 have found that needed larger amounts of marijuana to feel any effect or that could no longer get high on the same amount that used to get me high Is de cannabi ique t ema 2 a v O un 5 v T rage Is de rep t incipaux ou Guide pratique des pr 26 27 28 29 30 31 32 93 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 MACQ Marijuana Consequences Questionnaire Yes No As a result of marijuana use neglected to protect myself or partner from an STD or unwanted pregnancy have neglected obligations to family work or school because of my marijuana use often have ended up using marijuana on nights when had planned not to use marijuana When using marijuana have done impulsive things that regretted later often have found it difficult to limit how much marijuana use My marijuana use has gotten me into sexual situations have later regretted have not been able to remember large stretches of time while using marijuana While using marijuana have said harsh or cruel things to someone Because of my marijuana use have not slept properly My physical appearance has been harmed by my marijuana use have said things while us
12. VA OBSERVATOIRE FRAN AIS DES DROGUES ET DES TOXICOMANIES ST z oF www ofdt fr f d ration addiction OFDT F d ration Addiction 2013 Y Guide pratique des principaux outils de rep rage de l usage probl matique de cannabis chez les adolescents E Synth se r alis e par Ivana Obradovic I Sommaire OUTILS DE REP RAGE DE L USAGE PROBL MATIQUE SP CIFIQUES AU CANNABIS ALAC Alcohol Advisory Council 8 9 B MACQ Brief Marijuana Consequences Questionnaire 10 11 CAGE cannabis Cut Annoyed Guilty Eye opener 12 13 CAST Cannabis Abuse Screening Test 14 15 CPQ A et CPQ AS Cannabis Problems Questionnaire for Adolescents 16 20 CUDIT Cannabis Use Disorders Identification Test 22 23 CUDIT R Cannabis Use Disorders Identification Test Revised 24 25 CUPIT Cannabis Use Problems Identification Test 26 29 DETC Diminuer Entourage Trop Cannabis version francaise du CAGE 30 31 Know Cannabis Test 32 34 MACQ Marijuana Consequences Questionnaire 36 38 MSI X Marijuana Screening Inventory 40 42 PUM Problematic Use of Marijuana 44 45 SDS Severity of Dependence Scale ou Echelle de S v rit de la D pendance 46 47 a a i d v T v m 2 a v N 3 v T v a k J a v k v T oe 5 3 x m v E a N v T v 5 5 k a v T OUTILS DE REPERAGE DE L USAGE PROBLEMATIQUE D ALCOOL ET DE DROGUES ILLICIT
13. have felt anxious irritable lost my appetite or had stomach pains after stopping or cutting down on marijuana use 19 often have thought about needing to cut down or to stop using marijuana 20 have had less energy or felt tired because of my marijuana use 21 have lost motivation to do things because of my marijuana use O Q T 9 2 c o a M a T 2 T 9 x a a Q T M 9 a M a un 9 a T e z M 3 a fe g Q M A 9 3 9 z un CAGE cannabis Cut Annoyed Guilty Eye opener traduction francaise DETC Auteur s Lorraine T Midanik Universit de Berkeley Californie Etats Unis E mail swdean berkeley edu Date de publication 1998 Type Questionnaire d entretien structur en 4 items parmi les plus tudi s et les plus utilis s Objectifs Rep rer l abus et la d pendance de cannabis Population cible Adultes et adolescents P riode de temps sur Vie enti re laquelle porte l outil Cotations scores 2 r ponses positives voquent une consommation nocive de cannabis Dur e de passation 1 minute Langues Anglais flamand h breu japonais polonais portugais espagnol fran ais voir DETC Bibliographie Midanik LT Zahnd EG Klein D 1998 Alcohol and drug CAGE par ordre screeners for pregnant low income women the California Peri chronologique natal Needs Assessment Alcoholism Clinical an
14. 0 4 O Q o T 9 t 2 a M un T S T 9 Et a Q x T M g a o Q o E N 9 a o T z M 3 9 iy 2 Q o fe 9 3 Ss 9 T u a g v v T v S 2 a v lzy CU v T v a i J a v k v T oe 5 x 5 g v a n v T v 5 La 5 k a v T CUDIT R Cannabis Use Disorders Identification Test Revised Auteur s E mail Date de publication Type Objectifs Population cible P riode de temps sur laquelle porte l outil Cotations scores Dur e de passation Langues Bibliographie par ordre chronologique Sites Internet WY Simon Adamson National Addiction Centre ex NCTD Department of Psychological Medicine Christchurch School of Medicine amp Health Sciences University of Otago Nouvelle Z lande simon adamson otago ac nz 2010 Questionnaire d entretien structur version courte du CUDIT r duite 8 items dont 4 issus du CUDIT et 4 nouveaux items Permettre un rep rage bref des probl mes li s l usage de cannabis plus rapide que le CUDIT Adultes et adolescents 6 derniers mois Score total de 0 32 Score gt 13 usage probl matique de cannabis Moins de 5 minutes Anglais Adamson SJ Kay Lambkin FJ et al 2010 An improved brief measure of cannabis misuse the Cannabis Use Disord
15. 29 3 619 646 Alexander D 2003 Clinical pilot experiences using the Marijuana Screening Inventory MSI X Screening guidelines and case illustrations Journal of Social Work Practice in the Addictions 3 29 51 Alexander DE Leung P 2004 The Marijuana Screening Inventory MSI X Reliability factor structure and scoring criteria with a clinical sample Ameri can Journal of Drug and Alcohol Abuse 30 2 321 351 Alexander D Leung P 2006 The Marijuana Screening Inventory MSI X Concurrent convergent and discriminant validity with multiple measures American Journal of Drug and Alcohol Abuse 32 3 351 378 nd MSI X revised Marijuana Sreening Inventory MSI X REVISED MARIJUANA SCREENING INVENTORY YES Except NO Scoring 1 Have you had difficulty remembering something while using marijuana to the point it bothered you or a close friend 2 Have you ever had difficulty with either stopping or controlling your use of marijuana 3 Has using marijuana ever created problems between you and a close person spouse or a relative If so which close person 4 Has using marijuana ever interfered with any part of your work or occupation 5 Do you ever feel bad about your marijuana use 6 Have you ever been arrested even for a few hours while you were using marijuana Not for possession or dealing 7 Have you ever been arrested for drunk driving or the like wher
16. 7 What time of day do you use alcohol or drugs CIRCLE ALL THAT APPLY TO YOU a at night d in the morning or when first awake b afternoons after school e often get up during my sleep c before or during school or work to use alcohol or drugs 8 Why did you take your first drink or first use drugs CIRCLE ALL THAT APPLY a curiosity d to get away from my problems b parents or relatives offered e to get high or drunk c friends encouraged me to have fun 9 When you drink alcohol how much do you usually drink a 1 drink d 5 9 drinks b 2 drinks e 10 or more drinks c 3 4 drinks AADIS Adolescent Alcohol and Drug Involvement Scale 10 Whom do you drink or use drugs with CIRCLE ALL THAT ARE TRUE OF YOU a parents or adult relatives d with older friends b with brothers or sisters e alone c with friends or relatives own age 11 What effects have you had from drinking or drugs CIRCLE ALL THAT APPLY TO YOU a loose easy feeling d became ill b got moderately high e passed out or overdosed c got drunk or wasted f used a lot and next day didn t remember what happened 12 What effects has using alcohol or drugs had on your life CIRCLE ALL THAT APPLY a none f has gotten me into trouble at home b has interfered with talking to someone g was in a fight or destroyed property c has prevented me from having a good time h has resulted in an accident an injury d has interfered with m
17. Auteur s E mail Date de publication Type Objectifs Population cible P riode de temps sur laquelle porte l outil Cotations scores Dur e de passation Langues Bibliographie par ordre chronologique Site Internet DAP Drug and Alcohol Problem Quick Screen Richard H Schwartz P diatre Vienna Virginie Etats Unis smhp ucla edu 1990 Questionnaire d entretien structur en 27 questions regroupant 30 items Permettre un rep rage de l usage probl matique d alcool ou de drogues illicites en particulier dans les structures p diatriques Adolescents adapt un niveau de lecture quivalant la 6 re Vie enti re et ann e scolaire courante Seuil d usage probl matique 6 r ponses positives 10 minutes Anglais Schwartz RH Wirtz PW 1990 Potential substance abuse Detection among adolescent patients Using the Drug and Alcohol Problem DAP Quick Screen a 30 item questionnaire Clinical Pediatrics 29 1 38 43 http adai washington edu instruments pdf Drug_and_Alcohol_Prob lem_Quick_Screen_106 pdf DAP Drug and Alcohol Problem Quick Screen DAP Quick SCREEN Instructions for questionnaire Please answer yes no or uncertain if that is the case If you want your answers to he strictly confidential place a check mark here Yes No Uncertain 1 Has your mom or your dad lost a lot of trust in you recently Do they always seem to check up on you 2
18. Cocaine coke crack etc 0 5 4 6 Prescription stimulants Ritalin Concerta Dexedrine 0 2 5 4 6 Adderall diet pills etc Methamphetamine speed crystal meth ice etc 0 2 5 4 6 Inhalants nitrous oxide glue gas paint thinner etc 0 2 5 4 6 Sedatives or sleeping pills Valium Serepax Ativan Librium 0 2 5 4 6 Xanax Rohypnol GHB etc Hallucinogens LSD acid mushrooms PCP Special K 0 2 5 4 6 ecstasy etc Street opioids heroin opium etc 0 2 5 4 6 Prescription opioids fentanyl oxycodone OxyContin 0 2 5 4 6 Percocet hydrocodone Vicodin methadone buprenorphine etc Other Specify 0 2 5 4 6 m For patients who report Never having used any drug in the past 3 months Go to Questions 6 8 m For any recent illicit or nonmedical prescription drug use go to Question 3 3 In the past 3 months how often have you had 5 p a strong desire or urge to use first drug second drug etc 2 gt O Fa pe Fe 22 ZIE AE a Cannabis marijuana pot grass hash etc 0 2 3 4 6 b Cocaine coke crack etc 0 2 5 4 c Prescribed Amphetamine type stimulants Ritalin Concerta 0 2 3 4 6 Dexedrine Adderall diet pills etc d Methamphetamine speed crystal meth ice etc 0 2 3 4 6 e Inhalants nitrous oxide glue gas paint thinner etc O 2 5 4 6 f Sedatives or sleeping pills Valium Serepax Ativan Librium 0 2 5 4 6 Xanax Rohypnol GHB etc g Hallucinogens LSD
19. Oui Oui dit pr occup par votre consommation de PREMIERE jamais au cours mais pas SUBSTANCE DEUXIEME SUBSTANCE etc des 3 derniers au cours mois des 3 derniers mois a Tabac cigarette cigare pipe narguil tabac 0 6 3 chiquer etc b Boissons alcooliques bi re alcopop vin spiritueux etc 0 6 5 c Cannabis marijuana joint herbe hash etc 0 6 5 d Coca ne coke crack etc 0 6 3 e Stimulants de type amph tamine speed pilules tha 0 6 3 pilules coupe faim ecstasy etc f Solvants colle essence diluant etc 0 6 5 g Calmants ou somnif res Valium Seresta 3 Dormicum Rohypnol Stilnox etc h Hallucinog nes LSD champignons PCP etc 0 6 5 i Opiac s h ro ne morphine m thadone cod ine bupr norphine etc 0 6 3 j Autres sp cifiez 0 6 3 Question 7 Avez vous d j essay sans succ s de contr ler de dimi Non Oui Oui nuer ou d arr ter votre consommation de PREMIERE Jamais ac ours mals pas SUBSTANCE DEUXIEME SUBSTANCE etc des 3 derniers EU gouts mois des 3 derniers mois a Tabac cigarette cigare pipe narguil tabac chiquer 0 G 3 etc b Boissons alcooliques bi re alcopop vin spiritueux etc 0 6 3 c Cannabis marijuana joint herbe hash etc 0 6 5 d Coca ne coke crack etc 0 6 3 e Stimulants de type amph tamine speed 0 G 3 pilules tha pilules coupe faim ecstasy etc f Solva
20. Personal experience screening questionnaire Addictive Behaviors 17 5 479 490 Winters KC Remafedi G Chan BY 1996 Assessing drug abuse among gay bisexual young men Psychology of Addictive Behaviors 10 4 228 236 George MS Skinner HA 1991 Assessment In Drug use by adolescents Identification assessment and intervention Annis HM Davis CS eds Alcoholism and Drug Addiction Foundation Toronto 85 108 http portal wpspublish com portal page _pageid 53 69732 amp _dad portal amp _schema PORTAL PESQ Personal Experience Screening Questionnaire PESQ PERSONAL EXPERIENCE SCREENING QUESTIONNAIRE Copyright outil payant PERSONAL EXPERIENCE SCREENING Name or ID number QUESTIONNAIRE PESQ Deck Sat a SAMPLE ITEMS DIRECTIONS Ken C Winters Ph D This booklet asks about you and your experiences including those with alcohol and other drugs Some questions ask how often certain things have Published by happened Others ask if you agree with a statement Please read cach question WESTERN PSYCHOLOGICAL SERVICES carefully Circle the for the answer that is right for you Circle only one 12031 Wilshire Boulevard response option for each question Please answer every question wps Los Angeles CA 90025 1251 Publishers and Distributors Never Once or Twice PARTI Sometimes Often W often have you used alcohol or other drugs 1 At home sedan et maiis How often have
21. Validity of brief alco hol screening tests among adolescents A comparison of the AUDIT POSIT CAGE and CRAFFT Alcoholism Clinical and Experimental Research 27 1 67 73 Karila L Legleye S et al 2004 Consommations nocives de produits psu choactifs l adolescence R sultats pr liminaires de l tude Adotecno Alcoologie et Addictologie 26 2 99 109 Bernard M Bolognini M et al 2005 French validity of two substance use screening tests among adolescents A comparison of the CRAFFT and DEP ADO Journal of Substance Use 10 6 385 395 Karila L Legleye S et al 2007 Validation d un questionnaire de rep rage de l usage nocif d alcool et de cannabis dans la population g n rale le CRAFFT ADOSPA La Presse M dicale 36 4 582 590 2 a r z v v T v 5 Ld g 2 2 a v n 3 v T v lzy i J a v v T ee 5 x 5 g v a n v T v 5 La 5 k a v T Site Internet http www ceasar boston org clinicians crafft php CRAFFT Car Relax Alone Forget Family or Friend Trouble CRAFFT VERSION FRANCAISE Commencez ainsi Je vais vous poser quelques questions que je pose a tous mes patients Veuillez tre honn te Vos r ponses resteront confidentielles Partie A Au cours des 12 derniers mois avez vous Non Oui 1 Bu de l alcool plus que quelques gorg es 2 Fum de la marijuana ou du hasch
22. e z M 3 fe Q M A 3 9 z un ADIS Adolescent Drug Involvement Scale SCORING TEMPLATE Copy this to a transparency and add the total points from the highest number for each item DO NOT GIVE THIS PAGE TO RESPONDENT 1 How often do you use alcohol or other drugs such 0 2 3 4 5 6 7 as weed or rock 2 When did you last use alcohol or 0 2 3 4 5 6 7 drugs 3 I usually start to drink or use drugs because Circle all 1 2 3 4 5 that apply 4 What do you drink when you 1 2 3 4 5 12 What effects has using alcohol or drugs had on your life 0 Circle allthat apply na drink alcohol 8 c 5 How do you get c your alcohol or B drugs Circle all 1 2 5 4 5 v that you do T v 6 When did you gt first use drugs or Ss take your first 0 2 3 4 5 6 drink 7 What time of the day do you use 4 5 alcohol or drugs a Circle all that 1 2 3 apply to you Oo a 8 Mie a you take your first os drink or first use 1 2 3 4 5 v drugs Circle all that apply v A 9 When you drink alcohol how much 1 2 3 4 5 a do you usually drink v pe v 10 Whom do you drink 1 no or use drugs with wv Circle all that are true 2 3 4 5 of you1 gt 11 What effects have 6 x you had from drinking gt or drugs Circle all 1 2 5 4 5 A that apply to you E
23. facteur A Identifier un abus de substances pouvant justifier une valuation appro fondie Adolescents 12 19 ans en milieu scolaire Vie enti re et 30 derniers mois Score de 0 17 lt i risque faible d usage nocif Entre l et 6 risque mod r 7 risque lev Environ 8 minutes Anglais fran ais espagnol Rahdert E 1991 The adolescent assessment referral system manual DHHS Publication No ADM 91 1735 National Institute on Drug Abuse Rockville MD Latimer WW Winters KC Stinchfield RD 1997 Screening for drug abuse among adolescents in clinical and correctional settings using the Problem Oriented Screening Instrument for Teenagers American Journal of Drug and Alcohol Abuse 23 1 79 98 Knight JR Goodman E Pulerwitz T DuRant RH 2001 Reliability of the problem oriented screening instrument for teenagers POSIT in adolescent medical practice Journal of Adolescent Health 29 2 125 130 Danseco ER Marques PR 2002 Development and validation of a POSIT Short Form Screening for problem behaviors among adolescents at risk for substance use Journal of Child and Adolescent Substance Abuse 11 3 17 36 Latimer WW O Brien MS et al 2004 Screening for Substance abuse among school based youth in Mexico using the Problem Oriented Screening In strument POSIT for Teenagers Substance Use and Misuse 39 2 307 329 http adai washington edu instruments pdf Problem_Oriented_
24. g Q T e z N 3 M 2 Q o fe 9 gt 9 w a ASMA Assessment of Substance Misuse in Adolescence e INS Auteur s Paul Willner Centre for Substance Abuse Research Department of Psychology University of Wales Swansea Swansea Royaume Uni E mail p willner swansea ac uk Date de publication 2000 Type Questionnaire d entretien structur 8 items inspir du SMAQ Objectifs Rep rer l usage probl matique de substances Population cible Adolescents P riode de temps sur Vie enti re laquelle porte l outil Cotations scores Score total de O 12 partir de 8 usage potentiellement probl matique partir de 12 usage probl matique de substances Dur e de passation 5 minutes Langues Anglais Bibliographie Willner P 2000 Further validation and development of a screening par ordre instrument for the assessment of substance misuse in adolescents chronologique Addiction 95 11 1691 1698 Abou Saleh MT Bugelli T Dominoni A Fitzpatrick G 2008 The prevalence of substance misuse and emotional and behavioral problems in adolescents admitted to pediatric wards and those attending the antenatal clinic Addictive Disorders and their Treatment 7 1 25 30 Site Internet nd a a c d v v 5 ef W a a v D N S v v D i Oo a v v E 5 5 x 5 g J i T a N v v
25. gt 3 gw z un a g z v v T v 5 I Lod I 2 2 a v lzy n 3 v T v a k J a v k v T oe 5 x 5 g v a n v T v 5 LA 5 Lu a v T Auteur s E mail Date de publication Type Objectifs Population cible P riode de temps sur laquelle porte l outil Cotations scores Dur e de passation Langues Bibliographie par ordre chronologique Site Internet Know cannabis test Roel Kerssemakers Clinique Jellinek Amsterdam Pays Bas roel kerssemakers jellinek nl 2000 Questionnaire d entretien structur en 16 items d velopp dans la clinique Jellinek a Amsterdam Pays Bas valuer l impact de la consommation de cannabis sur la vie quotidienne Jeunes Vie enti re Score total de O 36 025 Pas de risque sp cifique 6 15 Risque av r 16 36 Risque s rieux Environ 20 minutes N erlandais flamand norv gien anglais nd http www knowcannabis org uk http www jellinek nl doedetest application mobile Know cannabis test KNOW CANNABIS TEST The test will help you assess your cannabis and its impact on your life The test has 16 questions Once you ve answered the questions you ll receive the test results immediately Depending on your score we ll make recommendations about your cannabis use 1 How often do you smoke cannabis 1 A few times a year O 2 Once or twi
26. votre famille 18 O ON O Rey O O 19 Avez vous manqu des jours de travail ou d cole cause de votre consommation de drogues 19 O foe O KES O O 20 Avez vous consomm de la drogue dans des situations o cela augmente le risque de se blesser comme par exemple op rer 20 O 1O OO O O de la machinerie utiliser une arme feu ou des couteaux traverser dans le trafic intense faire de l escalade ou se baigner 21 Avez vous conduit un v hicule moteur automobile bateau motocuclette VTT sea doo alors que vous aviez consomm 21 0 ES O EDF O O de la drogue 22 Avez vous t arr t pour avoir conduit un v hicule avec facult s affaiblies suite votre consommation de drogues 22 O 23 Avez vous eu des probl mes judiciaires autres qu arrestation pour conduite avec facult s affaiblies reli es votre 23 O consommation de drogues Si oui sp cifiez ___ 24 Est ce que votre consommation de drogues a diminu votre 24 capacit prendre soin de vos enfants Le D BA dans ses versions Alcool et Drogues est accompagn d un manuel d utilisation o le rationnel scientifique est largement d crit en plus des proc dures d administration et d interpr tation Vous pouvez vous le procurer en le t l chargeant sur le site Web du RISQ au www risqtoxico ca Pour informations contacter Nadine Blanchette Martin au 418 663 5008 poste 4932 ou au 1 866 303 5678 ou l adr
27. 10 Have you been physically sick after smoking 11 Have you passed out after a smoking session 12 Have you had pains in your chest or lungs after a smoking session 13 Have you felt paranoid after a smoking session 14 Have you lost any weight without trying to 15 Have you been neglecting yourself physically 16 Have you failed to wash for several days at a time 17 Have you felt depressed for more than a week 18 Have you felt so depressed that you felt like doing away with yourself 19 Have you given up any recreational activities you once enjoyed for smoking 20 Do you find it hard to get the same enjoyment from your usual interests 2 22 Have you driven while stoned Has your general health been poorer than usual 23 Have you felt more antisocial after smoking 24 Have you worried about getting out of touch with friends or family 25 Have you been concerned about a lack of motivation 26 Have you worried about feelings of personal isolation or detachment 27 Do you usually have a smoke in the morning to get yourself going O A T 7 t S A o un T gt S T 9 x S i a a o LL T M g a o a o F A g a o T e z N 3 r S o A fe EU 3 w nu a a E Y v vo 5 a a v D un E vo v D fon oO a v Qe i 5 3 x 5
28. 2 a v lzy n v T v lzy i J a v v T ee 5 x 5 g v a n v T v 5 La 5 k a v T Auteur s E mail Date de publication Type Objectifs Population cible P riode de temps sur laquelle porte l outil Cotations scores Dur e de passation Langues Bibliographie par ordre chronologique Sites Internet SDS cannabis Severity of Dependance Scale traduction francaise Echelle de la d pendance au cannabis SS LZ AlN Michael Gossop King s College Royaume Uni michael gossop iop kcl ac uk 1995 Questionnaire d entretien structur en 5 items Mesurer la d pendance psychologique induite par l usage de cannabis et l usage compulsif outil initialement con u pour l h ro ne la cocaine et les amph tamines Adultes et adolescents 3 derniers mois Score de 0 15 Seuil d usage probl matique fix 4 pour les adolescents et 3 pour les adultes 2 3 minutes Anglais chinois tch que farsi indon sien lithuanien polonais russe thai Vietnamien fran ais traduction par Tremblay J 1999 Gossop M Darke S et al 1995 The Severity of Dependence Scale SDS psychometric properties of the SDS in English and Australian samples of heroin cocaine and amphetamine users Addiction 90 5 607 614 Gossop M Best D Marsden J Strang J 1997 Test retest reliability of the Severity of Dependence Sca
29. 3mg D E ou mescaline Salvia Fentanyl Duragesic Dalmacol H ro ne Smack Dimetane Expectorant C DC Hydrocodone Tussionex Novahistex C et DH Hydromorphone Dilaudid Tussaminic DH Morphine MS Contin Triaminic C et DH Statex MS IR Interpr tation des scores de l ESD J autorise faire 0 2 Intervention premi re ligne en CSSS parvenir la pr sente valuation 3 5 R pondre aux questions 16 24 avant de et en discuter pour fin d orientation contacter l intervenant du centre sp cialis en toxicomanie pour discussion concernant Date ______ Signature usager l orientation 6 15 Intervention par centre sp cialis en toxicomanie Valide jusqu au chelle des Cons quences de la Consommation de Drogues ECCD Tremblay Rouillard amp Sirois 2000 Si l individu a un score se situant entre 3 et 5 l ESD demander les questions suivantes avant de contacter l intervenant de la ressource sp cialis e o S a Q a E S LES ES DEPUIS UN AN JE FESSES is fo SOP RONF DEPUIS UN AN amp S S F ERR tg 16 Est ce que votre consommation de drogues a nui votre rendement au travail l cole ou dans vos t ches m nag res 16 0 DO OO O O 17 Est ce que votre consommation de drogues a nui une de vos amiti s ou une de vos relations proches 17 0 Op O Rey O O 18 Est ce que votre consommation de drogues a nui votre mariage votre relation amoureuse ou
30. 9 i 2 a M un T 3 S T 9 x Et a Q x T M g a a o E A g Q T z M 3 M iy 2 Q fe 9 3 gt 9 w a B MACQ Brief Marijuana Consequences Questionnaire Auteur s Jeffrey S Simons Department of Psychology University of South Dakota Etats Unis E mail jsimons usd edu Date de publication 2012 Type Questionnaire d entretien structur en 21 items Objectifs Permettre une valuation rapide de la s v rit des cons quences de l usage de cannabis Population cible El ves P riode de temps sur 6 derniers mois laquelle porte l outil Mode de passation Score total de 0 21 cotations scores Dur e de passation 5 10 minutes Langues Anglais Bibliographie Simons JS Dvorak RD Merrill JE Read JP 2012 Dimensions par ordre and severity of marijuana consequences Development and vali chronologique dation of the Marijuana Consequences Questionnaire MACQ Addictive Behaviors 37 5 613 621 Site Internet nd a z v v T o S 2 a v lzy CU v T v lzy i J a v k v T oe 5 x 5 g v a n v T v 5 k 5 Lu a v T B MACQ Brief Marijuana Consequences Questionnaire B MACQ BRIEF MARIJUANA CONSEQUENCES QUESTIONNAIRE Instructions The following is a list of things that sometimes happen to people e
31. Addictions Nursing 22 4 214 223 http adai washington edu instruments pdf Cannabis Use Disorders Identification Test Revised 59 pdf ADAI CUDIT Cannabis Use Disorders Identification Test CUDIT CANNABIS USE DISORDERS IDENTIFICATION TEST Avez vous consomm du cannabis pendant les 6 derniers mois Oui O Non O Si OUI veuillez r pondre aux questions suivantes concernant votre consommation de cannabis pendant les 6 derniers mois Merci de cocher la case qui d crit le mieux votre consommation de cannabis pendant les 6 derniers mois 1 quelle fr quence consommez vous du cannabis QJamais O11 fois par mois 02 4 fois 02 3 fois 04 fois ou plus ou moins par mois par semaine par semaine 0 1 2 3 4 2 Les jours o vous avez consomm du cannabis vous tiez d fonc e pendant combien d heures pour une journ e type 01 ou2 O3 ou 4 O5 ou 6 O7 9 O10 ou plus 0 1 2 3 4 3 Combien de fois avez vous t d fonc e sous cannabis pendant 6 heures ou plus DJamais OMoins d une fois OUne fois OUne fois OTous les jours par mois par mois par semaine ou presque 0 1 2 3 4 4 Combien de fois pendant les 6 derniers mois vous est il arriv de ne plus pouvoir vous arr ter de consommer du cannabis une fois que vous aviez commenc DJamais OMoins d une fois OUne fois OUne fois OTous les jours par mois par mois par semaine ou presque 0 1 2 3 4 5 Combien de fois pendant les 6 derniers mois n ave
32. Adolescents DAST 10 Drug Abuse Screening Test in 10 Questions DAST 20 Drug Abuse Screening Test in 20 Questions DEBA D D pistage et valuation du besoin d aide drogues DEP ADO DEPistage de consommation probl matique d alcool et de drogue chez les ADOlescents NIDA Quick Screen NIDA Modified ASSIST Alcohol Smoking and Substance Involvement Screening Test PESQ Personal Experience Screening Questionnaire POSIT Facteur A Problem oriented screening instrument for teenagers POSIT short form POSIT version courte Problem oriented screening instrument for teenagers PUN Problematic Use of Narcotics SACS Substances and Choices Scale SMAQ Substance Misuse in Adolescence Questionnaire SSI AOD Simple Screening Instrument for Alcohol and Other Drug Abuse 50 54 56 58 60 61 62 63 64 70 72 74 76 77 80 81 82 83 84 85 88 91 92 95 96 102 104 105 106 107 108 109 110 111 112 113 114 115 116 117 O Q o T 9 t 2 a M un T S T 9 Et a a o x T M 9 la o 2 E A 9 ta T e z N 3 M 2 Q o fe o gt 9 u 2 a g z v v T v S g 2 2 a v lzy n v T v zy i J a v v T ee 5 x 5 g v a n v T v 5 ka 5 k a v T Auteur s E mail Date de publication Type Objectifs Population ci
33. Afew times a month O 4 A few times a week O 5 Every day O 15 Do you ever have trouble remembering what you said or did 1 No never O 2 Yes sometimes O 3 Yes quite often O 4 Yes almost all the time O 16 Has a friend or acquaintance of yours who also smokes cannabis ever told you that you should cut down your use 2 a d v v 5 S a v a N 5 v Tv v D i oO a v v 3 ee 5 5 x YU a wn v v sz 5 k a v D 1 Yes sometimes O 2 Yes regularly O 3 No O 4 No because they don t know smoke it O Score ranges 0 5 No added risk although taking drugs always carries risks 6 15 Definite risk You re taking too many chances Try to reduce the risks of your drug use 16 36 Serious risk Your drug use is getting out of hand Guide pratique des principaux outils de rep rage de l usage pobl matique de cannabis k e _ gt gt w nr A N 2 a g v v T v 5 Ld g 2 2 a v n 3 v T v a i J a o v T oe 5 x 5 g v a n v T v 5 LA 5 k a v T Auteur s E mail Date de publication Type Population cible P riode de temps sur laquelle porte l outil Cotations scores Dur e de passation Langues Bibliographie par ordre chronologiqu
34. Ali R et al 2012 A randomized controlled trial of a brief inter vention for illicit drugs linked to the Alcohol Smoking and Substance Involve ment Screening Test ASSIST in clients recruited from primary health care settings in four countries Addiction 107 5 957 966 http www who int substance_abuse activities assist_french pdf Voir Linking ASSIST scores to appropriate interventions p 26 Recommandations http www who int substance_abuse activities en Draft_The_ASSIST_Guidelines pdf ASSIST Alcohol Smoking and Substance Involvement Screening Test A OMS ASSIST V3 0 FRANCAIS Interviewen bassins sense Clinique L Identit patient liisma Dat lice sise INTRODUCTION A lire au patient Peut tre adapt au contexte local Je vous remercie d avoir accept de participer ce bref entretien portant sur l alcool le tabac et d autres drogues De nombreuses drogues certains m dicaments inclus peuvent affecter votre sant Pour bien vous soi gner il est important pour votre soignant d avoir des informations pr cises sur vos consommations Les questions qui suivent portent sur vos consommations d alcool de tabac et d autres drogues au cours de votre vie et des 3 derniers mois ind pendamment de la voie de consommation fum aval sniff inhal inject pris sous forme de pilule etc montrer CARTE REPONSE ASSIST Certaines des substances list es
35. Date de publication Type Objectifs Population cible P riode de temps sur laquelle porte l outil Cotations scores Dur e de passation Langues Bibliographie par ordre chronologique Site Internet CAST Cannabis Abuse Screening Test Fran ois Beck St phane Legleye Stanislas Spilka Observatoire fran ais des drogues et des toxicomanies OFDT francois beck inpes sante fr stephane legleye ined fr stanislas spilka ofdt fr 2003 CAST 2007 CAST avanc Questionnaire d entretien structur en 6 items Rep rer l usage nocif de cannabis l aide de six questions abordant les aspects probl matiques de la consommation Adolescents et jeunes adultes 12 derniers mois CAST CAST avanc Score total de 0a6 Score total de 0a 24 2 ou 3 risque lev d usage probl matique gt 7 usage probl matique gt 4 risque tr s lev d usage probl matique 5 minutes Fran ais anglais Beck F Legleye S 2003 Drogues et adolescence usages de drogues et contextes d usage entre 17 et 19 ans volutions r centes ESCAPAD 2002 OFDT Paris Beck F Legleye S Spilka S 2004 Drogues l adolescence Niveaux et contextes d usage de cannabis alcool tabac et autres drogues a 17 18 ans en France ESCAPAD 2003 OFDT Saint Denis Reynaud M Karila L et al 2005 Original strategies of screening evaluation and care of adolescent substance abuse Alcoholism Clinical and Experimental Re
36. M a T gt 2 T 9 g Et a Q LL T LA g amp o a r w ta o T M 3 Y r 2 S Q fa w EU A A 14 Have you ever been in a motor vehicle accident when the driver of the car truck or motorcycle in which you were riding was high or drunk a a rS 6 Y v T v m a a v D un v T v D fon a o v T oe 5 3 x 5 m v a N v T v k 5 K k a v T DAP Drug and Alcohol Problem Quick Screen 15 Do your closest friends prefer hash sinsemillian or quality Colombian if they can get it 16 After partying do you sometimes use eyedrops to get the red out 17 Have you ever gotten a straight friend high for the very first time 18 Do you feel out of place or bored if you attend a party in which alcohol is not served 19 Have you ever gotten violent or into physical fights with people when you had been drinking or when you were high 20 Have you ever lost any friends because they were too straight 21 Have you ever stayed away from home for one or two nights without your parent s knowledge because of a fight you had or because you did not want your parents to know about something you did 22 As a teenager have you ever been sent to a counselor social worker psychologist or psychiatrist because of family or school problems
37. Q4c Q5c Q6c Q7c Notez que la question 5 sur le tabac n est pas cod e et est calcul e ainsi Q2a Q3a Q4a Q6a Q7a L INTERVENTION RECOMMANDEE SE BASE SUR LE SCORE SUBSTANCE SP CIFIQUE Score Pas Intervention Traitement substance d intervention br ve plus intensif sp cifique relev a Tabac 0 3 4 26 22m b Alcool 0 10 11 26 527 c Cannabis 0 3 4 26 gt 27 d Cocaine 0 3 4 26 22m e Amph tamine ORS 4 26 gt 27 f Solvants 0 3 4 26 SA g Calmants ORS 4 26 22 h Hallucinog nes 0 3 4 26 gt 27 i Opiac s 0 3 4 26 gt 27 j Autres drogues OS 4 26 gt 27 NOTE L valuation approfondie et le traitement plus intensif peuvent tre prodigu s selon le contexte local par des professionnels de la sant de premier recours ou par un service sp cialis dans les addictions O Q T 9 i 2 S a M a T gt 2 T 9 g Et a Q LL T M g amp o a r w ta o T e N 3 Y r 2 S o Q la g gt 3 EU A 7 a a mn z d v T v m 2 a v D N 3 o T v a k J a v k v T oe 5 3 x m v E a N v T v 5 5 k a v T ASSIST Alcohol Smoking and Substance Involvement Screening Test B OMS ASSIST V3 0 CARTE R PONSE POUR LES PATIENTS Carte r ponse substances a Tabac cigarette cigare pipe narguil
38. SACS difficulties scale partir de 2 difficult s s v res de consommation 5 minutes Anglais Christie G Marsh R et al 2007 The Substances and Choices Scale SACS the development and testing of a new alcohol and other drug screening and outcome measurement instru ment for young people Addiction 102 9 1390 1398 http www sacsinfo com http www sacsinfo com docs SACSClinical pdf SACS Substances and Choices Scale SACS SUBSTANCES AND CHOICES SCALE NGI snes ne E sent ae ees Date of Birth iaa INO ws nds The SACS is only to be used by health professionals working with young people who are engaged in a treatment agency The questions in part A and B are about your use of alcohol and drugs over the last month This does not include tobacco or prescribed medicine Please answer every question as best you can even if you are not certain Tick only one box on each row A How often did you use each Didn t Once Morethan Most of the following in the last month use a week once days or less a week or more 1 Alcoholic drinks e g beer wine spirits premixes 2 Cannabis e g weed marijuana 3 Ecstasy and other party pills e g E Methadrone BZP 4 Hallucinogens e g LSD acid mushrooms ketamine 5 Inhalants e g glue petrol solvents paint nitrous 6 Amphetamines e g speed P ice whiz 7 Sedatives e g sleeping pills benzos downers valium 8 Synthet
39. The Drug Abuse Screening Test Addictive Beha viors 7 4 363 371 Gavin DR Ross HE Skinner HA 1989 Diagnostic validity of the Drug Abuse Screening Test in the assessment of DSM III drug disorders British Journal of Addiction 84 3 301 307 Maisto SA Carey MP Carey KB Gordon CM Gleason JR 2000 Use of the AUDIT and the DAST 10 to identify alcohol and drug use disorders among adults with a severe and persistent mental illness Psychological Assessment 12 2 186 192 Saltstone R Halliwell S Hayslip MA 1994 A multivariate evaluation of the Michigan Alcoholism Screening Test and the Drug Abuse Screening Test ina female offender population Addictive Behaviors 19 5 455 462 Staley D El Guebaly N 1990 Psychometric properties of the Drug Abuse Scree ning Test in a psychiatric patient population Addictive Behaviors 15 3 257 264 http adai washington edu instruments pdf Drug_Abuse_Screening_Test_ 105 pdf DAST 20 Drug Abuse Screening Test in 20 Questions DAST 20 DRUG ABUSE SCREENING TEST IN 20 QUESTIONS Les questions suivantes portent sur votre consommation de drogues sans inclure votre consommation d alcool au cours des 12 derniers mois Lisez attentivement chaque question puis noircissez le carr appropri Oui Non Les termes abus de drogues d signe soit 1 l utilisation de m dicaments sur ordon nance ou de m dicaments en vente libre exc dant les directives soit 2 usage d
40. cigarette cigare pipe narguil tabac a chiquer etc 0 5 6 7 8 b Boissons alcooliques bi re alcopop vin spiritueux etc 0 5 6 7 8 c Cannabis marijuana joint herbe hash etc 0 5 6 7 8 d Cocaine coke crack etc 0 5 6 7 8 e Stimulants de type amph tamine speed pilules tha pilules coupe faim ecstasy etc oS ES ar 8 f Solvants colle essence diluant etc 0 5 6 7 8 g Calmants ou somnif res Valium Seresta Dormicum Rohypnol Stilnox etc OAI ESA LARGE ET 8 h Hallucinog nes LSD champignons PCP etc 0 5 6 7 8 i Opiac s h ro ne morphine m thadone cod ine 0 5 6 7 8 bupr norphine etc j Autres sp cifiez 0 G 6 7 8 O Q T 7 t 2 S a o wv T gt a T 9 g x Et a Q LL T M g amp o a r w ta o T e N 3 Y r 2 S o Q la g gt 3 EU T 7 2 a I v v T v a 2 a v lzy CU E v T v a fon J a v v T oe 5 3 x m v E a n v T v 5 5 k a v T ASSIST Alcohol Smoking and Substance Involvement Screening Test Posez les Questions 6 et 7 concernant toutes les substances d j consomm es au cours de la vie savoir toutes celles avec r ponse positive la question 1 Question 6 Est ce qu un ami un proche ou quelqu un d autre s est d j Non
41. consommation probl matique d alcool et de drogues chez les adolescents et les adolescentes DEP ADO d ve loppement et qualit s psychom triques Drogues sant et soci t 3 1 19 35 Landry M Brunelle N Tremblay J Desjardins L RISQ CIRASST 2005 L uti lisation de la DEP ADO dans l intervention et les enqu tes questions thiques et m thodologiques RISQ Info 13 1 3 5 Bernard M Bolognini M Plancherel B Chinet L Laget J Stepahn P et al 2005 French validity of two substance use screening tests among adolescents A com parison of the CRAFFT and DEP ADO Journal of Substance Use 10 385 395 De Germond Burquier V Haller DM Narring F 2010 J te dis si tu m de mandes Rep rage de la consommation de substances aupr s d adoles cents et jeunes adultes Revue M dicale Suisse 6 253 1242 1247 http www risqtoxico ca documents DEP ADO_fr_V3 2_2008 pdf DEP ADO DEPistage de consommation probl matique d alcool et de drogue chez les ADOlescents DEP ADO GRILLE DE D PISTAGE DE CONSOMMATION PROBL MATIQUE D ALCOOL ET DE DROGUE CHEZ LES ADOLESCENTS version 3 2 SEPTEMBRE 2007 COTO N de dossier Date CELTA O Quel est ton niveau scolaire actuel Ann e Mois Jour O Secondaire O Secondaire II Nom Pr nom O Secondaire Ill O Secondaire IV ge Sexe O Gar on O Fille O Secondaire V O Autre niveau pr ciser R serv
42. de prendre de l alcool ou d autres drogues 5 Oubliez vous les choses que vous avez faites sous l effet de l alcool ou d autres drogues 6 L alcool ou les drogues vous causent ils des variations rapides d humeur comme par exemple d heureux triste ou vice versa 7 Manquez vous l cole ou arrivez vous en retard cause de votre consommation d alcool ou d autres drogues 8 Votre famille ou vos ami e s vous ont ils d j dit que vous deviez r duire votre consommation d alcool ou de drogues 9 Avez vous de s rieuses disputes avec vos ami e s ou votre famille cause de l alcool ou de la drogue 10 L alcool ou les autres drogues vous font ils faire des choses que vous ne feriez pas normalement ne pas respecter les r gles ne pas rentrer l heure pr vue la maison transgresser la loi 11 Avez vous d j eu l impression que vous ne pouviez pas contr ler votre utilisation d alcool ou d autres drogues O A T 9 i o amp M un T gt S T 9 S x Et a a o LL T M g a o a o F A g a o T e z N 3 r S o A fe EU 3 w w a 2 a g z v v T v 3 S a a v lzy N v T v a i J a v v T oe 5 x 5 g 2 v a n v T v 5 LA 5 k a v T Auteur s E mail Date de publication Type Obje
43. diff rencient ces outils population cible adultes adolescents p riode de temps sur laquelle porte l outil vie enti re douze derniers mois six derniers mois etc dur e de passation d une 60 minutes etc Le guide pr sente dans deux sections distinctes les outils sp cifiques au cannabis et ceux qui concernent les drogues illicites en g n ral ou l alcool et les drogues qui sont aussi applicables au cannabis Pour chaque outil une fiche signal tique rappelant les condi tions d administration et les caract ristiques du questionnaire est pr sent e sur la page de gauche sur fond parme et l int gralit du questionnaire figure en vis a vis sur la page de droite en version fran aise lorsque celle ci est disponible sinon par d faut en anglais Une bibliographie indicative est propos e pour chaque instrument elle dis tingue en gras les r f rences d finissant les conditions initiales d utilisation des outils telles qu elles ont t d crites par les auteurs du questionnaire 1 Par exemple les suivants ALAC CAST CRAFFT CUDIT CUDIT R CUPIT DAP DAST MACQ MSI X NM ASSIST ou NIDA Quick screen POSIT Facteur A SACS SDS 2 Dans les chelles impaires le niveau central permet de n exprimer aucun avis tandis que les chelles paires par exemple a quatre modalit s sont dites a choix forc a chaque r ponse est attribu e une note positive ou n ga tive ce qui permet de traiter les
44. dysfonctionnements voire des comportements risque corr l s un usage de cannabis Dans cette perspective les questionnaires abordent plusieurs facettes ou dimensions de l usage de cannabis Chaque composante de l usage probl matique de cannabis est explor e par plusieurs questions formant un domaine particulier du ques tionnaire qui sont rarement normalis es Elles explorent des domaines tels que la perte de m moire la capacit s abstenir de consommer du cannabis les circonstances de consom mation solitaire avant midi etc Guide pratique des pr Une attention particuli re doit tre port e a la validation de ces chelles de mesure qui reposent sur une structure complexe Comme pour tout instrument de mesure les quali t s du questionnaire doivent tre valu es et connues avant toute administration les mesures r alis es doivent tre bien reproductibles l outil choisi doit mesurer ce pour quoi il a t construit le questionnaire doit permettre de rendre compte d une modification m me minime du ph nom ne explor au sein d un groupe ou chez un m me individu En d autres termes il s agit d appr cier la fiabilit la validit et la sensibilit au change ment du questionnaire Ces points sont abord s dans la revue de la litt rature laquelle ce guide est annex Une bibliographie est cependant pr sent e pour chaque outil de re p rage qui permet d approfondir les conditions d ut
45. n 3 v T v a i J a v v T oe 5 x 5 g v a n v T v 5 LA 5 fon a v T Auteur s E mail Date de publication Type Objectifs Population cible P riode de temps sur laquelle porte l outil Cotations scores Dur e de passation Langues Bibliographie par ordre chronologique Site Internet NIDA Quick Screen ou NIDA Modified ASSIST Alcohol Smoking and Substance Involvement Screening Test National Institute on Drug Abuse NIDA information nida nih gov 2009 Questionnaire d entretien structur en 8 items Rep rer l usage de drogues licites alcool tabac m dicaments psycho tropes ou illicites dans les structures de m decine g n rale Adultes Vie enti re et 3 derniers mois Le Substance Involvement SI score est calcul en additionnant les scores obtenus pour les questions 1 6 score de O 33 pour le cannabis 20 risque faible 4 26 risque mod r gt 27 risque lev Environ 25 minutes Anglais WHO ASSIST Working Group 2002 The Alcohol Smoking and Substance Involvement Screening Test ASSIST development reliability and feasibility Addiction 97 9 1183 1194 Original ASSIST Smith PC Schmidt SM Allensworth Davies D Saitz R 2010 A Single Question Sreening Test for Drug Use in Primary Care Archives of Internal Medicine 170 13 1155 1160 http www nida nih gov nidamed screening nma
46. of money you have been spending on cannabis 6 Have you been in trouble with the police due to your smoking 7 Have you been physically sick after smoking 8 Have you passed out after a smoking session 9 Have you had pains in your chest or lungs after a smoking session 10 Have you had a persistent chest infection or cough 11 Have you felt paranoid or antisocial after a smoking session 12 Have you worried about getting out of touch with friends or family Score 1 for each yes answer Tentative cut off indicating need for further assessment is 3 a a d v T v m J a a v D un 3 v T v D k J a o k v T oe 5 3 x v a N v T v 5 K k a v T Guide pratique des principaux outils de rep rage de l usage pobl matique de cannabis 2 a g z v v T v S g 2 2 a v lzy n v T v zy i J a v v T ee 5 x 5 g v a n v T v 5 ka 5 k a v T Auteur s E mail Date de publication Type Population cible P riode de temps sur laquelle porte l outil Cotations scores Dur e de passation Langues Bibliographie par ordre chronologique Site Internet CUDIT Cannabis Use Disorders Identification Test SA ADS Simon Adamson National Addiction Centre ex NCTD Department of Psychologica
47. s Hospital de Boston O A T 9 i o A un T S T g x S a a o LL T M g a o a o E A g a o T e z N 3 r S o A fe gt 3 w u a a 5 d v T v m J a a v D un 5 v T v D k J a o k v T oe 5 3 x v a N v T v 5 k a v T CRAFFT Car Relax Alone Forget Family or Friend Trouble CRAFFT VERSION ANGLAISE NO YES 1 Have you ever ridden in a CAR driven by someone including yourself who was high or had been using alcohol or drugs 2 Do you ever use alcohol or drugs to RELAX feel better about yourself or fit in 3 Do you ever use alcohol or drugs while you are by yourself ALONE 4 Do you ever FORGET things you did while using alcohol or drugs 5 Do your FAMILY or FRIENDS ever tell you that you should cut down on your drinking or drug use 6 Have you ever gotten into TROUBLE while you were using alcohol or drugs Scoring 2 or more positive items indicate the need for further assessment Guide pratique des principaux outils de rep rage de l usage pobl matique de cannabis 2 a g z v v T v S g 2 2 a v lzy n v T v a i J a v v T oe 5 x 5 g v a n o T v 5 LA 5 k a v T
48. ta consommation d alcool ou de drogues O O Fa un intervenant C vd y 7 Quelle a t ta consommation de tabac au cours des 12 derniers mois oa noircir une seule r ponse O Pas consomm O La fin de semaine ou 1 2 fois par semaine e O l occasion O 3 fois et par semaine mais pas tous les jours S O Une fois par mois environ O Tous les jours SCORE TOTAL Signature de l intervenant e V J R Recherche et intervention sur les susbtances psychoactives Qu bec 950 rue de Louvain Est Montr al Qu bec H2M 2E8 T l 514 385 3490 3112 T l c 514 385 4685 Courriel risq cirasst ssss gouv qc ca http www risqtoxico ca DEP ADO DEPistage de consommation probl matique d alcool et de drogue chez les ADOlescents GRILLE DE COTATION DEP ADO version 3 2 1 Au cours des 12 derniers mois as tu consomm l un de ces produits et si oui quelle a t la fr quence de ta consommation Pas Une fois La fin de 3 fois Tous consomm l occasion par mois semaine ou et par les jours environ 1 a2 fois semaine par semaine mais pas tous les jours Alcool 0 1 2 5 4 5 Cannabis 0 1 2 3 4 5 Coca ne 0 1 2 3 4 5 Colle solvant 0 1 2 3 4 5 Hallucinog nes 0 1 2 3 4 5 H roine 0 1 2 3 4 5 Amph tamines speed 0 1 2 3 4 5 Autres 0 1 2 3 4 5 Lun ou l autre des m dicaments suivants pris sans ordonnance barbituriques s datifs hypnotiques tranq
49. v T ee 5 x 5 g v a n v T v 5 La 5 k a v T DEBA D D pistage et valuation du besoin d aide drogues Auteur s E mail Date de publication Type Objectifs Population cible P riode de temps sur laquelle porte l outil Cotations scores Dur e de passation Langues Bibliographie par ordre chronologique Site Internet i Jo l Tremblay test d velopp au Qu bec joel tremblay uqtr ca 2009 Questionnaire d entretien structur D terminer si le niveau de consommation de drogues illicites ou de m di caments n cessite une intervention Le DEBA D permet de classer les indi vidus en fonction de la gravit des probl mes li s la consommation de drogues selon trois cat gories correspondant des niveaux de services Population g n rale adulte hors femmes enceintes 12 derniers mois Une intervention est jug e n cessaire si le cannabis est consomm gt 1 fois par semaine La d pendance est ensuite valu e en six questions adapt es du SDS tra duction en fran ais par J Tremblay 1999 m Score de 0 a2 d pendance faible ou nulle avec intervention possible aupr s du m decin de premier recours m De 3 5 points une d pendance mod r e est retenue avec pour suite du questionnaire m Score de 5 15 d pendance lev e avec proposition d une prise en charge sp cialis e arr t du test La consommation probl ma
50. validity Drug and Alcohol Dependence 80 3 313 319 Martin G Copeland J Gilmour S Gates P Swift W 2006 The Ado lescent Cannabis Problems Questionnaire CPQ A Psychometric properties Addictive Behaviors 31 12 2238 2248 Deady M 2009 A review of screening assessment and outcome mea sures for drug and alcohol settings Network of Alcohol amp other Drug Agen cies NADA Strawberry Hills NSW Proudfoot H Vogl L Swift W Martin G Copeland J 2010 Deve lopment of a short cannabis problems questionnaire for adolescents in the community Addictive Behaviors 35 7 734 737 http www ncpic org au CPQ A et CPQ A S Cannabis Problems Questionnaire for Adolescents CPQ A 27 ITEMs All the questions apply to your experiences from smoking cannabis in the last 3 months Please answer all the questions by ticking yes or no In the last 3 months Yes No Have you tended to smoke more on your own than you used to Have you worried about meeting people you do not know when you are stoned Have you spent more time with smoking friends than other kinds of friends Have your friends criticised you for smoking too much Have you had any debts Have you sold any of your belongings to buy cannabis Do you find yourself making excuses about money Have you been caught out lying about money OWIDI NII oO A UJN Have you been in trouble with the police due to your smoking
51. 2 hepatitis convulsions bleeding etc 5 25 Have you ever gone to anyone for help for a drug problem 1 0 2 26 Have you ever been in a hospital for medical problems related to your drug use 1 0 5 27 Have you ever been involved in a treatment program specifically related to drug use 1 0 2 28 Have you been treated as an outpatient for problems related to drug abuse 1 0 M a Scoring and interpretation A score of 1 is given for each YES response except for items 4 5 and 7 for which a NO 9 response is given a score of 1 Based on data from a heterogeneous psychiatric patient population cutoff scores of 6 gt through 11 are considered to be optimal for screening for substance use disorders Using a cutoff score of 6 has been z found to provide excellent sensitivity for identifying patients with substance use disorders as well as satisfactory spe eg cificity i e identification of patients who do not have substance use disorders Using a cutoff score of lt 11 somewhat n reduces the sensitivity for identifying patients with substance use disorders but more accurately identifies the patients who do not have a substance use disorders Over 12 is definitely a substance abuse problem In a heterogeneous psy chiatric patient population most items have been shown to correlate at least moderately well with the total scale scores The items that correlate poorly with the total scale scores appear to be items 4 7 16 20 and 22
52. 3 Special K ecstasy etc ct 2 h Street opioids heroin opium etc 0 5 6 S i Prescribed opioids fentanyl oxycodone 0 5 6 2 OxyContin Percocet hydrocodone Vicodin A methadone buprenorphine etc j Other Specify 0 3 6 a wa Instructions Ask Question 8 if the patient endorses any drug that might be injected including those that might be listed in the other category e g steroids Circle appropriate response 2 a r v v T v 2 a v lzy n 3 v T v lzy k J a v k v T ee 5 3 x m v a n v T v 5 5 fon a v T oO NIDA Quick Screen ou NIDA Modified ASSIST Alcohol Smoking and Substance Involvement Screening Test 8 Have you ever used any drug by injection No never Yes but not Yes NONMEDICAL USE ONLY in the past in the past 3 months 3 months m Recommend to patients reporting any prior or current intravenous drug use that they get tested for HIV and Hepatitis B C m f patient reports using a drug by injection in the past three months ask about their pattern of in jecting during this period to determine their risk levels and the best course of intervention o If patient responds that they inject once weekly or less OR fewer than 3 days in a row provide a brief intervention including a discussions of the risks associated with injecting o If patient responds that they inject more than once per wee
53. 363 371 Martino S Grilo CM Fehon DC 2000 Development of the Drug Abuse Screening Test for adolescents DAST A Addictive Behaviors 25 1 57 70 Maisto SA Carey MP Carey KB Gordon CM Gleason JR 2000 Use of the AUDIT and the DAST 10 to identify alcohol and drug use disorders among adults with a severe and persistent mental illness Psychological Assessment 12 2 186 192 French MT Roebuck MC McGeary KA Chitwood DD McCoy CB 2001 Using the Drug Abuse Screening Test DAST 10 to analyze health services utilization and cost for substance users in a community based setting Subs tance Use and Misuse 36 6 7 927 946 Bedregal LE Carter Sobel L Sobell MB Simco E 2006 Psychometric cha racteristics of a Spanish version of the DAST 10 and the RAGS Addictive Be haviors 31 2 309 319 Yudko E Lozhkina O Fouts A 2007 A comprehensive review of the psy chometric properties of the Drug Abuse Screening Test Journal of Substance Abuse Treatment 32 2 189 198 nd DAST 10 DRUG ABUSE SCREENING TEST EN 10 QUESTIONS DAST 10 Drug Abuse Screening Test in 10 Questions I m going to read you a list of questions concerning information about your potential involvement with drugs excluding alcohol and tobacco during the past 12 months When the words drug abuse are used they mean the use of prescribed or over the counter medica tions drugs in excess of the directions and any non medi
54. 5 k a v kz 5 ASMA Assessment of Substance Misuse in Adolescence ASSESSMENT OF SUBSTANCE MISUSE IN ADOLESCENCE ASMA YES NO If you use drugs do you have a favourite drug you use N If you use drugs do you ever do so alone 3 Do you use drugs because you re bored lonely or anxious 4 If you use drugs do you think a lot about drugs and drug use uo Do you plan your day to make sure you can use drugs 6 Do you need to use more and more drugs to get high N Do you feel irritable or anxious if you don t use drugs 8 Do you miss your favourite drug you don t use for a while O Q o T 9 i 2 a M un T 3 S T 9 x Et a Q o x T M w o 2 E A g Q T e z N 3 M 2 Q o fe 9 gt EU u 2 a z v v T v 5 Ld g 2 2 a v n 3 v T v zy i J a v v T ee 5 x 5 g v a n v T v 5 LA 5 Lu a v T Auteurs E mail Date de publication Type Objectifs Population cible P riode de temps sur laquelle porte l outil Mode de passation cotations scores Dur e de passation Langues Bibliographie par ordre chronologique Sites Internet ASSIST Alcohol Smoking and Substance Involvement Screening Test Organisation mondiale de la san
55. 6 How often in the past 6 months have you had a problem with your memory or concentration after using cannabis Never Less than monthly Monthly Weekly Daily or almost daily 0 1 2 3 4 7 How often do you use cannabis in situations that could be physically hazardous such as driving operating machinery or caring for children Never Less than monthly Monthly Weekly Daily or almost daily 0 1 2 3 4 8 Have you ever thought about cuttind down or stopping your use of cannabis Never Yes but not Yes during the past in the past 6 months 6 months 0 2 4 9 Q o T 9 i 2 a M un T 3 S T 9 x Et a Q o x T M g a o Q o E N 9 a o T z M 3 i iy 2 Q o fe 9 3 gt 9 T u a a c d v v 5 Lod W a a v D un S v v D i O a v vo i 5 3 x 5 g 2 v c 5 a N v v 5 Lu a v kz 5 O Auteur s E mail Date de publication Type Objectifs Population cible P riode de temps sur laquelle porte l outil Cotations scores Dur e de passation Langues Bibliographie par ordre chronologique Site Internet CUPIT Cannabis Use Problems Identification Test Jan Bashford Nouvelle Z lande janbashford gmail com 2010 Questionnaire d entretien structur en 16 items Permettre un rep rage rapide de l usage probl matique
56. Anglais fran ais Alcohol Advisory Council of New Zealand 1996 Guidelines for alcohol and drug assessment Review of alcohol and drug scree ning diagnostic and evaluation instruments Alcohol Advisory Council of New Zealand Wellington http alac rnzcgp org nz info full_guideline pdf ALAC ALCOHOL ADVISORY COUNCIL Oui 1 Votre entourage s est il plaint de votre consommation de cannabis 2 Avez vous des probl mes de m moire imm diate 3 Avez vous d j eu des pisodes d lirants lors d usage de cannabis 4 Consid rez vous qu il est difficile de passer une journ e sans joint 5 Manquez vous d nergie pour faire les choses que vous faisiez habituellement 6 Vous tes vous d j senti e pr occup e par les effets de votre usage de cannabis 7 Avez vous plus de difficult s tudier int grer des informations nouvelles 8 Avez vous d j essay sans succ s de diminuer ou d arr ter votre usage de cannabis 9 Aimez vous planer tre d fonc e stoned d s le matin 10 tes vous de plus en plus souvent d fonc e 11 Avez vous ressenti le manque des maux de t te de l irritabilit ou des difficult s de concentration quand vous diminuez ou arr tez l usage du cannabis Non Trois r ponses affirmatives indiquent un usage probl matique de cannabis ALAC Alcohol Advisory Council O Q o T
57. Date de publication Type Objectifs Population cible P riode de temps sur laquelle porte l outil Cotations scores Dur e de passation Langues Bibliographie par ordre chronologique Site Internet MSI X revised Marijuana Sreening Inventory Dale Alexander PhD Associate Professor Graduate School of Social Work University of Houston Etats Unis dalexander uh edu 2003 Questionnaire d entretien structur en 31 items la version initiale en com portant 39 Permettre un rep rage rapide des difficult s li es un usage probl matique de cannabis appelant une valuation approfondie Adultes Vie enti re 31 questions binaires oui non font l objet d un score score maximum 26 questions 27 31 non comprises dans le score final Score gal 0 risque nul d usage probl matique de cannabis Score compris entre 1 et 2 risque faible d usage probl matique de cannabis Score compris entre 3 et 5 risque mod r d usage probl matique de cannabis Score gt 6 risque d usage probl matique de cannabis lev 5 10 minutes Anglais Alexander D 2003 A review of marijuana assessment dilemmas Time for marijuana specific screening methods Journal of Social Work Practice in the Addictions 3 4 5 28 Alexander D 2003 A marijuana screening inventory experimental version description and preliminary psychometric properties American Journal of Drug and Alcohol Abuse
58. ES APPLICABLES AU CANNABIS O a T g i AADIS Adolescent Alcohol and Drug Involvement Scale 50 54 ADIS Adolescent Drug Involvement Scale 56 58 8 ADOSPA Adolescents et substances psychoactives version fran aise du CRAFFT 60 61 E ASMA Assessment of Substance Misuse in Adolescence 62 63 5 ASSIST Alcohol Smoking and substance involvement screening test 64 70 E CRAFFT Car Relax Alone Forget Family or friends Trouble 72 74 S DAP Drug and Alcohol Problem Quick Screen 76 77 et DAST A Drug Abuse Screening Test Adolescents 80 81 E DAST 10 Drug Abuse Screening Test in 10 Questions 82 83 DAST 20 Drug Abuse Screening Test in 20 Questions 84 85 a T DEBA D D pistage et valuation du besoin d aide drogues 88 91 D DEP ADO DEPistage de consommation probl matique d alcool 92 95 E et de drogue chez les ADOlescents a NIDA Quick Screen NIDA Modified ASSIST Alcohol Smoking 96 102 z and Substance Involvement Screening Test a PESQ Personal Experience Screening Questionnaire 104 105 2 POSIT Facteur A Problem oriented screening instrument for teenagers 106 107 POSIT short form POSIT version courte Problem oriented screening 108 109 instrument for teenagers 3 PUN Problematic Use of Narcotics 110 111 SACS Substances and Choices Scale 112 113 SMAQ Substance Misuse in Adolescence Questionnaire 114 115 SSI AOD Simple Screening Instrument for Alcohol and Other Drug Abuse 116 117 5 D gt
59. Have you skipped at least one class in school each week during the school year so that you could have some fun with your friends 3 During the past school year did your teachers or school administra tors get you angry enough to cause you to shout at them or threaten them with physical harm 4 Do you use tobacco products cigarettes snuff etc 5 Have your parents made you so angry that you have had serious argumentsin which there is cursing threats to hurt them throwing things or punching walls 6 Have you ever had an an school or out of school suspension for any reason 7 Does your mom or your dad often drink so much that they repeatedly embarrass you 8 Did you receive even if it was unfair more than two D or F grades on your last report card in the current or just finished school year 9 In the past 6 months did your parents hassle you at least a few times because they accused you of drinking alcohol or smoking some pot 10 Have most of your closest friends gone all the way with at least two people 11 Do you find that you can really get into your favourite music at home or at a good concert with a little help from some pot 12 Do most of your closest friends usually drink four or more beers in the first hour of a party 13 Do you sometimes ride in a care driven by someone including you self who is high or who appears to have had too much to drink O Q T 9 i 2 S a
60. Scree ning_Instrument_for_Teenagers_188 pdf POSIT Facteur A Problem oriented screening instrument for teenagers POSIT FACTEUR A PROBLEM ORIENTED SCREENING INSTRUMENT FOR TEENAGERS Oui Non 1 Avez vous des probl mes l cole dus l alcool ou aux drogues 2 Avez vous d j t accidentellement bless ou avez vous accidentellement bless quelqu un d autre apr s avoir consomm une quantit importante d alcool ou de drogues 3 Est ce que vous ratez des activit s parce que vous d pensez trop d argent pour l alcool ou les autres drogues 4 Avez vous d j eu l impression d tre d pendant l alcool ou aux autres drogues 5 Etes vous oblig de consommer de plus en plus de drogues ou d alcool pour obtenir l effet que vous voulez 6 Avez vous d j quitt une soir e parce qu il n y avait ni alcool ni autres drogues 7 Avez vous constamment envie de prendre de l alcool ou d autres drogues 8 Avez vous d j eu un accident de voiture ou de deux roues sous l effet de l alcool ou d autres drogues 9 Oubliez vous les choses que vous avez faites sous l effet de l alcool ou d autres drogues 10 Au cours du dernier mois avez vous conduit une voiture ou un deux roues sous l effet de l alcool ou d autres drogues 11 L alcool ou les drogues vous causent ils des variations rapides d humeur comme par exemple d heureux triste ou vice versa 12 Manquez vous l cole ou a
61. a M a un 9 a T e z M 3 a fe g Q M A 3 9 z a 2 a g v v T v 3 2 a v lzy CU v T v zy k J a v v T oe 5 3 x m 2 v a n v T v 5 La 5 k a v T Auteur s E mail Date de publication Type Objectifs Population cible P riode de temps sur laquelle porte l outil Cotations scores Dur e de passation Langues Bibliographie par ordre chronologique Site Internet DAST 20 Drug Abuse Screening Test in 20 Questions bed Harvey A Skinner Addiction Research Foundation Department of Health Science Toronto Canada harvey skinner yorku ca 1982 Questionnaire d entretien structur en 20 items version courte du DAST en 28 items lui m me inspir du Michigan Alcoholism Screening Test MAST Rep rer des troubles li s l usage de drogues illicites et valuer la n cessit d une prise en charge Adultes et adolescents 12 derniers mois Score total de 0 a 20 valuant le risque d usage probl matique 0 Aucun risque gt Monitoring monitor 1 5 Risque faible RA Conseil brief counselling 6 10 Risque possible ga Suivi ambulatoire outpatient selon les crit res du DSM 11 15 Risque substantiel 16 20 Risque s v re za Suivi intensif gt Suivi intensif 5 minutes Anglais fran ais Skinner HA 1982
62. acause of drug use 6 Have you hurt anybody while high on drugs 7 Are you looking for drugs stronger than you have previously used 8 Do you often feel desire for drugs 9 Have you ever used drug when you were alone 10 Have you had a serious argument with friends because of your drug use O Q T 9 2 c o a M a T 2 T 9 x a a Q T M 9 a M a un 9 a T e z M 3 a Q g ol Q o A 9 5 9 z un 2 a g v v T v 3 2 a v lzy CU v T v a k J a v k v T oe 5 x 5 g v a n v T v 5 La 5 k a v T Auteur s E mail Date de publication Type Objectifs Population cible P riode de temps sur laquelle porte l outil Cotations scores Dur e de passation Langues Bibliographie par ordre chronologique Sites Internet SACS Substances and Choices Scale VV ae N a Grant Christie Community Alcohol amp Drug Youth Service Auckland Nouvelle Z lande grant christie waitematadhb govt nz 2007 Questionnaire d entretien structur Rep rer l usage probl matique d alcool ou de drogues illicites et mesurer l volution d un traitement utilis seul ou avec le SDQ Adolescents 13 18 ans 30 derniers jours Score de 0 20 qui d termine l opportunit d un traitement
63. acid mushrooms PCP Special K 0 2 3 4 6 ecstasy etc 3 h Street Opioids heroin opium etc 0 2 5 4 6 O Q T 9 t 2 o a o un T a S T 9 Et a Q x LL T M g o Q E A 9 a o T e z N 3 9 2 o Q fe 9 3 EU T u i Prescribed opioids fentanyl oxycodone OxyContin Percocet hydrocodone Vicodin methadone buprenorphine etc j Other Specify 0 2 3 4 6 NIDA Quick Screen ou NIDA Modified ASSIST Alcohol Smoking and Substance Involvement Screening Test 4 During the past 3 months how often has your use of first drug second drug etc led to health social legal o o or financial problems 3 EENES i gavel es pape ela 2 G a la IAS a Cannabis marijuana pot grass hash etc 0 5 6 b Cocaine coke crack etc 0 5 6 7 c Prescribed Amphetamine type stimulants Ritalin Concerta O 4 5 6 7 n Fe s Dexedrine Adderall diet pills etc a d Methamphetamine speed crystal meth ice etc 0 4 5 6 7 e Inhalants nitrous oxide glue gas pain thinner etc 0 4 5 6 3 f Sedatives or sleeping pills Valium Serepax Ativan 0 4 5 6 7 T Librium Xanax Rohypnol GHB etc 3 g Hallucinogens LSD acid mushrooms PCP Special K 0 4 5 6 7 ecstasy etc h Street opioids heroin opium etc 0 4 5 6 7 au i Prescribed opioids fentanyl oxycodone OxyContin 0 4 5 6 7 a Percocet h
64. atment Improvement Protocol TIP Series 42 SAMHSA Rockville MD 497 512 Kills Small NJ Simons JS Stricherz M 2007 Assessing criterion validity of the Simple Screening Instrument for Alcohol and Other Drug Abuse SSI AOD in a college population Addictive Behaviors 32 10 2425 2431 Knight JR Goodman E Pulerwitz T DuRant RH 2000 Reliabilities of short substance abuse screening tests among adolescent medical patients Pedia trics 105 4 Pt 2 948 953 Knight JR Wechsler H et al 2002 Alcohol abuse and dependence among U S college students Journal of Studies on Alcohol 63 3 263 270 http www ncbi niIm nih gov books bv fcgi rid hstat5 section 77099 SSI AOD Simple Screening Instrument for Alcohol and Other Drug Abuse SIMPLE SCREENING INSTRUMENT FOR ALCOHOL AND OTHER DRUGS SSI AOD During the past 6 months 1 Have you used alcohol or other drugs such as wine beer hard liquor pot coke heroinor other opiates uppers downers hallucinogens or inhalants Yes 2 Have you felt that you use too much alcohol or other drugs Yes 3 Have you tried to cut down or quit drinking or using drugs Yes 4 Have you gone to anyone for help because of your drinking or drug use such as Alcoholics Anonymous Narcotics Anonymous Cocaine Anonymous counselors or a treatment program Yes 5 Have you had any of the following Put a check mark next to any problems you have experienced O Bla
65. been high have felt very sick to my stomach or thrown up after using marijuana Oo OND have gotten into trouble at work or school because of marijuana use 10 often used more marijuana than originally had planned 11 My marijuana use has created problems between muself and my boyufriend girlfriend spouse parents or other near relatives 12 have been unhappy because of my marijuana use 13 have gotten into physical fights because of my marijuana use 14 have spent too much time using marijuana 15 have not gone to work or have missed classes or school because of using marijuana being high or after effects feeling hung over 16 have felt like needed a hit of marijuana after l d gotten up that is before breakfast 17 have become very rude obnoxious or insulting after using marijuana 18 have felt guilty about my marijuana use 19 have damaged property or done something disruptive like setting off a fire alarm or other things like that after using marijuana 20 Because of my marijuana use have not eaten properly 21 have been less physically active because of my marijuana use 22 have had trouble sleeping after stopping or cutting down on marijuana use 23 My boufriend girlfriend spouse parents have complained to me about my marijuana use O A T 7 t S A o un T gt S T 9 x S a A LL T LA g a o a o
66. bis on a regular basis 32 Have your parent s complained about you smoking 33 Have your parent s tried to stop you from having a smoke 34 Have you argued with them about your smoking 35 Have you tried to avoid your parents s after you have been smoking If you have had any regular boufriend s girlfriend s partner s in the past 3 months answer these questions Otherwise go to the next section Thinking about the partner that you spent the most time Yes No with over the past 3 months 36 Does he she use cannabis on a regular basis 37 Has he she complained about your smoking 38 Have you argued with him her about smoking 39 Has he she threatened to leave you because of your smoking 40 Have you avoided him her after you have been smoking If you have been enrolled in school tertiary education or any courses of study in the last 3 months answer these questions Otherwise go to the following section In the last 3 months Yes No 4 42 Have you been unable to attend classes because of smoking 43 Have your school course marks dropped 44 Have you gone to classes stoned Have you been less interested or motivated in schoolwork study 45 Have you been less able to concentrate on your schoolwork study 46 Have you smoked on school premises 47 Have you been unable to complete homework because of your smoking 48 Have you had complaints from teachers about your work 49 Have you been disciplined or s
67. ble P riode de temps sur laquelle porte l outil Cotations scores Dur e de passation Langues Bibliographie par ordre chronologique Site Internet AADIS Adolescent Alcohol and Drug Involvement Scale Paul Moberg Center for Health Policy and Program Evaluation University of Wisconsin Medical School dpmoberg facstaff wisc edu dpmoberg wisc edu 2001 Questionnaire d entretien structur 14 items adapt de l AAIS Adolescent Alcohol Involvement Scale Permettre un rep rage bref de l usage de drogues licites alcool tabac et illicites qui fournisse une indication sur les suites donner Adolescents Vie enti re m 0 Pas d usage d alcool ou de drogues illicites m 1 36 Usage av r d alcool ou de drogues illicites qui reste en de du seuil de troubles au sens du DSM IV m gt 37 Usage av r d alcool ou de drogues illicites qui pourrait correspon dre aux crit res d abus du DSM IV recommandations pour une orientation vers un professionnel sp cialis need for a full professional full assessment 5 10 minutes Anglais Mayer J Filstead WJ 1979 The Adolescent Alcohol Involvement Scale an instrument for measuring adolescents use and misuse of alcohol Journal of Studies on Alcohol 40 3 291 300 Moberg DP 1983 Identifying adolescents with alcohol problems A field test of the Adolescent Alcohol Involvement Scale Journal of Studies on Alcohol 44 4 701 721 W
68. cal use of drugs The various classes of drugs may include cannabis e g marijuana hash solvents tranquilizers e g Valium barbiturates cocaine stimulants e g speed hallucinogens e g LSD or narcotics e g heroin Remember that the questions do not include alcohol or tobacco If you have difficulty with a statement then choose the response that is mostly right You may choose to answer or not answer any of the questions in this section These questions refer to the past 12 months 1 Have you used drugs other than those required for medical reasons 2 Do you abuse more than one drug at a time 3 Are you always able to stop using drugs when you want to If never use drugs answer Yes 4 Have you had blackouts or flashbacks as a result of drug use 5 Do you ever feel bad or guilty about your drug use If never use drugs choose No 6 Does your spouse or parents ever complain about your involvement with drugs 7 Have you neglected your family because of your use of drugs 8 Have you engaged in illegal activities in order to obtain drugs 9 Have you ever experienced withdrawal symptoms felt sick when you stopped taking drugs 10 Have you had medical problems as a result of your drug use e g memory loss hepatitis convulsions bleeding etc NO YES O Q T 9 2 c a M un T S T 9 a a Q T M 9
69. cannabis sans y arriver 6 Avez vous eu des probl mes a cause de votre consommation de cannabis dispute bagarre accident mauvais r sultats 0 j 1 1 1 l cole Lesquels CAST AVANC Au cours des 12 derniers mois Jamais Rarement De temps Assez Tr s Une seule croix par ligne en temps souvent souvent 1 Avez vous fum du cannabis avant midi 2 Avez vous fum du cannabis lorsque vous tiez seul e 0 1 3 4 3 Avez vous eu des probl mes de m moire quand vous fumiez du cannabis 0 1 2 3 4 4 Des amis ou des membres de votre famille vous ont ils dit que vous devriez r duire votre consommation de cannabis 5 Avez vous essay de r duire ou d arr ter votre consommation de cannabis sans y arriver 6 Avez vous eu des probl mes cause de votre consommation de cannabis dispute bagarre accident mauvais r sultats 0 1 5 3 7 l cole Lesquels O a v s g t 2 a M un T 5 S D o x i a a D M 2 g a a A w Q v 3 i 2 o a fe 5 o A u 2 a g z v v T v 2 2 a v lzy n 3 v T v lzy i J a v v T ee 5 x 5 g v a n v T v 5 La 5 k a v T CPQ A et CPQ A S Cannabis Problems Questionnaire for Adolescents Auteur s E
70. ce amonth O 3 Once or twice a week O 4 Every day or almost every day O 2 How much money do you spend on cannabis in an average week 1 Less than 10 00 O 2 10 00 30 00 O 3 30 00 70 00 O 4 More than 70 00 O 3 How often are you stoned 1 More than half of the day O 2 A few hours every day O 3 A few times a week O 4 A few times a month O 5 Once a month orless O 4 When you smoke cannabis how often do you light up a second joint to get extra stoned O 1 Never 2 Sometimes O 3 Regularly O 4 Almost always O 5 Do you ever smoke cannabis in combination with other substances such as alcohol cocaine or ecstasy Please ignore tobacco when answering this question 1 Yes often 2 Yes sometimes O 3 No never O 6 When do you usually smoke cannabis Click each relevant option 1 Morning 2 Afternoon O 3 Evening O 4 Night O 7 What are the most important reasons why you use cannabis Click below three reasons that apply to you It s more fun than drinking alcohol To relieve boredom To feel good l m just accustomed to taking it it s part of the game It s nice to smoke with friends To relieve feelings of depression To help me relax like before going to sleep To perform or concentrate better forget my problems for a while 10 To change the effects of other substances drugs or alcohol 11 I don t know O Q T 9 2 c a M un T S T 9
71. ckouts or other periods of memory loss O Injury to your head after drinking or using drugs O Convulsions or delirium tremens DTs O Hepatitis or other liver problems O Felt sick shaky or depressed when you stopped drinking or using drugs O Felt coke bugs or a crawling feeling under the skin after you stopped using drugs O Injury after drinking or using O Used needles to shoot drugs Circle yes if at least one of the eight items above is checked Yes 6 Has drinking or other drug use caused problems between you and your family or friends Yes 7 Has your drinking or other drug use caused problems at school or at work Yes 8 Have you been arrested or had other legal problems such as bouncing bad checks driving while intoxicated theft or drug possession Yes 9 Have you lost your temper or gotten into arguments or fights while drinking or using drugs Yes 10 Do you need to drink or use drugs more and more to get the effect you want Yes 11 Do you spend a lot of time thinking about or trying to get alcohol or other drugs Yes 12 When drinking or using drugs are you more likely to do something you wouldn t normally do such as break rules break the law sell things that are important to you or have unprotected sex with someone Yes 13 Do you feel bad or guilty about your drinking or drug use Nes The next questions are about lifetime experiences 14 Have you ever had a drinking or other d
72. ctifs Population cible P riode de temps sur laquelle porte l outil Cotations scores Dur e de passation Langues Bibliographie par ordre chronologique Site Internet PUN Problematic Use of Narcotics Katarzyna Okulicz Kozaryn Janusz Sierostawski kokulicz ipin edu pl 2007 Questionnaire d entretien structur en 10 items Distinguer les usages occasionnels et probl matiques de drogues risque lev de d velopper des troubles li s l usage de drogues Adolescents 13 18 ans pr sentant des signes d usage de drogue 12 derniers mois 2 r ponses affirmatives indiquent une forte probabilit 88 d usage probl matique de cannabis 2 5 minutes Polonais anglais traduction par l auteur Okulicz Kozaryn K Sierolawski J 2007 Validation of the Problematic Use of Narcotics PUN sreening test for drug using adolescents Addictive Behaviors 32 640 646 nd PUN Problematic Use of Narcotics PROBLEMATIC USE OF Narcotics PUN Theses questions concern your experience associated with drug use in the past 12 months Yes No 1 Have you ever skippped school classes or came late to school because of drugs 2 Have you ever gotten into trouble at school because of drug use 3 Have you ever bought drugs from drug dealer 4 Have you ever spent on drugs so much money that you had to give up other things or activities you like 5 Have you had problems with the police be
73. d Experimental Re search 22 1 121 125 Hinkin CH Castellon SA et al 2001 Screening for drug and alcohol abuse among older adults using a modified version of the CAGE American Journal on Addictions 10 4 319 326 Site Internet http pubs niaaa nih gov publications inscage htm NIAAA a z v v T v 5 Ld 2 a v lzy CU E v T v a k J a v k v T oe 5 x 5 g v a n v T v 5 LA 5 Lu a v T CAGE cannabis Cut Annoyed Guilty Eye opener traduction francaise DETC CAGE CANNABIS CUT ANNOYED GUILTY EYE OPENER Yes No 1 Have you ever tried to or felt the need to Cut down on your smoking 2 Do you ever get Annoyed when people tell you to quit smoking 3 Do you ever feel Guilty about smoking 4 Do you ever smoke within half an hour of waking up Eye opener Two or more positive responses to the following CAGE questions suggests dependence O Q o T 9 i 2 a M un T 3 S T 9 x Et a Q o x T M w o 2 E A g Q T e z N 3 M 2 Q o fe 9 gt 9 a 2 a g v v T v 5 Ld g 2 2 a v n 3 v T v lzy i J a v v T ee 5 x 5 g v a n v T v 5 La 5 k a v T Auteur s E mail
74. dance 10 11 12 13 14 15 16 20 22 23 24 25 26 29 30 31 32 34 36 38 40 42 44 45 46 47 O Q o T 9 t 2 a M un T S T 9 Et a Q o x T M w la o 2 E A g Q T e z N 3 M 2 Q o fe o gt 9 nu 2 a g v v T v 5 Ld g 2 2 a v n 3 o T v zy i J a v v T oe 5 x m 2 v a n v T v 5 LA 5 fon a v T Auteur s E mail Date de publication Type Objectifs Population cible P riode de temps sur laquelle porte l outil Mode de passation cotations scores Dur e de passation Langues Bibliographie par ordre chronologique Site Internet ALAC Alcohol Advisory Council Alcohol Advisory Council ALAC Nouvelle Z lande m johnson alac org nz 1996 Questionnaire d entretien structur 11 items Rep rer diff rents aspects de l usage nocif de cannabis tels que les trou bles cognitifs les l ments de la d pendance dont le syndrome de se vrage les complications psychiatriques et les r percussions sociales de la consommation Le questionnaire ALAC sp cifique au cannabis s inspire du questionnaire con u pour valuer la consommation de substances psychoactives Jeunes Vie enti re Trois r ponses affirmatives indiquent un usage probl matique de cannabis Environ 3 minutes
75. de cannabis Adultes et adolescents a partir d un niveau de lecture quivalant 7 8 ann es de scolarisation 12 derniers mois et 3 derniers mois Score total de O aucun usage 82 usage r gulier ou quotidien tr s probl matique Les 16 items du CUPIT mesurent le concept d usage risque au sens du DSMICIM items 1 et 2 l abus et la d pendance 3 10 et les probl mes socio sanitaires li s l usage 11 16 Usage probl matique de cannabis score gt 20 adultes et adolescents 8 10 minutes Anglais Bashford J Flett R Copeland J 2010 The Cannabis Use Problems Identification Test CUPIT development reliability concurrent and predictive validity among adolescents and adults Addiction 105 4 615 625 http ncpic org au static downloads workforce cannabisinfo assessmen t tools cannabis use problems identification test pdf CUPIT Cannabis Use Problems Identification Test CUPIT CANNABIS USE PROBLEMS IDENTIFICATION TEST Some people can use cannabis without developing any serious problems Others can experience health problems or other kinds of problems If you answer the questions below it can help you to work out if you are having any problems with cannabis There are no right or wrong answers For each question TICK M the answer closest to your cannabis use over the past 12 months 1 On how many days have you used cannabis during the past 12 months If there was no pattern to y
76. donn es en calculant une moyenne et un cart type Les chelles mesurant le degr d accord ou de d saccord vis a vis d une affirmation comme l chelle de Likert du nom du psychologue am ricain Rensis Likert sont beaucoup utilis es en psychologie sociale mais aussi dans l valuation de la validit sociale d une intervention psychologique O A T 9 t S A M un T gt S T 9 x S i a o T M y a o a o F A a o T e z N 3 o r S o A fe gt 3 En u 4 _ gt ALTE ELE r RAGE SP CIFIQUES OUTILS DE REP AU CANNABIS siqeuue ap anbiewajqod abesn ap He1 d 1 ap sjnno xnednund s p anbneid apiny ALAC Alcohol Advisory Council B MACQ Brief Marijuana Consequences Questionnaire CAGE cannabis Cut Annoyed Guilty Eye opener CAST Cannabis Abuse Screening Test CPQ A et CPQ AS Cannabis Problems Questionnaire for Adolescents CUDIT Cannabis Use Disorders Identification Test CUDIT R Cannabis Use Disorders Identification Test Revised CUPIT Cannabis Use Problems Identification Test DETC Diminuer Entourage Trop Cannabis version fran aise du CAGE Know Cannabis Test MACQ Marijuana Consequences Questionnaire MSI X Marijuana Screening Inventory PUM Problematic Use of Marijuana SDS Severity of Dependence Scale Echelle de s v rit de la d pen
77. drunk Became ill Passed out Used a lot and next aaa dealt fl feeling moderately or wasted or overdosed day didn t remember r drugs Circle a that apply to you 1 high what happened 12 What effects has Has Has Has Have lost Has gotten Wasina_ Has resulted in an using alcohol or drugs interfered prevented interfered friends me into fight or accident an injury had on your life with talking me from with my because trouble at destroyed arrest or being puni Circle allthat apply to someone havinga school of use home property shed at school for goodtime work using alcohol or drugs 13 How do you feel No I can I can control often feel Ineed help to have had professional about your use of problem control it myself but bad about control myself help to control my alcohol or drugs at all and set my friends my use drinking or drug use Circle allthat apply O limits on easily myself influence me 14 How do others see Can t say When luse My family or friends My family or friends My family or friends you in relation to your or normal I tend to advise me to control tell me to get help for have already gone alcohol or drug use formy age neglectmy or cut down on myuse my alcohol or drug use for help about my O family or use friends O Q T 9 a 2 a M a T 5 2 T 9 x a a M LL T M 4 i a M a un y a T
78. e Site Internet I MACQ Marijuana Consequences Questionnaire Jeffrey S Simons Department of Psychology University of San Diego Etats Unis jsimons usd edu 2012 Questionnaire d entretien structur 50 items adapt du YAACQ Young Adult Alcohol Consequences Questionnaire Adultes et adolescents 6 derniers mois Score total de 0 50 15 20 minutes Anglais Simons JS Dvorak RD Merrill JE Read JP 2012 Dimensions and severity of marijuana consequences Development and validation of the Marijuana Consequences Questionnaire MACQ Addictive Behaviors 37 5 613 621 http www robdvorak net resources Simons 20et 20al 20201 2 pdf I MACQ Marijuana Consequences Questionnaire MACQ MARIJUANA CONSEQUENCES QUESTIONNAIRE Instructions The following is a lit of things that sometimes happen to people either during or after they have been using marijuana Select either YES or NO to indicate whether that item describes something that has happened to you IN THE PAST 6 MONTHS Yes No 1 While using marijuana have said or done embarrassing things 2 The quality of my work or schoolwork has suffered because of my marijuana use 3 Ihave felt badly about myself because of my marijuana use 4 have driven a car when was high vi have felt in a fog sluggish tired or dazed the morning after using marijuana have passed out from marijuana use have taken foolish risks when I have
79. e lev de d velopper des troubles li s l usage de cannabis Adolescents 13 18 ans pr sentant des signes d usage de cannabis 12 derniers mois 3 r ponses affirmatives indiquent une forte probabilit 80 d usage probl matique de cannabis 2 5 minutes Polonais anglais traduction par l auteur Okulicz Kozaryn K 2007 Ocena psychometrycznych wlas ciwosci testu Problemowe uzywanie marihuany PUM dla dorastajacych Postepy Psychiatrii i Neurologii 16 105 111 nd PUM PROBLEMATIC USE OF MARIJUANA 1 Have you ever skipped school classes or come late to school because of cannabis use 2 Have you had a serious argument with family members because of your cannabis use 3 Have you had a serious argument with friends because of your cannabis use 4 Have you ever bought cannabis yourself 5 Do you have more and more problems in studying and understanding new information 6 Have you ever used cannabis when you were alone 7 Do you often feel desire for cannabis 8 Have you ever spent so much money on cannabis that you had to resign from other things or activities Yes No PUM Problematic Use of Marijuana O Q T 9 i 2 o a M un T gt S T 9 x Et a Q x LL T M g o a E A g Q T e T N 3 r 2 o Q fe EU 3 EU T u 2 a r z v v T v S g 2
80. e Dexedrine A rosol Alprazolam Xanax Flunitraz pam Rohypnol V Benzedrine Adderall Crystal Colle eue ae Fluraee pam Dine D Crack fum j M tamph tamine Chrystaimeth Chloroforme Buspirone Buspar Hydrate de Chloral Freebase fum M th drine sail oa D capant Chlordiaz poxide Librax Nitraz pam Mogadon renu pnenidare Ritalin ee Librium T maz pam Restoril au 1 in D Sener Clonaz pam Rivotril Triazolam Halcion D F entermine lonamin D Peinture Chloraz pate Tranxene D Zapelon Starnoc D Castin A ine Preludine D Poppers Diaz pam Valium Zipoclone Imovane enm trazine Preludine D L gende Hydroxyzine Atarax Re are Loraz pam Ativan Barbituriques s ee Meprobamate 282 MEP Butalbital Fiorinal Trianal Hat Oxaz pam Serax D Ph nobarbital Bellergal b us pone Donnatal D Discontinue 2 Cannabis 3 PCP 4 Hallucinog nes 7 Opiac s Pot K tamine Acide Bupr norphine Suboxone Pentazocine Talwin Sirops avec cod ine Hasch Ketalar Champignons psylocybine Cod ine Empracet 222 P thildine Demerol ou hydrocodone Huile PCP souvent Ecstasy MDMA MDA Tylenol C Fiorinal C Propoxyphene Darvon Ces sirops sont en vente libre de haschich vendu sous le L S D Robaxacet 8 Speedball h ro ne mais derri re le comptoir nom de mess Mescaline Diph noxylate Lomotil coca ne Benylin cod ine 3
81. e alcohol or other drugs were not involved but where you yourself knew marijuana was 8 Have you ever been arrested for possession of or for dealing in marijuana 9 Of the times you have sex are you usually more than all the time using marijuana 10 Has using marijuana ever interfered with any part of your education learning or job performance 11 Have others pointed out to you how marijuana was affecting you adversely 12 Before today have you ever consulted a health or mental professional concerning problems associated with marijuana use 13 If you do not smoke cigarettes have you ever had a cough that lasted more than 3 months while smoking marijuana 14 Do you use marijuana every day for several days in arow 15 Do you ever use marijuana before noon 16 Do you ever use marijuana throughout the whole day 17 Do you ever experience nervousness headaches or irritability alter stopping marijuana YES 1 YES 1 YES 1 YES 1 YES 1 YES 1 YES 1 YES 1 YES 1 YES 1 YES 1 YES 1 YES 1 YES 1 YES 1 YES 1 YES 1 O Q T 9 i 2 S a M a T gt 2 T 9 g Et a Q LL T M g amp o Q r w ta o T M 3 Y r 2 S Q fa w EU T 7 MSI X revised Marijuana Sreening Inventory YES NO Scoring Except 18 When you have important things to ta
82. e de publication Type Objectifs Population cible P riode de temps sur laquelle porte l outil Cotations scores Dur e de passation Langues Bibliographie par ordre chronologique Site Internet SSI AOD Simple Screening Instrument for Alcohol and Other Drug Abuse Winters Ken C Center for Adolescent Substance Abuse Department of Psychiatry University of Minnesota Etats Unis winte001 tc umn edu 1994 Questionnaire d entretien structur en 16 items dont 14 font l objet d un score Rep rer les signes et les sympt mes signalant des troubles li s l usage d al cool ou de drogues illicites Jeunes et adultes Vie enti re et 6 derniers mois Score total compris entre O et 14 Risque d abus 0 Aucun ou faible DS Minimal 4 et plus Mod r ou lev valuation approfondie recommand e 5 10 minutes Anglais Winters K Zenilman J 1994 Simple Screening Instrument for outreach for alcohol and other drug abuse and infectious diseases Treatment Improvement Protocol TIP Series 11 SAMHSA Center for Substance Abuse Treatment Rockville MD Knight JR Goodman E Pulerwitz T DuRant RH 2000 Reliabilities of short substance abuse screening tests among adolescent medical patients Pedia trics 105 4 Pt 2 948 953 Center for Substance Abuse Treatment 2005 Screening instruments Ap pendix H In Substance abuse treatment for persons with co occurring di sorders Tre
83. e drogues a des fins non m dicales Les drogues en question se classent comme suit le cannabis comme marijuana et le haschish les solvants les tranquillisants comme les Valium les barbituriques la cocaine les stimulants comme les speed les hallucinog nes comme le LSD ou les narcotiques comme l h ro ne Lisez attentivement chaque question en choisissant votre r ponse oui ou non puis cochez la r ponse appropri e Veuillez r pondre a chaque question Si certaines questions posent des difficult s choisissez la r ponse la plus a appropri e Rappelez vous que ces questions ne s appliquent pas aux boissons alcoolis es Oui Non 5 1 Avez vous fait usage de drogues autres que les m dicaments administr s 1 0 2 Avez vous fait un usage abusif de m dicaments sur ordonnance 1 0 3 Utilisez vous plus d une drogue la fois 1 0 2 4 Pouvez vous vous passer de drogues pendant une semaine complete 0 1 z 5 tes vous toujours capable d arr ter d utiliser des drogues ou des m dicaments quand vous le voulez 3 0 z 6 Avez vous eu de br ves pertes de m moire blackouts ou des irruptions E de souvenirs flashbacks apr s avoir pris une drogue ou un m dicament 1 0 z 7 Votre consommation de drogues ou de m dicaments suscite t elle un sentiment de culpabilit oude malaise de votre part 1 0 8 Vos parents ou votre conjoint se plaignent ils de votre comportement a vis a vis des drog
84. einforce abstinence Screening is complete E f the patient says Yes to one or more days of heavy drinking patient is an at risk drinker Please see NIAAA website How to Help Patients Who Drink Too Much A Clinical Approach http pubs niaaa nih gov publications Practitioner CliniciansGuide2005 clinicians_guide htm for informa tion to Assess Advise Assist and Arrange help for at risk drinkers or patients with alcohol use disor ders E f patient says Yes to use of tobacco Any current tobacco use places a patient at risk Advise all tobacco users to quit For more information on smoking cessation please see Helping Smokers Quit A Guide for Clinicians http www ahrq gov clinic tobacco clinhlpsmksqt htm E f the patient says Yes to use of illegal drugs or prescription drugs for non medical reasons proceed to Question 1 of the NIDA Modified ASSIST 1 This guide is designed to assist clinicians serving adult patients in screening for drug use The NIDA Quick Screen was adapted from the single question screen for drug use in primary care by Saitz et al available at http archinte ama assn org cgi re print 1 70 13 1155 and the National Institute on Alcohol Abuse and Alcoholism s screening question on heavy drinking days avai lable at http pubs niaaa nih gov publications Practitioner CliniciansGuide2005 clinicians_guide htm The NIDA modified ASSIST was adapted from the World Health Organization WHO Alcohol Smoking and Sub
85. ers Identification Test Revised CUDIT R Drug and Alcohol Dependence 110 1 2 137 143 http adai washington edu instruments pdf Cannabis Use Disorders Identification Test Revised 59 pdf http Awww addiction org nz CUDIT R Cannabis Use Disorders Identification Test Revised CUDIT R CANNABIS USE DISORDERS IDENTIFICATION TEST REVISED Have you used any cannabis over the past six months YES O NODO If YES please answer the following questions about your cannabis use Circle the response that is most correct for you in relation to your cannabis use over the past six months 1 How often do you use cannabis Never Monthly 2 4 times 2 3 times 4 or more times or less a month a week a week 0 1 2 3 4 2 How many hours were you stoned on a typical day when you have been using cannabis Less than 1 lor2 3or4 5 o0r6 7 or more 0 1 2 3 4 3 How often during the past 6 months did you find that you were not able to stop using cannabis once you had started Never Less than monthly Monthly Weekly Daily or almost daily 0 1 2 3 4 4 How often during the past 6 months did you fail to do what was normally expected from you because of using cannabis Never Less than monthly Monthly Weekly Daily or almost daily 0 1 2 3 4 5 How often in the past 6 months have you devoted a great deal of your time to getting using or recovering from cannabis Never Less than monthly Monthly Weekly Daily or almost daily 0 1 2 3 4
86. esse courriel suivante nadine blanchette martin ssss gouv qc ca DEBA D D pistage et valuation du besoin d aide drogues RAPPORT PERSONNALIS D BA DROGUES Tremblay J Simoneau H Blanchette Martin N Landry M amp Bergeron J 2012 Susbstance s Fr quences consomm e s lt 1xX 1 3x 1 2x 3xet dans la derni re ann e mois mois sem sem gt 0O O O gt O O O O gt O O O O Toutes substances confondues O O O Consommation 3 fois mois cannabis occasionnelle Moins de 1 fois mois toute autre drogue Consommation 1 fois sem ou plus cannabis risque 1 fois mois ou plus toute autre drogue Posologie non suivie Non prescrit m dicaments Consommation de cannabis Le tableau suivant pr sente la fr quence d usage du cannabis chez les Canadiens Vous dites consommer du cannabis la fr quence de par On remarque donc que des Canadiens de votre age consomment aussi souvent que vous Femmes Hommes Fr quence de consommation 1 Jamais 92 8 84 6 Une ou deux fois 2 7 43 Au moins une fois par mois 1 5 3 0 Au moins une fois par semaine 1 6 4 2 Au moins une fois par jour 1 5 3 8 Consommation d autres drogues Le tableau suivant pr sente le pourcentage de Canadiens qui ont d clar avoir fait usage de drogues illicites dans la derni re ann e Les pourcentages encercl s correspondent votre groupe d ge et votre type de consommat
87. f the answers seem exactly right please pick the ones that come closest to being true If a question doesn t apply to you you may leave it blank 1 How often do you use alcohol or other drugs such as weed or rock a never e several times a week b once or twice a year f every day c once or twice a month g several times a day d every weekend 2 When did you last use alcohol or drugs a never used alcohol or drugs e the last week ago b not for over a year f yesterday c between 6 months and 1 year ago g today or the same day was taken into d several weeks ago treatment or custody 3 usually start to drink or use drugs because CIRCLE ALL THAT APPLY a like the feeling d feel stressed nervous tense full of worries b to be like my friends or problems c am bored or just to have fun kickin it e feel sad lonely sorry for myself 4 What do you drink when you drink alcohol a wine d hard liquor vodka whisky etc b beer e a substitute for alcohol c mixed drinks 5 How do you get your alcohol or drugs CIRCLE ALL THAT YOU DO a Supervised by parents or relatives d get from friends b from brothers or sisters e buy my own on the street or with false ID c from home without parents knowledge 6 When did you first use drugs or take your first drink CIRCLE ONE a never d at ages 12 or 13 b after age 15 e at ages 10 or 11 c at ages 140r15 f before age 10
88. ic cannabinoids smokable herbal highs 9 Opiates e g heroin morphine methadone codeine 10 Cocaine e g coke crack blow 11 Other drug Write name here 12 Other drug Write name here B Mark one box on each row on the basis of Not Somewhat Certainly ra 5 3 how things have been for you over the last month true true true 5523 SRSA 1 took alcohol or drugs when was alone 0 1 2 3 S g S 2 I ve thought I might be hooked or addicted 0 1 2 208 B to alcohol or drugs 8 G38 3 Most of my free time has been spent getting hold of 0 1 2 Flg z taking orrecovering from alcohol or drugs 325e 4 I ve wanted to cut down on the amount of alcohol 0 1 2 ees and drugs that am using ZEG 5 My alcohol and drug use has stopped me getting 0 1 2 5 5 importantthings done S45 6 My alcohol or drug use has led to arguments with 0 1 2 2 53 the people llive with family flatmates or caregivers etc 822 7 lve had unsafe sex or an unwanted sexual experience 0 1 2 FES when taking alcohol or drugs 326 8 My performance or attendance at school or at work 0 1 2 Fan has been affected by my alcohol or drug use 9 I did things that could have got me into serious trouble stealing vandalism violence etc when using alcohol 0 1 2 or drugs 10 I ve driven a car while under the influence of alcohol or drugs or have been driven by someone under 0 1 2 the influence SACS difficulties scale C Fi
89. icaments s datifs toutes les semaines O De plus d un m decin questions suivantes Non prescrits K2 gt s amp eget Fg a X S 2 Cannabis O O O Fons i SIRER O O RSDR 112 O O Of 4 Hallucinog nes O O too 5 Coca ne OIOIOIO O O O Of Sia 6 Autres stimulants O O Siren lus d une des Re OJo ite Oo oop plus d une des Sa pliste nm drogues2 8 8 Inhalants O O ILORS demander la F Si l usager a recours plus question 9 gt 9 Fr quence cumul e d un mode de consommation des drogues 2 8 confondues O O tem pour un seul produit les noter tous Si vous avez coch dans une zone grise passez aux questions 10 15 Sinon terminez ici chelle de S v rit de la D pendances ESD Traduction par Tremblay J 1999 du Severity of Dependance Scale SDS de Gossop M Darke S Griffiths P Hando J Powis B Hall W amp Strand J 1995 Choisir la drogue la plus consomm e O M d s datifs O Cocaine ou celle causant probl mes et poser O Cannabis O Autres stimulants les quest 10 14 uniquement O PCP O Opiac s pour cette drogue O Hallucinog nes O Inhalants g d J R pondez aux 5 questions suivantes gk S amp fig en pensant votre consommation de ese amp amp SES Pe DEPUIS UN AN SIF od S SES 10 Avez vous pens que vous aviez perdu le contr le de vo
90. ich 3 Utilis autre chose pour vous droguer autre chose comprend les drogues illicites m dicaments en vente libre et sous ordonnance et ce qui s inhale ou s aspire A l usage de la clinique seulement le patient a t il r pondu oui une ou plusieurs questions de la partie A Non O Oui O Posez uniquement la question Posez les 6 questions CRAFFT sur la VOITURE puis arr tez vous Partie B Non Oui 1 Etes vous d j mont dans une VOITURE dont le conducteur y compris vous m me conduisait sous l effet de l alcool ou de drogues 2 Prenez vous de l alcool ou de la drogue pour vous D TENDRE pour tre mieux dans votre peau ou pour vous sentir mieux accept e 3 Prenez vous de l alcool ou de la drogue lorsque vous tes SEUL E 4 Vous arrive t il d OUBLIER de faire des choses importantes lorsque vous tes sous l emprise de l alcool ou de la drogue 5 Est ce que votre FAMILLE ou vos AMIS vous disent de r duire votre consommation d alcool ou de drogue 6 Avez vous d j eu des ENNUIS lorsque vous tiez sous l emprise de l alcool ou de drogues Instructions de notation l usage du personnel clinique seulement Notation CRAFFT chaque r ponse affirmative dans la partie B vaut 1 point Un score total de 2 ou plus indique un d pistage positif et qu une valuation suppl mentaire est requise Reproduit avec l autorisation du Center for Adolescent Substance Abuse Research au Children
91. iew schedule and manual Western Psychological Services Los Angeles Winters KC Latimer W Stinchfield RD 1999 The DSM IV criteria for adolescent alcohol and cannabis use disorders Journal of Studies on Alco hol 60 3 337 344 Winters KC Botzet A Anderson N Bellehumeur T Egan B 2001 Screening and assessment study Wisconsin Division of Juvenile Corrections Alcohol and other drug abuse State of Wisconsin Department of Corrections Madi son Wisconsin http uwphi pophealth wisc edu programs evaluation research adis htm ADIS Adolescent Drug Involvement Scale These questions refer to your use of alcohol and other drugs like marijuana weed or cocaine rock Circle the answers which describe your use of alcohol and or other drug s Even if none of the ans wers seems exactly right please pick the ones that come closest to being true If a question doesn t apply to you you may leave it blank 1 How often do Once or Once or Every Several Every day Several you use alcohol or twice twice weekend timesa times other drugs such a year amonth week a day as weed or rock 2 When did you Never used Not for Between 6 Several Last week Yesterday Today last use alcohol or alcohol or overa months and weeks drugs drugs O year 1year ago ago 3 I usually start to like the To be like my friends I am bored or just to feel stressed feel sad drin
92. ilisation de l instrument Les outils de rep rage pr sent s dans ce document s av rent diff renci s de nombreux gards Certains sont sp cifiques au cannabis d autres sont des questionnaires g n ralistes applicables plusieurs drogues La plupart sont uniquement disponibles en langue anglaise d autres ont t traduits en fran ais la comparabilit entre la version originale et la version traduite doit alors tre attest e par une validation clinique en France En outre la plupart des questionnaires peuvent tre utilis s comme outils d auto va luation de la consommation hors entretien m dical tandis que d autres ont t con us pour tre administr s par un professionnel ces h t ro questionnaires peuvent parfois n cessiter un niveau de formation minimal de la part des intervenants m dicaux Les modalit s de r ponse possibles varient galement d un outil l autre certains ou tils pr voient des r ponses binaires oui non alors que lorsqu il s agit d chelles psy chom triques les choix de r ponse comprennent un nombre limit de modalit s g n ralement en nombre impair le plus souvent de 3 9 chelonn es en fonction de la fr quence jamais rarement de temps en temps assez souvent tr s souvent ou du degr d accord pas du tout d accord pas d accord ni en d saccord ni d accord d accord tout fait d accord Enfin d autres caract ristiques
93. inaire quant un ventuel usage probl matique de cannabis et ou une probl matique de sant mentale en lien avec l usage de ce produit 2 a v O N 5 v T Le r le des questionnaires dans le recueil d informations aupr s du patient est variable Ils peuvent tre utilis s par le m decin selon les cas pour conduire un entretien structur ou standardis ou semi structur rage E L entretien structur est une forme d entretien qui repose le plus souvent sur l adminis tration d un questionnaire par un enqu teur ou un clinicien L administrateur de l entretien intervient directement pour diriger l entretien en s appuyant sur un guide relativement contraignant les questions leur ordre les termes utilis s sont fix s l avance L adminis trateur peut cependant se permettre de poser des questions compl mentaires pour mieux comprendre certaines r ponses du patient m Un entretien semi structur est une forme d entretien guid o quelques questions seu lement sont pr par es l avance et o les autres questions sont g n ralement labor es au cours de l entretien ils de rep t incipaux ou Contrairement aux questionnaires qui explorent des maladies dont la d finition fait l objet d un consensus et o le diagnostic peut tre tabli travers des questions normalis es les questionnaires de rep rage d un usage probl matique de cannabis s attachent identifier d ventuels
94. ing marijuana that later regretted have awakened the day after using marijuana and found could not remember a part of the evening before have been overweight because of my marijuana use haven t been as sharp mentally because of my marijuana use have received a lower grade on an exam or paper than ordinarily could have because of marijuana use have tried to quit using marijuana because thought was using too much have felt anxious irritable lost my appetite or had stomach pains after stopping or cutting down on marijuana use have not had as much time to pursue activities or recreation because of my marijuana use have injured someone else while using marijuana or high often have thought about needing to cut down or to stop using marijuana have had less energy or felt tired because of my marijuana use have had a blackout after using marijuana heavily i e could not remember hours at a time Using marijuana has made me feel depressed or sad have felt panicked or paranoid after using marijuana have lost motivation to do things because of my marijuana use Guide pratique des principaux outils de rep rage de l usage pobl matique de cannabis 2 a r z v v T v 2 a v lzy CU v T v zy k J a v v T oe 5 3 x m 2 v a n v T v 5 La 5 k a v T Auteur s E mail
95. ion Groupe Hallucino Cocaine Speed Ecstasy Au moins 1 d ge speed ecstasy hallucinog nes ou h ro ne F H F H FH F H F H 15 19 93 169 94 103 90 7 6 11 3 90 188 20 7 20 24 148 234 118180 76146 99 169 225 33 5 25 34 119 238 106194 42119 47 127 17 6 31 6 35 44 DEMI 11 7 21 4 ESSOR ns 2 7 O6 45etplus 40 99 36 87 2567 ns ns 63 124 Degr de d pendances aux drogues Ceci correspond l impression g n rale ressentie par une per sonne lorsqu une drogue envahit progressivement sa vie Selon votre score au questionnaire qui est de VOUS avez un degr de d pendance qui est dans la zone Les cons quences associ es votre consomma tion de drogue s Vous avez r pondu des questions au sujet des cons quences de votre consommation de drogue s qui portaient sur vos res ponsabilit s votre implication dans des situations dangereuses pour vous vos possibles difficult s avec la justice ou dans vos relations interpersonnelles Selon ce que vous rapportez votre consommation de drogue s entra ne des cons quences qui vous placent dans la zone Degr de risque D gr de estim pour un d pendance Fr quence des cons quences de la consommation de drogue s au cours de la derni re ann e adulte en sant Sur les O N ON U1 Risques D pendance lev s lev e Fr quentes Toutes les sem Ex 52 fois et p r aux s
96. isniewski NM Glenwick DS Graham JR 1985 MacAndrew scale and sociodemographic correlates of adolescent alcohol and drug use Addictive Behaviors 10 1 55 67 Moberg DP Hahn L 1991 The Adolescent Drug Involvement scale Journal of Adolescent Chemical Dependency 2 1 75 88 Winters KC Henly GA 1993 Adolescent Diagnostic Interview schedule and manual Western Psychological Services Los Angeles CA Winters KC Latimer W Stinchfield RD 1999 The DSM IV criteria for ado lescent alcohol and cannabis use disorders Journal of Studies on Alcohol 60 3 337 344 http uwphi pophealth wisc edu programs evaluation research adis survey pdf AADIS Adolescent Alcohol and Drug Involvement Scale ADOLESCENT ALCOHOL AND DRUG INVOLVEMENT SCALE AADIS A DRUG USE HISTORY For each drug listed please circle one number under the category that best describes your use pattern If you are currently in residential treatment or secure custody please answer regarding how often you typically used it before you entered treatment or were taken into custody Consider only drugs taken wi thout prescription from your doctor for alcohol don t count just a few sips from someone else s drink a Never Tried Several Several Week Several Daily Several A tried but quit times times ends times times ayear amonth only aweek a day gz Smoking Tobacco i Cigarettes cigars 0 1 2 3 4 5 6 7 Alcohol Bee
97. ither during or after they have been using marijuana Select either YES or NO to indicate whether that item describes something that has happened to you IN THE PAST 6 MONTHS Yes No 1 The quality of my work or schoolwork has suffered because of my marijuana use 2 Ihave driven a car when was high Ww have felt in a fog sluggish tired or dazed the morning after using marijuana 4 Ihave been unhappy because of my marijuana use 5 Ihave gotten into physical fights because of my marijuana use 6 Ihave spent too much time using marijuana 7 Ihave felt like needed a hit of marijuana after l d gotten up 8 have become very rude obnoxious or insulting after using marijuana 9 Ihave been less physically active because of my marijuana use 10 have had trouble sleeping after stopping or cutting down on marijuana use 11 I have neglected obligations to family work or school because of my marijuana use 12 When using marijuana have done impulsive things that regretted later 13 have awakened the day after using marijuana and found could not remember a part of the evening before 14 have been overweight because of my marijuana use 15 haven t been as sharp mentally because of my marijuana use 16 have received a lower grade on an exam or paper than ordinarily could have because of my marijuana use 17 have tried to quit using marijuana because thought was using too much 18
98. ituations au plan Sur les responsabilit s dangereuses judiciaire relations Ques 16 19 24 Ques 20 et 21 Ques 22 et 23 Ques 17 et 18 Fr quentes lev es Fr quentes Toutes les sem EX2 Toutes les sem Ex 52 fois et arrestations et Ex 52 fois et R guli res Tous les mois Ex 12 51 fois U ANW Risques D pendance mod r s mod r e Faible Occasionnelles d pendance Pas tous les mois Ex 1 11 fois Risques faibles Aucune Jamais Nom de la personne Signature de l intervenant R guli res Ex 4 51 fois Occasionnelles Ex 1 3 fois Jamais Jamais R guli res Tous les mois Ex 12 a 51 fois Occasionnelles Ex 1 arrestation Occasionnelles Pas tous les mois Ex 1 11 fois Jamais Date Ann e Mois Jour a a T 9 Ei a un T S T 9 S x fe S Ei a a T M y C a A Ce T z M 3 a e S a le gt 3 En un 2 a g z v v T v 2 2 a v lzy n 3 v T v zy k J a v v T oe 5 3 x m 2 v a n v T v 5 La 5 k a v T DEP ADO DEPistage de consommation probl matique d alcool Auteur s E mail Date de publication Type Objectifs Population cible P riode de temps
99. ium Seresta Dormicum z Rohypnol Stilnox etc onz 5 6 w h Hallucinog nes LSD champignons PCP etc oal a Z 6 5 i Opiac s h ro ne morphine m thadone cod ine 0 2 3 4 6 2 bupr norphine etc 2 j Autres sp cifiez 0 2 3 4 6 v a Si jamais tous les items de la Question 2 passez la Question 6 5 Si une ou plusieurs substances de la Question 2 ont t utilis es au cours des 3 derniers mois a continuez avec les Questions 3 4 et 5 pour chaque substance consomm e D Question 3 Fe e J Au cours des 3 derniers mois combien de fois avez vous eu un a v fort d sir ou un besoin irr sistible de consommer PREMIERE S s 3 z SUBSTANCE DEUXIEME SUBSTANCE etc g a Y E Ss a PENSE 5 2al ela l gie s T oiala m a Tabac cigarette cigare pipe narguil tabac chiquer etc 0 3 4 5 6 a E b Boissons alcooliques bi re alcopop vin spiritueux etc 0 3 4 5 6 c Cannabis marijuana joint herbe hash etc 0 3 4 5 6 2 d Coca ne coke crack etc 0 3 4 5 6 z e Stimulants de type amph tamine speed pilules tha pilules 0 3 4 5 6 3 coupe faim ecstasy etc Ca f Solvants colle essence diluant etc 0 3 4 5 6 a g Calmants ou somnif res Valium Seresta Dormicum 0 3 A 5 6 2 Rohypnol Stilnox etc E h Hallucinog nes LSD champignons PCP etc 0 3 4 5 6 i Opiac s h ro ne morphine m thadone cod ine 0 3 4 5 6 bupr norphi
100. k sO daily always O Q o T 9 t 2 a M un T S T 9 Et a a o x T M 9 la o 2 E A 9 ta T e z N 3 M 2 Q o fe o gt 9 w a a a cS d v T v m a a v D un 3 v T v a k J a v k v T oe 5 3 x m v E a N v T v 5 5 k a v T CUPIT Cannabis Use Problems Identification Test Over the past 12 months 5 How much of the average day do you spend or feel stoned 000 hours 101 2 hours 203 4 hours 3015 6 hours 407 8 hours 5019 or more hours 6 How difficult do you think you would find it to stop using or go without cannabis altogether oO not at all difficult iDa bit difficult 20 quite difficult 30 very difficult 4O impossible 7 What was the longest time you went without using cannabis 1016 months or longer 203 5 months 301 2 months 402 3 weeks 5D one week 6X14 6 days 702 3 days sLlone day Uno days at all 8 Have you felt that you needed cannabis of never 1O sometimes 20 quite often 30 very often 40 always all the time 9 Have you been able to stop using cannabis when you wanted to 4D never at no time sO sometimes not often 20 quite often half the time iO very often usually oO always all the time 10 Have you found it difficult
101. k OR 3 or more days in a row refer for further assessment Note Recommend to patients reporting any current use of alcohol or illicit drugs that they get tes ted for HIV and other sexually transmitted diseases Tally Sheet for scoring the full NIDA Modified ASSIST Instructions For each substance labeled a j add up the scores received for questions 2 7 above This is the Substance Involvement SI score Do not include the results from either the Q1 or Q8 above in your SI scores Substance Involvement Score Total SI SCORE a Cannabis marijuana pot grass hash etc b Cocaine coke crack etc c Prescription stimulants Ritalin Concerta Dexedrine Adderall diet pills etc d Methamphetamine speed crystal meth ice etc e Inhalants nitrous oxide glue gas paint thinner etc f Sedatives or sleeping pills Valium Serepax Xanax Ativan Librium Rohypnol GHB etc g Hallucinogens LSD acid mushrooms PCP Special K ecstasy etc h Street Opioids heroin opium etc i Prescription opioids fentanyl oxycodone OxyContin Percocet hydrocodone Vicodin methadone buprenorphine etc j Other Specify Use the resultant Substance Involvement SI Score to identify patient s risk level To determine patient s Hrisk levelH based on his or her HSI scoreH see the table below Level of risk associated with different substance involvement score ranges for illicit or nonmedical prescripti
102. k or USE drugs feeling have fun kickin it nervous tense full of lonely sorry because Circle all worries or problems for myself that apply p y 4 What do you Beer Mixed Hard liquor vodka whiskey A substitute drink when you drinks etc for alcohol drink alcohol 5 How do you get Supervised From From home without Get from Buy on my own on the street your alcohol or by parents brothers parents knowledge my friends or with false ID drugs Circle all or relatives or sisters that you do 1 6 When did you Never After age Atages 14 Atages 12 At ages 10 or 11 Before age 10 first use drugs or 0 15 or 15 or 13 take your first 0 drink 7 What time of At night Afternoons Before or during In the morning often get up during the day do you use 1 after school school or work or when first my sleep to use alcohol or drugs awaken alcohol or drugs Circle all that apply to you 8 Why did you Curiosity Parents Parents To get away from To get high or drunk take your first 1 orrelatives or relatives offered my problems drink or first use offered drugs Circle all that apply 9 When you drink 1 drink 2 drinks 3 4 drinks 5 9 drinks 10 or more drinks alcohol how much do you usually drink 10 Whom do you drink Parents With With friends or relatives With older friends Alone or use drugs with or adult brothers own age Circle all that are true relatives 1 orsisters of you 11 What effects have Loose easy Got Got
103. l Medicine Christchurch School of Medicine amp Health Sciences University of Otago Nouvelle Z lande simon adamson otago ac nz 2003 Questionnaire d entretien structur en 10 items sp cifique au canna bis adapt de l AUDIT Alcohol Use Disorders Identification Test Saun ders et al 1993 Adultes et adolescents 6 derniers mois Score total de 0 a 40 Score gt 8 abus ou d pendance 5 minutes Anglais allemand italien n erlandais fran ais Adamson SJ Sellman JD 2003 A prototype screening instru ment for cannabis use disorder the Cannabis Use Disorders Iden tification Test CUDIT in an alcohol dependent clinical sample Drug and Alcohol Review 22 3 309 315 Annaheim B Rehm J Gmel G 2008 How to screen for problematic cannabis use in population surveys An evaluation of the Cannabis Use Disorders Identification Test CUDIT in a Swiss sample of adolescents and young adults European Addiction Research 14 4 190 197 Annaheim B Scotto TJ Gmel G 2010 Revising the Cannabis Use Disor ders Identification Test CUDIT by means of Item Response Theory Inter national Journal of Methods in Psychiatric Research 19 3 142 155 Thake J Davis CG 2011 Assessing problematic cannabis use Addiction Research and Theory 19 5 448 458 Guillem E Notides C et al 2011 Psychometric properties of the cannabis use disorders identification test in French cannabis misusers Journal of
104. l usage 7 1 Au cours des 12 derniers mois as tu consomm l un de ces produits eNe et si oui quelle a t la fr quence de ta consommation ar gt noircir une seule r ponse par produit Fa 7 v un x z P Pas Une fois Lafin de 3 fois Tous Sii a I consomm loccasion parmois semaine ou et par lesjours e amp h re ENS SN environ 1 2 fois semaine SANS DURS par semaine mais pas g 3 g g a j tous les jours fs fs PS Alcool O O O O O O Cannabis ex mari O O O O O O pot haschich etc Cocaine ex coke O O O O O O snow crack freebase etc Colle solvant O O O O O O Hallucinog nes ex LSD PCP ecstasy O O O O O O mescaline buvard etc H ro ne ex smack O O O O O O Amph tamines O O O O O O speed ex upper Autres O O O O O O Lun ou l autre des m dicaments suivants pris sans ordonnance barbituriques s datifs hypnotiques tranquillisants ritalin 2 a Au cours de ta vie as tu d j consomm O Oui gt Passez 2b l un de ces produits de fa on r guli re O Non gt Passez 3 1 fois semaine pendant au moins 1 mois b A quel ge as tu commenc de l alcool Ans consommer r guli rement une ou des drogues Ans 3 Au cours de ta vie t es tu d j inject des drogues O Oui O Non Si la question 1
105. le Letter Addiction 92 3 3533 3354 Swift W Copeland J Hall W 1998 Choosing a diagnostic cut off for cannabis dependence Addiction 93 11 1681 1692 Martin G Copeland J Gates P Gilmour S 2006 The Severity of Dependence Scale SDS in an adolescent population of cannabis users Reliability valid ity and diagnostic cut off Drug and Alcohol Dependence 83 1 90 93 Conway KP Levy J et al 2010 Measuring addiction propensity and sever ity The need for a new instrument Drug and Alcohol Dependence 111 1 2 4 12 Cuenca Royo AM Sanchez Niub6 A et al 2012 Psychometric properties of the CAST and SDS scales in young adult cannabis users Addictive Behav iors 37 6 709 715 http www who int substance_abuse research_tools severitydependencesc ale en index html http adai washington edu instruments pdf Severity_of_Dependence_Scale _397 pdf http ncpic org au static pdfs assessment tools severity of dependance scale pdf SDS cannabis Severity of Dependance Scale traduction francaise Echelle de la d pendance au cannabis SDS CANNABIS SEVERITY OF DEPENDENCE SCALE ECHELLE DE SEVERITE DE LA DEPENDANCE ESD Au cours des 3 derniers mois 1 Avez vous pens que vous aviez perdu le contr le de votre consommation de cannabis Jamais ou presque jamais Quelquefois Souvent Toujours ou presque toujours 0 1 2 3 2 Est ce que l id e de ne pas consommer du tout de cannabis vou
106. lk about with someone does your using marijuana interfere so that YES 1 often the important things don t get resolved 19 Have you ever lost friends or girlfriends or boyfriends because of your marijuana use el 20 Have you ever had difficulty getting your job done H because of using marijuana MESEI g 21 Do you olten use marijuana secretly or lie to close VESE f friends or to your spouse about you marijuana use gt y 22 Do you often find yourself needing to use larger VESS amounts or to smoke more marijuana to get high 23 Do you often feel that using marijuana keeps you from YES 1 getting things done that you need to do 24 Have you ever been to a self help group meeting simi lar to Narcotics Anonymous or Alcoholics Anonymous MES me because you were concerned about your marijuana use 25 Have you ever gotten into trouble at school or work VESE where using marijuana was part of the problem 3 y 26 Have you ever had difficulty getting your work school a work or homework done because you were high from VESE marijuana 27 Do you ever wake up in the morning after having used marijuana and no other drugs the night before and don t feel rested If so about how many times in an average week v D pan v Is de rep 28 Do you ever use marijuana to feel better when you are nervous or depressed If so about how many times in an average month t 29 Have you ever had an accident
107. mail Date de publication Type Objectifs Population cible P riode de temps sur laquelle porte l outil Cotations scores Dur e de passation Langues Bibliographie par ordre chronologique Site Internet Jan Copeland Directrice du National Cannabis Prevention and Information Centre NCPIC Sydney Australie j copeland unsw edu au 2005 2006 Questionnaire d entretien structur plusieurs versions du questionnaire 12 27 46 et 58 items inspir du CPQ pour adultes lui m me issu de l APQ Alcohol Problems Questionnaire en 46 items Rep rer les troubles li s l usage de cannabis chez les adultes Copeland et al 2005 et adolescents Martin et al 2006 Population g n rale CPQ A adapt aux adolescents 3 derniers mois Score total de 0 27 CPQ A en 27 items 0 58 CPQ A en 58 items 0a 12 CPQ A S gt usage probl matique partir de 3 1 2 minutes CPQ A S Anglais Copeland J Swift W Rees V 2001 Clinical profile of participants in a brief intervention program for cannabis use disorder Journal of Substance Abuse Treatment 20 1 45 52 Copeland J Swift W Roffman R Stephens R 2001 A randomized control led trial of brief cognitive behavioral interventions for cannabis use disor der Journal of Substance Abuse Treatment 21 2 55 64 Copeland J Gilmour S Gates P Swift W 2005 The Cannabis Problems Questionnaire Factor structure reliability and
108. mily or friends troubles origi nellement labor et valid aux tats Unis Voir CRAFFT page 72 73 ADOLESCENTS ET SUBSTANCES PSYCHOACTIVES ADOSPA ADOlescents et Substances PsychoActives Au cours des douze derniers mois 1 Etes vous d ja mont e dans un v hicule Auto moto scooter conduit par quelqu un vous y compris qui avait trop bu ou qui tait sous l emprise de drogue s 2 Avez vous d j utilis e de l alcool ou d autres drogues pour vous D tendre vous sentir mieux ou tenir le coup 3 Vous est il arriv d Oublier ce que vous aviez fait ou de faire des choses que vous n auriez pas faites sous l emprise de drogues s ou d alcool 4 Consommez vous de l alcool et d autres drogues quand vous tes Seul e 5 Avez vous d j eu des Probl mes en consommant de l alcool ou d autres drogues 6 Vos Amis ou votre famille vous ont ils d j dit que vous deviez r duire votre consommation de boissons alcoolis es ou de drogue s Oui Oui Oui Oui Oui Oui Non Non Non Non Non Non Au moins 2 r ponses affirmatives sur les 6 questions indiquent un usage nocif de drogues ou d alcool c est dire un mode de consommation r p t qui entra ne des m faits sur le plan physique affectif psychologique ou social O Q o T 9 i 2 a un T x 3 S T 9 x a Q o x T M w la o 2 E A
109. nally how often have you used tobacco Never Once More than Most days e g cigarettes cigars in the last month a week once or more or less a week oO o o o Date completed orenen eao CICA aee a a a nad Sed ounce nsec true Notes O A T 9 i o A un T S T 9 x S a a o LL T M g a o a o F A g a o T e z N 3 r S o A fe EU 3 w u I SMAQ Substance Misuse in Adolescence Questionnaire Auteur s Swadi Harith D partement de Psychiatrie et de sciences comportementales Universit des Emirats arabes unis E mail harith swadi cdhb govt nz Date de publication 1997 Type Questionnaire d entretien structur en 9 items Objectifs Rep rer les adolescents en situation d abus de substances Population cible Adolescents P riode de temps sur Vie enti re laquelle porte l outil Cotations scores Un score de 5 ou plus doit conduire une valuation approfondie Dur e de passation 2 minutes Langues Anglais Bibliographie Swadi H 1997 Substance Misuse in Adolescence Questionnaire par ordre SMA Q A pilot study of a screening instrument for problematic use chronologique of drugs and volatile substances in adolescents Child and Adolescent Mental Health 2 2 63 69 Swadi H 2000 Substance misuse in adolescents Advances in Psychiatric Treatment 6 3 201 210 Site Internet nd 2 a g
110. ne etc j Autres sp cifiez 0 3 Z 5 G ASSIST Alcohol Smoking and Substance Involvement Screening Test Question 4 Au cours des 3 derniers mois combien de fois votre consom z mation de PREMIERE SUBSTANCE DEUXIEME SUBSTANCE g 2 3 etc a t elle entra n des probl mes de sant ou des probl mes alg 3 3 sociaux l gaux ou financiers AIE SE EE vy see sas o e u 5 ay 2 T Oak a Tabac cigarette cigare pipe narguil tabac a chiquer etc 0 4 5 6 7 b Boissons alcooliques bi re alcopop vin spiritueux etc 0 4 5 6 7 c Cannabis marijuana joint herbe hash etc 0 4 5 6 7 d Cocaine coke crack etc 0 4 5 6 7 e Stimulants de type amph tamine speed pilules thai pilules 0 4 5 7 coupe faim ecstasy etc f Solvants colle essence diluant etc 0 4 5 6 7 g Calmants ou somnif res Valium Seresta Dormicum 0 4 5 6 7 Rohypnol Stilnox etc h Hallucinog nes LSD champignons PCP etc 0 4 5 6 7 i Opiac s h ro ne morphine m thadone cod ine k 0 4 5 6 7 bupr norphine etc j Autres sp cifiez 0 4 5 6 7 Question 5 Au cours des 3 derniers mois combien de fois n avez vous pas pu A a accomplir ce qui tait normalement attendu de vous en raison T 3 de votre consommation de PREMIERE SUBSTANCE DEUXIEME g amp R as SUBSTANCE etc mill gy Saleen eas ns i e CA a E S Cons wy 2 E Gal a Tabac
111. nts colle essence diluant etc 3 g Calmants ou somnif res Valium Seresta Dormicum Rohypnol Stilnox etc 3 h Hallucinog nes LSD champignons PCP etc 0 6 5 i Opiac s h ro ne morphine m thadone cod ine 3 bupr norphine etc 0 6 j Autres sp cifiez 0 6 3 ASSIST Alcohol Smoking and Substance Involvement Screening Test Question 8 Non Oui Oui jamais au cours mais pas des 3 derniers au cours mois des 3 derniers mois Avez vous d ja pris de la drogue en injection USAGE NON MEDICAL SEULEMENT NOTE IMPORTANTE Demandez aux patients qui se sont inject des drogues durant les 3 derniers mois quelle a t la fr quence d injection durant cette p riode afin d valuer le niveau de risque et de d terminer les priorit s d intervention FR QUENCE D INJECTION RECOMMANDATIONS Une fois par semaine ou moins OU Intervention br ve incluant la carte moins de 3 jours de suite risques associ s avec l injection Plus d une fois par semaine OU valuation approfondie et traitement 3 a 3 jours ou plus de suite plus intensi Comment calculer un score pour une substance sp cifique Pour chaque substance d sign e de a aj additionnez les scores obtenus pour les Questions 2 7 N incluez pas le r sultat de la Question 1 ou de la Question 8 dans ce score Par exemple un score pour le cannabis serait calcul ainsi Q2c Q3c
112. on drug use 0 3 Lower risk 4 26 Moderate Risk 27 High risk Guide pratique des principaux outils de rep rage de l usage pobl matique de cannabis BM MER D R 4 2 a g z v v T v S g 2 2 a v lzy n v T v a i J a v k v T oe 5 x 5 g 2 v a n v T v 5 LA 5 Lu a v T Auteur s E mail Date de publication Type Objectifs Population cible P riode de temps sur laquelle porte l outil Cotations scores Dur e de passation Langues Bibliographie par ordre chronologique Site Internet PESQ Personal Experience Screening Questionnaire Ken Winters Center for Adolescent Substance Abuse Department of Psychiatry University of Minnesota Etats Unis winte001 tc umn edu 1991 Questionnaire d entretien structur en 40 items sous copyright Rep rer les troubles psychosociaux li s l usage d alcool ou de drogues illicites et la n cessit d une valuation approfondie des troubles li s a l usage Adolescents 12 18 ans Vie enti re Calcul du score assist par ordinateur drapeau rouge ou vert selon la s v rit du probl me 10 minutes Anglais Winters KC 1991 Personal Experience Screening Questionnaire PESQ manual Western Psychological Services Los Angeles CA Winters KC 1992 Development of an adolescent alcohol and other drug abuse screening scale
113. our cannabis use please make your best estimate 101 6 days less than one day a month 207 12 days an average pattern of one day a month 30113 36 days an average pattern of 2 3 days a month 40137 52 days an average pattern of one day a week 5053 104 days an average pattern of 2 days a week eC up to 208 days an average pattern of 3 4 days a week 7Oup to 312 days an average pattern of 5 6 days a week sO up to 365 days daily most days 2 Now please think about your recent cannabis use On how many days have you used cannabis over the past 3 months 90 days o no days 101 2 days less than one day a month 203 4 days an average pattern of one day a month 305 9 days an average pattern of 2 3 days a month 40110 15 days an average pattern of one day a week 5016 26 days an average pattern of 2 days a week 60127 52 days an average pattern of 3 4 days a week 7053 78 days an average pattern of 5 6 days a week 80 79 90 days daily most days Over the past 12 months 3 How many times would you use cannabis on a typical day when you were using Note at least one hour between each new use iOonce 20 twice 303 4 times 405 6 times 507 9 times 6010 or more times 4 How often have you used cannabis first thing in the morning of never 1Oonce or twice 20 less than monthly sO monthly 40 one day a week sOseveral days a wee
114. peuvent tre prescrites par un m decin comme par ex des m dica ments contre la douleur des calmants des somnif res des coupe faim des stimulants Pour cet entre tien nous ne prenons pas en compte les m dicaments pris sur ordonnance m dicale Cependant si vous avez pris ces m dicaments pour des raisons autres que celles de la prescription ou que vous les avez pris plus fr quemment ou plus haute dose que prescrit je vous prie de me le faire savoir Soyez assur que toutes les informations recueillies seront trait es de fa on strictement confidentielle y compris celles concernant les drogues illicites ou interdites Note Avant de poser les questions suivantes donnez la CARTE REPONSE ASSIST au patient Question 1 S il s agit d une passation lors d un suivi veuillez comparer les r ponses du patient avec celles donn es lors de l valuation initiale Toute diff rence devrait tre investigu e Parmi les substances suivantes lesquelles avez vous d j consomm es Non Oui au cours de votre vie a Tabac cigarette cigare pipe narguil tabac chiquer etc b Boissons alcooliques bi re alcopop vins spiritueux etc c Cannabis marijuana joint herbe hash etc d Cocaine coke crack etc e Stimulants de type amph tamine speed pilules thai pilules coupe faim ecstasy etc Se S per e N WNW WW f Solvants colle essence diluant etc 0 g Calmants ou somnif res Valium
115. ping pills Valium Serepax Ativan Xanax Librium Rohypnol GHB etc g Hallucinogens LSD acid mushrooms PCP Special K ecstasy etc h Street opioids heroin opium etc i Prescription opioids fentanyl oxycodone OxyContin Percocet hydrocodone Vicodin methadone buprenorphine etc j Other specify m Given the patient s response to the Quick Screen the patient should not indicate NO for all drugs in Question 1 If they do remind them that their answers to the Quick Screen indicated they used an illegal or prescription drug for nonmedical reasons within the past year and then repeat Question 1 If the patient indicates that the drug used is not listed please mark Yes next to Other and continue to Question 2 of the NIDA Modified ASSIST m f the patient says Yes to any of the drugs proceed to Question 2 of the NIDA Modified ASSIST a r v v T v ay g 2 a v CU E v T v lzy k J a v v T ee 5 3 x m E v a n v T v 5 5 Lu a v T NIDA Quick Screen ou NIDA Modified ASSIST Alcohol Smoking and Substance Involvement Screening Test Question 2 of 8 NIDA Modified ASSIST g 3 2 In the past three months how often have you used as a the substances you mentioned first drug second drug etc z a A S HIS is s Cannabis marijuana pot grass hash etc 0 2 5 4 6
116. porte l outil Cotations scores Score total de O 11 Dur e de passation 5 minutes Langues Anglais Bibliographie Latimer WW Winters KC Stinchfield RD 1997 Screening par ordre for drug abuse among adolescents in clinical and correctional chronologique settings using the Problem Oriented Screening Instrument for Teenagers American Journal of Drug and Alcohol Abuse 23 1 79 98 Danseco ER Marques PR 2002 Development and validation of a POSIT Short Form Screening for problem behaviors among adolescents at risk for substance use Journal of Child and Adolescent Substance Abuse 11 3 17 36 Site Internet nd 2 a g v v T v 3 2 a v lzy CU v T v lzy i J a v k v T oe 5 x 5 g v a n v T v LA 5 k a v T POSIT version courte Problem oriented screening instrument for teenagers POSIT SHORT FORM POSIT VERSION COURTE PROBLEM ORIENTED SCREENING INSTRUMENT FOR TEENAGERS Oui Non 1 Avez vous d ja t accidentellement bless ou avez vous accidentellement bless quelqu un d autre apr s avoir consomm une quantit importante d alcool ou de drogues 2 Avez vous d j eu l impression d tre d pendant l alcool ou aux autres drogues 3 Etes vous oblig de consommer de plus en plus de drogues ou d alcool pour obtenir l effet que vous voulez 4 Avez vous constamment envie
117. que t ema 2 a v O N 5 v T rage Is de rep t incipaux ou Guide pratique des pr DAST 20 Drug Abuse Screening Test in 20 Questions Le questionnaire sur la consommation de drogues DAST 20 est une mesure g n rale de l usage excessif de drogues Il value le degr de s v rit de la consommation de drogues Le DAST 20 fournit un indice quantitatif des probl mes reli s la consommation de drogues notam ment certains sympt mes de d pendance aux drogues et d autres cons quences r sultant de l usage abusif de drogues psychoactives pendant la p riode des 12 derniers mois Le terme abus de drogues signifie soit 1 l utilisation excessive de m dicaments sur ordonnance ou de m dicaments en ventre libre soit 2 l usage de drogues des fins non m dicales Les drogues en ques tion se classent comme suit le cannabis comme la marijuana et le haschich les solvants les tranquil lisants comme le Vallium les barbituriques la cocaine les stimulants comme les speed et l ecstasy les hallucinog nes comme le LSD ou les narcotiques comme l h ro ne Consignes d utilisation Les questions portent sur la consommation de drogues sans inclure la consommation d alcool au cours des 12 derniers mois Lisez attentivement chaque question en choisissant votre r ponse oui ou non puis encerclez la r ponse appropri e Veuillez r pondre chaque question Si cer
118. r Wine Liquor 0 1 2 3 4 5 6 7 N r 2 T Marijuana or Hashish Zh Weed grass blunts 0 1 2 3 4 5 6 7 LSD MDA Mushrooms Peyote other z hallucinogens ACID o shrooms 0 1 2 3 4 5 6 7 Amphetamines Speed a Ritalin Ectasy Crystal 0 1 3 4 5 6 7 Powder Cocaine a Coke Blow 0 1 2 3 4 5 6 7 ae E Rock Cocaine S Crack rock freebase 0 1 2 3 4 5 6 7 a Barbiturates Quaaludes downers ei ludes blues 0 1 2 3 4 5 6 7 4 le PCP angel dust 0 1 2 3 4 5 6 7 o T Heroin other opiates 2 smack horse opium D morphine 0 1 2 3 4 5 6 7 3 Y Inhalants 0 1 2 3 4 5 6 7 Eh Glue gasoline spray cans O whiteout rush etc 0 1 2 3 4 5 6 7 a Valium Prozac other Q tranquilizers without Rx 0 1 2 3 4 5 6 7 5 5 OTHER DRUG 0 1 2 3 4 5 6 7 2 a v o T v m a a v D CU 3 v T v lzy k J a v k v T oe 5 3 x 2 v E a n v T v 5 5 k a v T AADIS Adolescent Alcohol and Drug Involvement Scale B AADIS These questions refer to your use of alcohol and other drugs like marijuana weed or cocaine rock If you are currently in residential treatment or in custody please answer regarding the time you were living in the com munity before you started treatment or were taken into custody Circle all the answers which describe your use of alcohol and or other drug s Even if none o
119. rrivez vous en retard cause de votre consommation d alcool ou d autres drogues 13 Votre famille ou vos ami e s vous ont ils d j dit que vous deviez r duire votre consommation d alcool ou de drogues 14 Avez vous de s rieuses disputes avec vos ami e s ou votre famille a cause de l alcool ou de la drogue 15 L alcool ou les autres drogues vous font ils faire des choses que vous ne feriez pas normalement ne pas respecter les r gles ne pas rentrer l heure pr vue la maison transgresser la loi 16 Avez vous des difficult s garder vos ami e s cause de l alcool ou d autres drogues 17 Avez vous d j eu l impression que vous ne pouviez pas contr ler votre utilisation d alcool ou d autres drogues O Q T 9 2 a M un T 5 2 T 9 x a a Q T M 9 a M a un 9 a T e z M 3 a fe g ol Q A 9 5 9 z un POSIT version courte Problem oriented screening instrument for teenagers Auteur s William Latimer pour la version courte en 11 items Department of Clinical and Health Psychology University of Florida Etats Unis E mail wwilatimer phhp ufl edu Date de publication 1997 Type Questionnaire d entretien structur en 11 items Objectifs Rep rer l abus ou la d pendance d alcool ou de drogues illicites Population cible Adolescents P riode de temps sur Vie enti re laquelle
120. rug problem Yes 15 Have any of your family members ever had a drinking or drug problem Yes 16 Do you feel that you have a drinking or drug problem now Yes No No No No No No No No No No No No No No No No SCORE Questions 1 and 15 are not scored Number of Yes Answers Screened positive a score of 4 or greater O Q T 9 2 c a M un T S T 9 a a Q o T M 9 a M a un 9 a T e z M 3 a fe g Q A 3 EU z un Is de cannabi ique t ema 2 a v O un 5 v T rage Is de rep t incipaux ou Guide pratique des pr Cr dits photos Ademoeller Fotolia com Binkski Fotolia com Cristian Ciobanu Fotolia com Elena Fotolia com Fred Fotolia com Orlando Bellini Fotolia com Radu Razvan Fotolia com raphtong Fotolia com Samuel Maissonnier Fotolia com Fr d rique Million OFDT Maquette Fr d rique Million OFDT
121. s a rendu inquiet ou anxieux Jamais ou presque jamais Quelquefois Souvent Toujours ou presque toujours 0 1 2 3 3 Est ce que votre consommation de cannabis vous a pr occup Pas du tout Un peu De temps en temps Beaucoup 0 1 2 3 4 Avez vous souhait tre capable d arr ter votre consommation de cannabis Jamais ou presque jamais Quelquefois Souvent Toujours ou presque toujours 0 1 2 3 5 Jusqu quel point est ce que ce serait difficile pour vous d arr ter de consommer ou de vivre sans cannabis Facile Assez difficile Tr s difficile Impossible 0 1 2 3 Score 115 Traduit par Tremblay J 1999 du SDS O a v s g i 2 a M un T 5 S D ry x Et a a D M 2 g a a A w Q v 3 i 2 o a fe 5 o T un Guide pratique des principaux outils de rep rage de l usage pobl matique de cannabis OUTILS DE REPERAGE ALCOOL ET DROGUES ILLICITES APPLICABLES di ds AADIS Adolescent Alcohol and Drug Involvement Scale ADIS Adolescent Drug Involvement Scale ADOSPA Adolescents et substances psychoactives version francaise du CRAFFT ASMA Assessment of Substance Misuse in Adolescence ASSIST Alcohol Smoking and substance involvement screening test CRAFFT Car Relax Alone Forget Family or friends Trouble DAP Drug and Alcohol Problem Quick Screen DAST A Drug Abuse Screening Test
122. search 29 7 1264 1267 Legleye S Karila L Beck F Reynaud M 2007 Validation of the CAST a general population Cannabis Abuse Screening Test Journal of Substance Use 12 4 233 242 Legleye S Piontek D Kraus L 2011 Psychometric properties of the Cannabis Abuse Screening Test CAST in a French sample of adolescents Drug and Alcohol Dependence 113 2 3 229 235 Legleye S Kraus L Piontek D Phan O Jouanne C 2012 Validation of the Cannabis Abuse Screening Test in a sample of cannabis inpatients European Addiction Research 18 4 193 200 Legleye S Piontek D Kraus L Morand E Falissard B 2013 A validation of the Cannabis Abuse Screening Test CAST using a latent class analysis of the DSM IV among adolescents International Journal of Methods in Psychiatric Research 22 1 16 26 http www ofdt fr BDD publications docs eisxsst9 pdf CAST Cannabis Abuse Screening Test Au cours des 12 derniers mois Jamais Rarement De temps Assez Tr s Une seule croix par ligne entemps souvent souvent 1 Avez vous fum du cannabis avant midi 2 Avez vous fum du cannabis lorsque vous tiez seul e 0 0 1 1 1 3 Avez vous eu des probl mes de m moire quand vous fumiez du cannabis 0 1 1 1 1 4 Des amis ou des membres de votre famille vous ont ils dit que vous devriez r duire votre consommation de cannabis 5 Avez vous essay de r duire ou d arr ter votre consommation de
123. sistent mental illness Psychological Assessment AAP WSS 1S2 Yudko E Lozhkina O Fouts A 2007 A comprehensive review of the psy chometric properties of the Drug Abuse Screening Test Journal of Substance Abuse Treatment 32 2 189 198 Smith PC Schmidt SM Allensworth Davies D Saitz R 2010 A single ques tion screening test for drug use in primary care Archives of Internal Medicine 170 13 1115 1160 http ctndisseminationlibrary org display 819 htm http adai washington edu instruments pdf Drug_Abuse_Screening_Test_105 pdf DAST A Drug Abuse Screening Test Adolescents THE DRUG ABUSE SCREENING TEST ADOLESCENTS DAST A Directions The following questions concern information about your involvement with drugs Drug abuse re fers to 1 the use of prescribed or over the counter drugs in excess of the directions and 2 any non me dical use of drugs Consider the past year 12 months and carefully read each statement Then decide whether your answer is YES or NO and check the appropriate space Please be sure to answer every question YES NO 1 Have you used drugs other than those required for medical reasons 1 0 2 Have you abused prescription drugs 1 0 3 Do you abuse more than one drug at a time 1 0 4 Can you get through the week without using drugs other than those required 0 1 a for medical reasons a 5 Are you always able to stop using drugs when you want to 0 1 5 P
124. son 12 Have you been physically sick after smoking 13 Have you passed out after a smoking session 14 Have you had pains in your chest or lungs after a smoking session 15 Have you had a persistent chest infection or cough 16 Have you felt paranoid or antisocial after a smoking session 17 Have you had any accidents requiring hospital admission after smoking 18 Have you lost any weight without trying to 19 Have you been neglecting yourself physically 20 Have you felt depressed for more than a week 21 Have you felt so depressed you felt like doing away with yourself 22 Have you given up any activities you once enjoyed because of smoking 23 Have you had less energy than in the past 24 Have you found it hard to get the same enjoyment from your usual interests 25 Has your general health been poorer than usual 26 Have you driven while stoned 27 Have you worried about getting out of touch with friends or family 28 Have you been concerned about a lack of motivation 29 Have you felt less able to concentrate than usual 30 Have you worried about feelings of personal isolation or detachment ND Oo NI IN gt CPQ A et CPQ A S Cannabis Problems Questionnaire for Adolescents ADDITIONAL ITEMS If you have lived with a parent or guardian in the past 3 months answer these questions Otherwise go to the next section In the last 3 months Yes No 31 Do your parent s use canna
125. ssist pdf http www drugabuse gov nidamed screening http www nida nih gov nidamed resguide screeningtool html http www drugabuse gov nmassist NIDA Quick Screen ou NIDA Modified ASSIST Alcohol Smoking and Substance Involvement Screening Test NIDA Quick SCREEN V1 0F1 Sex F M Age Introduction Please read to patient Hi I m nice to meet you If it s okay with you l d like to ask you a few questions that will help me give you better medical care The questions relate to your experience with alcohol cigarettes and other drugs Some of the substances we ll talk about are prescribed by a doctor like pain medications But will only record those if you have taken them for reasons or in doses other than prescribed I ll also ask you about illicit or illegal drug use but only to better diagnose and treat you Instructions For each substance mark in the appropriate column For example if the patient has used cocaine monthly in the past year put a mark in the Monthly column in the illegal drug row NIDA Quick Screen Question a a S E DS 5 In the past year how often have you used the following D S 5 2 re ro 2 22 oO O v T Z gt ARS Alcohol For men 5 or more drinks a day For women 4 or more drinks a day Tobacco Products Prescription Drugs for Non Medical Reasons Illegal Drugs E f the patient says NO for all drugs in the Quick Screen r
126. stance Involvement Screening Test ASSIST Version 3 0 developed and published by WHO available at http www who int substance_abuse activities assist_v3_english pdf O Q T 7 t 2 S a o wv T gt a T 9 g x Et a Q LL T LA g amp o a r w ta o T O 3 Y r 2 S Q o la w EU 7 NIDA Quick Screen ou NIDA Modified ASSIST Alcohol Smoking and Substance Involvement Screening Test QUESTIONS 1 8 OF THE NIDA MoDIFIED ASSIST V2 0 Instructions Patients may fill in the following form themselves but screening personnel should offer to read the questions aloud in a private setting and complete the form for the patient To preserve confi dentiality a protective sheet should be placed on top of the questionnaire so it will not be seen by other patients after it is completed but before it is filed in the medical record Question 1 of 8 NIDA Modified ASSIST In your LIFETIME which of the following substances have you ever used Yes No Note for Physicians For prescription medications please report nonmedical use only a Cannabis marijuana pot grass hash etc b Cocaine coke crack etc c Prescription stimulants Ritalin Concerta Dexedrine Adderall diet pills etc d Methamphetamine speed crystal meth ice etc e Inhalants nitrous oxide glue gas paint thinner etc f Sedatives or slee
127. stionnaire d entretien structur en 6 items Objectifs Rep rer un usage nocif de substances psycho actives alcool ou drogues illicites et d terminer le niveau de risque tude ADOTECNO Population cible Adolescents et jeunes adultes lt 21 ans P riode de temps sur Vie enti re laquelle porte l outil Cotations scores Risque d usage nocif d alcool ou de drogues illicites m score de 0 1 point risque faible m score gt 2 risque mod r notamment de cannabis abus ou d pendance m score gt 3 risque lev Dur e de passation 1 3 minutes Langues Anglais chinois cr ole haitien h breu japonais khmer laotien russe por tugais espagnol turc vietnamien traductions du Massachusetts Depart ment of Public Health tch que fran ais voir ADOSPA Bibliographie Knight JR Shrier LA et al 1999 A new brief screen for adolescent par ordre substance abuse Archives of Pediatrics and Adolescent Medicine chronologique 153 6 591 596 Knight JR Sherritt L A SL Harris SK Chang G 2002 Validity of the CRAFFT substance abuse screening test among adolescent clinic patients Archives of Pe diatrics and Adolescent Medicine 156 6 607 614 Cummins LH Chan KK et al 2003 Validity of the CRAFFT in American Indian and Alaska Native adolescents screening for drug and alcohol risk Journal of Studies on Alcohol 64 5 727 732 Knight JR Sherritt L Harris SK Gates EC Chang G 2003
128. sur laquelle porte l outil Cotations scores Dur e de passation Langues Bibliographie par ordre chronologique Site Internet et de drogue chez les ADOlescents i Michel Germain Michel Landry Conseiller recherche au Centre Dollard Cormier Institut universitaire sur les d pendances Montr al Qu bec et Professeur associ a la Facult de m decine et des sciences de la sant de l Universit de Sherbrooke michel landry ssss gouv qc ca 2004 Questionnaire d entretien structur en 7 items Permettre au m decin un rep rage des consommations probl matiques d alcool ou de drogues illicites et le conseiller sur la suite donner Jeunes de 11 18 ans Vie enti re et 12 derniers mois Version 7 items Version 6 items Indication Score de 0 8 0 13 pas d intervention feu vert Score de 9 16 14 19 intervention souhaitable feu jaune Score gt 17 gt 20 intervention n cessaire feu rouge 15 minutes et 1 2 minutes pour la correction temps suppl mentaire pour l interpr tation des r sultats en lien avec le jeune Fran ais version 3 2 septembre 2007 grille valid e pour une population qu b coise de 14 17 ans anglais Version 3 2 septembre 2007 grille non valid e mais traduction valid e inuktitut Version 3 1 octobre 2003 grille adapt e en 2004 et non valid e Landry M Tremblay J Guyon L Bergeron J Brunelle N 2004 La grille de d pistage de la
129. t OMS 1997 phase l 2011 fin de la phase IV Questionnaire d entretien structur 8 items D pistage bref de la consommation de drogues tabac alcool cannabis cocaine stimulants opiac s etc pour d terminer la suite de la prise en charge m dicale m Tous les adolescents vus en m decine de premier recours en particulier dans les services m dicaux universitaires et les services de soins destin s aux jeunes m Patients dont les sympt mes sugg rent un usage de substances m Patients pour lesquels un usage de substances est contre indiqu m Femmes enceintes Vie enti re et 3 derniers mois 0 3 pas d intervention 4 26 intervention br ve gt 27 traitement plus intensif par un m decin de premier recours ou service sp cialis noter que les scores concernant l alcool sont diff rents avec une r partition respectivement de 0 10 11 26 et gt 27 De 4 15 minutes selon le nombre de substances consomm es Anglais fran ais WHO ASSIST Working Group 2002 The Alcohol Smoking and Substance Involvement Screening Test ASSIST development reliabi lity and feasibility Addiction 97 9 1183 1194 Humeniuk R Ali R et al 2008 Validation of the Alcohol Smoking And Sub stance Involvement Screening Test ASSIST Addiction 103 6 1039 1047 Thake J Davis CG 2011 Assessing problematic cannabis use Addiction Re search and Theory 19 5 448 458 Humeniuk R
130. t second drug etc 3 months 3 months a Cannabis marijuana pot grass hash etc 0 5 6 b Cocaine coke crack etc 0 5 6 c Prescribed Amphetamine type stimulants 0 5 6 Ritalin Concerta Dexedrine Adderall diet pills etc d Methamphetamine speed crystal meth ice etc 0 3 6 e Inhalants nitrous oxide glue gas paint thinner etc 0 5 6 a f Sedatives or sleeping pills Valium Serepax 0 5 6 a Xanax Ativan Librium Rohypnol GHB etc 2 g Hallucinogens LSD acid mushrooms PCP 0 3 6 o Special K ecstasy etc h Street opioids heroin opium etc 0 3 6 i Prescribed opioids fentanyl oxycodone 0 3 6 OxyContin Percocet hydrocodone Vicodin z methadone buprenorphine etc i j Other Specify 0 3 6 Y x et 7 Have you ever tried and failed to control No Yes but not Yes in an cut down or stop using first drug never in the past the past second drug etc 3 months 3 months z E a Cannabis marijuana pot grass hash etc 0 5 6 b Cocaine coke crack etc 0 5 6 e c Prescribed Amphetamine type stimulants Ritalin 0 3 6 Concerta Dexedrine Adderall diet pills etc d Methamphetamine speed crystal meth ice etc 0 3 6 a e Inhalants nitrous oxide glue gas paint thinner etc 0 5 6 f Sedatives or sleeping pills Valium Serepax Xanax 0 5 6 8 Ativan Librium Rohypnol GHB etc g Hallucinogens LSD acid mushrooms PCP 0 3 6
131. tabac chiquer etc b Boissons alcooliques bi re alcopop vins spiritueux etc c Cannabis marijuana joints herbe hash etc d Coca ne coke crack etc e Stimulants de type amph tamine speed pilules tha pilules coupe faim ecstasy etc f Solvants colle essence diluant etc g Calmants ou somnif res Valium Seresta Dormicum Rohypnol Stilnox etc h Hallucinog nes LSD champignons PCP etc i Opiac s h ro ne morphine m thadone cod ine bupr norphine etc j Autres sp cifiez Carte r ponse ASSIST questions 2 5 Jamais pas de consommation au cours des 3 derniers mois Une ou deux fois une ou deux fois au cours des 3 derniers mois Mensuellement une trois fois en un mois Hebdomadairement une quatre fois par semaine Chaque jour ou presque chaque jour cinq sept jours par semaine Carte r ponse ASSIST questions 6 8 Non jamais Oui mais pas au cours des 3 derniers mois Oui durant les derniers 3 mois Guide pratique des principaux outils de rep rage de l usage pobl matique de cannabis BM MER D 4 CRAFFT Car Relax Alone Forget Family or Friend Trouble Auteur s John R Knight Professeur en P diatrie Center for Adolescent Substance Abuse Research Children s Hospital de Boston Etats Unis E mail knight_j a1 tch harvard edu john knight childrens harvard edu Date de publication 1999 Type Que
132. taines questions posent des difficult s choisissez la r ponse la plus appropri e Pointage et interpr tation 1 Le pointage du test DAST 20 est effectu en additionnant les r ponses obtenues Le pointage total varie de 0 20 2 Les r ponses NON aux questions 4 et 5 indiquent un probl me li la consommation de drogues et don nent 1 point 3 Une r ponse OUI toutes les autres questions indique un probl me li la consommation de drogues et donnent 1 point 4 Un pointage de z ro indique qu aucun probl me li la consommation de drogues n a t signal Les pointages sup rieurs refl tent le degr relatif des probl mes du client en ce qui concerne la consom mation de drogues Un pointage de 20 indique des probl mes importants li s l usage abusif des drogues Plusieurs tudes Skinner 1982 Gavin Ross et al 1989 pr sentent des donn es valables justifiant luti lisation d un seuil de positivit de 5 ou plus sur l chelle DAST 20 pour signifier un usage abusif de drogues 1a5 6a10 it 15 16 20 Niveau peu lev Niveau de probl mes Niveau de probl mes Niveau de probl mes de probl mes possiblement mod r possiblement substantiel possiblement s v res Guide pratique des principaux outils de rep rage de l usage pobl matique de cannabis BA MED W 2 a r g v o T v 5 td 2 2 a v CU 3 o T v lzy i J a v
133. tique ou l abus sont recherch s en neuf ques tions sans d termination de seuil Si le m decin d tecte des l ments de consommation risque une intervention br ve est conseill e Une inter vention sp cialis e est pr conis e si un probable abus est diagnostiqu nd Anglais version 1 7 2008 fran ais version 1 8 2009 Tremblay J Blanchette Martin N 2009 Manuel d utilisation du DEBA Alcool Drogues Jeu Service de recherche CRUV ALTO Qu bec Tremblay J Simoneau H Blanchette Martin N Landry M Bergeron J 2012 Rapport personnalis DEBA Alcool RISQ Montr al QC http www risqtoxico ca documents DEBA_D_v1 8p_18dec09 pdf http www risqtoxico ca risq www deba php DEBA D D pistage et valuation du besoin d aide drogues DEBA D D PISTAGE ET EVALUATION DU BESOIN D AIDE DROGUES V1 8 Pp Tremblay J Rouillard P amp Sirois M 2000 R v 18 d cembre 2009 z Age _ N de dossier O Femme O Homme Pr nom de l usager en lettres moul es s v p Nom de l usager en lettres moul es s v p Dans la liste des produits suivants indiquer quelle fr quence la personne a consomm de chacun de ceux ci depuis un ans Questionner sur chacun des produits Liste des noms de produits les plus communs au verso N t l r sidence Autre n t l phone Si prend med s datifs D passe posologie 1 M d
134. to get through a day without using cannabis of never 10 sometimes 20 quite often sO very often 4O always all the time CUPIT Cannabis Use Problems Identification Test Over the past 12 months 11 Did your use of cannabis ever interfere with get in the way of your work at school your job or your home life of never 1O sometimes 20 quite often 30 very often 4O always all the time 12 Have you lacked the energy to get things done in the way you used to of never 1O sometimes 20 quite often sO very often 4O always all the time 13 Have you given up things you used to enjoy or were important because of cannabis e g work school sports hobbies being with family and friends etc oUnone at all nothing 17 one or two things 20 quite a few things 30 lots of things 4O everything 14 Has anything you had planned or were expected to do not happened after using cannabis e g a family outing chores taking care of children homework an assignment appointment job interview training attending school or work etc oO never 10 sometimes 20 quite often sO very often 4O always all the time 15 Have you had problems concentrating and remembering things oO never iO sometimes 20 quite often 30 very often 40 always all the time 16 Did you ever use cannabis after you had decided not to oC never 1O sometimes 20 quite often sO very often 4O always all the time O Q
135. tre consommation de 10 O O O 11 Est ce que l id e de ne pas consommer du tout de vous a rendu inquiet ou anxieux 11 O O O O 12 Est ce que votre consommation de vous a pr occup e 12 O O O 13 Avez vous souhait tre capable d arr ter votre consommation de 13 O O O O 14 Jusqu quel point est ce que ce serait difficile pour vous 14 O Facile 0 O Tr s difficile 2 d arr ter de consommer ou de vivre sans O Assez difficile 1 Impossible 3 15 Voulez vous recevoir de l aide pour changer vos habitudes O Oui ESD Total de consommation de m dicaments ou de drogues O Non L Interpr tation au verso Date F so c Ann e Mois Jour Nom pr nom de l intervenant e en lettres moul es s v p Initiale de l intervenant O Q o T 9 t 2 a M un T S T 9 Et a Q x T M w o 2 E N g Q T z M 3 M iy 2 Q o fe o 3 gt 9 w a IS de cannabi ique t ema 2 a v O N 5 v T Is de rep rage t incipaux ou Guide pratique des pr D BA D D pistage et valuation du besoin d aide drogues Tremblay J Rouillard P amp Sirois M 2000 R v 18 d cembre 2009 N de dossier 1 M dicaments s datifs 5 Coca ne 6 Autres stimulants 8 Inhalants Anxiolytiques Hypnotiques Coca ne pris e Amph tamin
136. tu n as consomm aucun des produits mentionn s gt passe la question 7 O A T 9 i o amp M un T gt S T g x Et a a o LL T LA g a o a o F N g a o T z M 3 r S a o fe w u 4 As tu consomm de l alcool ou d autres drogues O Oui O Non au cours des 30 derniers jours Germain M Guyon L Landry M Tremblay J Brunelle N Bergeron J 2007 DEP ADO Grille de d pistage de consommation probl matique d alcool et de drogues chez les adolescents et les adolescentes Version 3 2 septembre 2007 Recherche et intervention sur les susbtances psychoactives Qu bec RISQ DEP ADO DEPistage de consommation probl matique d alcool et de drogue chez les ADOlescents N de dossier R serv a l usage R de l intervenant 5 Au cours des 12 derniers mois combien de fois as tu pris SCORE BRUTS FACTORIELS a Gar ons i 5 consommations d alcool ou plus dans une m me occasion Fois ii 8 consommations d alcool ou plus dans une m me occasion N Fois b Filles L i 5 consommations d alcool ou plus dans une m me occasion A Fois N Fe A 6 Au cours des 12 derniers mois cela t est il arriv Oui Non a ta consommation d alcool ou de drogue a nui O O ta sant physiq
137. ue Site Internet ADIS Adolescent Drug Involvement Scale D Paul Moberg Center for Health Policy and Program Evaluation University of Wisconsin Medical School dpmoberg facstaff wisc edu 1991 Questionnaire d entretien structur 12 items Mesurer le niveau d usage de drogues illicites chez l adolescent outil adapt de l chelle AAIS Adolescent Alcohol Involvement Scale de Mayer and Filstead Adolescents Vie enti re Plus le score est lev plus l engagement dans l usage de drogues est im portant drug involvement 4 5 minutes Anglais Mayer J Filstead WJ 1979 The Adolescent Alcohol Involvement Scale an instrument for measuring adolescents use and misuse of alcohol Journal of Studies on Alcohol 40 3 291 300 Moberg DP 1983 Identifying adolescents with alcohol problems A field test of the Adolescent Alcohol Involvement Scale Journal of Studies on Alcohol 44 4 701 721 Moberg DP 1985 The social control of deviance Intervention with adolescent alcohol and other drug users Ph D Dissertation University of Wisconsin Madison Wisniewski NM Glenwick DS Graham JR 1985 MacAndrew scale and sociodemographic correlates of adolescent alcohol and drug use Addictive Behaviors 10 1 55 67 Moberg DP Hahn L 1991 The Adolescent Drug Involvement scale Journal of Adolescent Chemical Dependency 2 1 75 88 Winters KC Henly GA 1993 Adolescent Diagnostic Interv
138. ue ex probl mes digestifs overdose infection S irritation nasale tu as t bless e etc v b tu as eu des difficult s psychologiques cause O O de ta consommation d alcool ou de drogue ex anxi t d pression probl mes de concentration pens es suicidaires etc E c ta consommation d alcool ou de drogue a nui tes relations O O E wv avec ta famille a Sl d ta consommation d alcool ou de drogue a nui une O O v de tes amiti s ou ta relation amoureuse 5 e tu as eu des difficult s l cole a cause de ta consommation O O d alcool ou de drogue ex absence suspension baisse des notes baisse v de motivation etc vd v f tu as d pens trop d argent ou tu en as perdu beaucoup O O m cause de ta consommation d alcool ou de drogue ka U i a g tu as commis un geste d linquant alors que tu avais v consomm de l alcool ou de la drogue m me si la police O O a v ne t a pas arr t ex vol avoir bless quelqu un vandalisme vente T de drogues conduite avec facult s affaiblies etc N D h tu as pris des risques alors que tu avais consomm de l alcool O O z ou de la drogue ex relations sexuelles non prot g es ou invraisemblables x jeun consuite d un v lo ou activit s sportives sous intoxication etc 5 Ay i tu as eu l impression que les m mes quantit s d alcool O O 5 ou de drogues avaient maintenant moins d effet sur toi F j tu as parl de
139. ues ou des m dicaments 1 0 9 Est ce que l abus de drogues ou de m dicaments vous a caus des ennuis a avec votre conjoint ou vos parents 1 0 E 10 Avez vous perdu des amis cause de votre usage de drogues ou de m dicaments 1 0 D FRE Ts a 11 Avez vous n glig votre famille cause de votre usage de drogues M ou de m dicaments 1 0 12 Avez vous eu des ennuis au travail caus s par l abus de drogues ou de m dicaments 1 0 13 Avez vous perdu un emploi cause de l usage de drogues ou de m dicaments 1 0 4 gt z fe i a 14 Vous tes vous battu e en tant sous l influence de drogues ou de m dicaments 1 0 15 Vous tes vous engag e dans des activit s ill gales dans le but d obtenir 5 des drogues ou des m dicaments 1 0 T ELE mae z RE M 16 Avez vous t arr t e pour possession de drogues ill gales 1 0 3 17 Avez vous prouv des sympt mes de sevrage vous tes vous senti malade a apr s avoir interrompu votre consommation de drogues ou de m dicaments 1 0 2 18 Avez vous eu des probl mes m dicaux suite votre usage de drogues w ou de m dicaments p ex pertes de m moire h patite convulsions saignements etc 1 0 19 Avez vous cherch de l aide pour r soudre un probl me de drogues 9 ou de m dicaments 1 0 3 20 Avez vous suivi un programme de traitement sp cifiquement 2 li l usage de drogues ou de m dicaments 1 0 n DAST 20 Total Is CRETE i
140. uillisants ritalin p 2 b Au cours de ta vie as tu d j consomm l un de ces produits de fa on r guli re Alcool lt 12 ans 5 Drogues lt 14ans 5 12 15ans 2 14 15ans 2 16ansou 1 16ansou 1 3 Au cours de ta vie t es tu d j inject des drogues Oui 8 Non 0 4 As tu consomm de l alcool ou d autres drogues au cours des 30 derniers jours Oui 8 Non 0 5 Au cours des 12 derniers mois combien de fois as tu pris 8 Gar ons 5 Filles consomma tions d alcool ou plus dans une m me occasion Aucune fois 0 1 2fois 1 3 25 fois 2 26 fois et plus 3 6 Au cours des 12 derniers mois cela t est il arriv Oui 8 Non 0 FAIRE LE TOTAL DES POINTS 13 et moins FEU VERT Aucun probl me vident de consommation aucune intervention n cessaire Entre 14 et 19 FEU JAUNE Probl me en mergence intervention pr coce souhaitable 20 et FEU ROUGE Probl me vident intervention sp cialis e n cessaire 1 Cette grille de cotation se rattache la DEP ADO version 3 2 septembre 2007 La grille de cotation a t conserv e telle quelle depuis octobre 2003 puiqu aucune modification n a t requise O A T 9 i o A un T S T 9 x S a a o LL T LA g a o a o F N g a o T z M 3 r S a o fe w w u 2 a g z v v T v 2 2 a v lzy
141. uspended from school because of smoking If you have been employed either part time or full time Yes No in the past 3 months please answer these questions 50 Have you found your work less interesting than you used to 5 52 Have you missed a whole day at work after a smoking session Have you been unable to arrive on time for work due to your smoking 53 Have you been less able to do your job because of smoking 54 Have you gone to work stoned 55 Has anyone at work complained about you being late or absent 56 Have you had any formal warnings from your employers 57 Have you been suspended or dismissed from work 58 Have you had any accidents at work after smoking O Q o T 9 i 2 a M un T 3 S T 9 x Et a Q o x T M w la o 2 E A g Q T e z N 3 M 2 Q o fe 9 gt 9 un CPQ A et CPQ A S Cannabis Problems Questionnaire for Adolescents CPQ A S SHORT FORM Scale and scoring Please place a cross X next to Yes or No In relation to your cannabis use Yes No 1 Have you tended to smoke more on your own than you used to 2 Have you worried about meeting people you don t know when you are stoned 3 Have you spent more time with smoking friends than other kinds of friends 4 Have your friends criticised you for smoking too much 5 Have you found yourself worried about the amount
142. ver sheet to respondent Name ID DOB Date Age Sex 1 Male 2 Female Ethnicity 1 African American 2 Asian 3 Caucasian European American 4 Hispanic 5 Native American Indian 6 OTHER Home Community Reason for Screening AADIS SCORING RESULTS Items B 1 14 are scored The weights assigned are basically the same as those originally used on the AAIS For each item B 1 14 add the weights associated with the highest category circled weights are the numbers in square brackets on the interview version Section A is not scored If more than one ans wer is circled use the highest The higher the total score the more serious the level of alcohol drug in volvement AADIS SCORE Score of 37 or above suggests need for a full professional substance abuse assessment DO YOU RECOMMEND FULL ASSESSMENT Regardless of the AADIS score 0 NO 1 YES COMMENTS Screened By Guide pratique des principaux outils de rep rage de l usage pobl matique de cannabis EA pnd R 4 2 a r v v T v 2 2 a v lzy n 3 v T v zy i J a v v T ee 5 x 5 g v a n v T v 5 ka 5 k a v T Oo Auteur s E mail Date de publication Type Objectifs Population cible P riode de temps sur laquelle porte l outil Cotations scores Dur e de passation Langues Bibliographie par ordre chronologiq
143. while using marijuana If so about how many accidents have you had nu 30 Have you ever had a bad trip a bummer or felt very anxious and paranoid while using marijuana If so about how many times has this happened incipaux ou 31 Do you ever use marijuana to feel normal If so about how often a month Scored 0 No problem Scored 1 2 Low risk pattern of marijuana use Scored 3 5 Moderate risk pattern of marijuana use Scored gt 6 High risk problematic pattern of marijuana use Guide pratique des pr Guide pratique des principaux outils de rep rage de l usage pobl matique de cannabis as a g z d v T v 5 Ld g 2 2 a v N o T v a i J a v k v T oe 5 x 5 g 2 v a N v T v 5 LA 5 Lu a v T Auteur s E mail Date de publication Type Objectifs Population cible P riode de temps sur laquelle porte l outil Cotations scores Dur e de passation Langues Bibliographie par ordre chronologique Site Internet PUM Problematic Use of Marijuana Katarzyna Okulicz Kozaryn Janusz Sierostawski Katarzyna Kocon kokulicz ipin edu pl 2007 Questionnaire d entretien structur en 8 items Permettre un rep rage rapide d un usage probl matique de cannabis en distinguant les situations d usage occasionnel des usages probl matiques risqu
144. y school work arrest or being punished at school e have lost friends because of use for using alcohol or drugs 13 How do you feel about your use of alcohol or drugs CIRCLE ALL THAT APPLY a no problem at all d I often feel bad about my use b can control it and set limits on myself e need help to control myself c can control myself but my friends f have had professional help to easily influence me control my drinking or drug use 14 How do others see you in relation to your alcohol or drug use CIRCLE ALL THAT APPLY a can t say or normal for my age d my family or friends tell me to get help for b when use tend to neglect my family my alcohol or drug use or friends e my family or friends have already gone for help c my family or friends advise me to control about my use or cut down on my use O Q o T 9 t 2 a M un T S T 9 Et a a o x T M 9 la o 2 E A 9 ta T e z N 3 M 2 Q o fe o gt 9 w a a v v T v m a a v D CU 3 v T v lzy k J a v v T oe 5 3 x m E v E a n v T v 5 5 k a v T AADIS Adolescent Alcohol and Drug Involvement Scale ADOLESCENT ALCOHOL AND DRUG INVOLVEMENT SCALE AADIS Survey Version COVER SHEET TO BE COMPLETED BY STAFF Do not give this co
145. ydrocodone Vicodin methadone buprenorphine etc gt j Other Specify 0 4 5 6 7 3 LA 5 During the past 3 months how often have you failed F 2 to do what was normally expected of you because of your use of first drug second drug etc 5 K g IS ce S E S alle Ss e a T AIS ORNE M D 3 a Cannabis marijuana pot grass hash etc DNS 6 7 8 A b Cocaine coke crack etc 5 6 8 c Prescribed Amphetamine type stimulants Ritalin Concerta 0 5 6 Zi 8 Ss Dexedrine Adderall diet pills etc d Methamphetamine speed crystal meth ice etc 0 5 6 7 8 A e Inhalants nitrous oxide glue gas paint thinner etc 0 5 6 7 8 Z f Sedatives or sleeping pills Valium Serepax Ativan Librium 0 5 6 7 8 v Xanax Rohypnol GHB etc g Hallucinogens LSD acid mushrooms PCP Special K 0 5 6 7 8 5 ecstasy etc a h Street Opioids heroin opium etc 0 5 6 7 8 S i Prescribed opioids fentanyl oxycodone OxyContin Percocet 0 5 6 7 8 3 hydrocodone Vicodin methadone buprenorphine etc j Other Specify 0 5 6 7 8 Instructions Ask Questions 6 amp 7 for all substances ever used i e those endorsed in the Question 1 NIDA Quick Screen ou NIDA Modified ASSIST Alcohol Smoking and Substance Involvement Screening Test 6 Has a friend or relative or anyone else ever No Yes but not Yes in expressed concern about your use of first drug never in the past the pas
146. you 10 Made excuses to your parents about your alcohol or drug use semen When using alcohol or other drugs how often have you 16 Spilled things bumped into things fallen down or had trouble walking around Te LES 18 19 1 ap sjnno xnedpurid sap anbijeid apiny In order to get or pay for alcohol or other drugs hoy often have yo 20 Sold drugs Ban PLEASE TURN THE FORM OVER AND COMPLETE PARTS II AND III want a Fanrioht 1004 hy WESTERN PEVCHAT AGICAaT SERVICES M S g a M a un LY a v z N 3 a 2 a A 3 5 o un 2 a g z v v T v 5 Ld g 2 2 a v n 3 v T v lzy i J a v v T ee 5 x 5 g v a n v T v 5 La 5 k a v T POSIT Facteur A Problem oriented screening instrument for teenagers Auteur s E mail Date de publication Type Objectifs Population cible P riode de temps sur laquelle porte l outil Cotations scores Dur e de passation Langues Bibliographie par ordre chronologique Site Internet Elizabeth Rahdert National Institute on Drug Abuse NIDA National Institutes of Health Bethesda Maryland tats Unis Elizabeth_Rahdert nih gov 1991 Questionnaire d entretien structur en 17 items sur usage et l abus d alcool ou de drogues illicites section du POSIT sur les drogues
147. z v v T v S g 2 2 a v lzy n v T v a i J a v k v T oe 5 x m v a n v T v 5 k 5 k a v T I SMAQ Substance Misuse in Adolescence Questionnaire SUBSTANCE MISUSE IN ADOLESCENCE QUESTIONNAIRE SMAQ Answers with a yes score 1 and answers with a no score 0 Yes No 1 Are the effects of the drug more important to you than the adventure of use 1 0 2 Do you have a favourite drug 1 0 3 Do you ever use alone 1 0 4 Do you use to suppress feeling sad bored lonely confused or anxious 1 0 5 Are you thinking a lot about drugs and drug use 1 0 6 Do you plan your day to make sure you can use 1 0 7 Do you need to use more to get high now than before 1 0 8 Do you feel depressed irritable or anxious if you do not use 1 0 9 Do you crave for or miss your favourite drug 1 0 A total score of 5 or more is a strong indication for further detailed assessment O Q o T 9 t 2 a M un T S T 9 Et a Q o x T M w la o 2 E A g Q T e z M 3 M iy 2 Q o fe 9 gt 9 a 2 a r g v o T v 3 g oy 2 a v lzy CU v T v lzy i J a v v T ee 5 x 5 g v a n v T v 5 La 5 k a v T Auteur s E mail Dat
148. z vous pas fait ce que l on attendait de vous parce que vous aviez consomm du cannabis DJamais OMoins d une fois OUne fois OUne fois OTous les jours par mois par mois par semaine ou presque 0 1 2 3 4 6 Combien de fois pendant les 6 derniers mois avez vous prouv le besoin de consommer du cannabis le matin afin de pouvoir vous mettre en route apr s un usage important de cannabis la veille DJamais OMoins d une fois OUne fois OUne fois OTous les jours par mois par mois par semaine ou presque 0 1 2 3 4 7 Combien de fois pendant les 6 derniers mois vous tes vous senti e coupable ou avez vous eu des regrets apr s avoir consomm du cannabis DJamais OMoins d une fois OUne fois OUne fois OTous les jours par mois par mois par semaine ou presque 0 1 2 3 4 8 Combien de fois pendant les 6 derniers mois avez vous eu des troubles de la m moire ou avez vous eu du mal vous concentrer apr s avoir consomm du cannabis DJamais OMoins d une fois OUne fois OUne fois OTous les jours par mois par mois par semaine ou presque 0 1 2 3 4 9 Vous tes vous fait mal ou avez vous bless physiquement quelqu un parce que vous aviez consomm du cannabis dans les 6 derniers mois Nong Oui O 0 4 10 Une personne telle qu un parent un e ami e un m decin ou un professionnel de la sant s est elle inqui t e de votre usage de cannabis ou vous a t elle conseill de diminuer votre consomma tion de cannabis Nong Oui O

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