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Substance Use Monthly Form

404 Shared Subjects

N/A
Clinical Assessments
Substance Use
04/06/2016
subusmf01
02/06/2023
View Change History
01
Query Element Name Data Type Size Required Description Value Range Notes Aliases
subjectkey GUID Required The NDAR Global Unique Identifier (GUID) for research subject NDAR*
src_subject_id String 20 Required Subject ID how it's defined in lab/project
interview_date Date Required Date on which the interview/genetic test/sampling/imaging/biospecimen was completed. MM/DD/YYYY
interview_age Integer Required Age in months at the time of the interview/test/sampling/imaging. 0::1440 Age is rounded to chronological month. If the research participant is 15-days-old at time of interview, the appropriate value would be 0 months. If the participant is 16-days-old, the value would be 1 month.
sex String 20 Required Sex of subject at birth M;F; O; NR M = Male; F = Female; O=Other; NR = Not reported gender
Query monthsbl Float Recommended Actual number of months from Baseline
Query days_baseline Integer Recommended Days since baseline
Query subus25 Integer Recommended Does the client currently use alcohol? 1;0 1=Yes; 0=No
Query subus26 Integer Recommended If client currently uses alcohol, number of drinks/week
Query subus27 Integer Recommended If currently using alcohol, has client tried to cut back or stop drinking? 1;0 1=Yes; 0=No
Query ca824 Integer Recommended Lifetime history - Marijuana: Currently abuses the substance - current use 0;1 0=No; 1=Yes subus28
Query subus29 Integer Recommended If not currently using marijuana, has the client used marijuana in the past? 1;0 1=Yes; 0=No
Query subus30 Integer Recommended Does the client currently use any other recreational drugs? 1;0 1=Yes; 0=No
subus31 String 50 Recommended Specify other recreational drugs
Query scid21 Integer Recommended 21. Have you ever been treated as an outpatient or hospitalized for drugs or alcohol problems 0;1; 999 0 = No; 1 = Yes; 999 = Legitimately Skipped subus32
Query subus33 Integer Recommended Age at first treatment or hospitalization for substance use (in years)
Query subtr4 Integer Recommended In the past 30 days, did you spend the night in a substance use program? 1;0 1=Yes; 0=No
Query night Integer Recommended 3c. Total Number of Nights in Past Month subtr4a
Query subtr4b Integer Recommended Provider code of program
Query subtr50 Integer Recommended In the past 30 days, did you receive any alcohol or drug counseling? 0;1 1=Yes; 0=No
Query outvisit Integer Recommended outpatient number of visits subtr50a
Query subtr50b Integer Recommended Average duration of this type of visit
Query subus66 Integer Recommended In the past 30 days, how many days have you used any alcohol at all? drugs30_alcoholdaysinpast30
Query surq_1e Integer Recommended In the past 30, what is your best estimate for the number of days you got drunk or "very, very high" on alcohol subus67
Query surq_3a Integer Recommended In the past 30 days, what is your best estimate as to how many days you used marijuana drugs30_marijuanaincludingthcfor, subus68
Query frquency_other Integer Recommended Think specifically about the past 30 days, including today. During the past 30 days, on how many days did you use any other medicines or drugs or substances? PX031301_Frequency_Other 0::31;-5; -9; -999 Number of days; -5= Item seen but not answered; -9= Item skipped by show-if logic; -999= Data not submitted (incomplete, item not seen) subus69
Query subus70 Integer Recommended In the past 30 days, how many days have you used prescription medications that were not prescribed for you?
Query visit String 60 Recommended Visit name
alcmj01 Integer Recommended On how many occasions (if any) during the last 30 days have you used alcohol and marijuana at the same time?that is, so that their effects overlapped? 0::100
auti_02 Integer Recommended [baseline only] In the 30 days before you became pregnant, how often did you usually have any kind of drink containing alcohol? [all other timepoints] In the past 30 days, how often did you usually have any kind of drink containing alcohol? 0::7 0 = Never; 1 = Once; 2 = 2 to 3 times; 3 = Once a week; 4 = Twice a week; 5 = 3 to 4 days a week; 6 = 5 to 6 days a week; 7 = Everyday
auti_03 Integer Recommended On the days that you drank alcohol, how many standard drinks did you normally have? 1::10; 77 1 = 1 drink; 2 = 2 drinks; 3 = 3 drinks; 4 = 4 drinks; 5 = 5 to 7 drinks; 6 = 8 to 11 drinks; 7 = 12 to 17 drinks; 8 = 18 to 23 drinks; 9 = 24 to 35 drinks; 10 = 36 drinks or more; 77 = Prefer not to answer
auti_04 Integer Recommended [Baseline only] Please indicate how many times you tried to quit using alcohol in the 30 days before you became pregnant. [all timepoints, including baseline] Please indicate how many times you tried to quit using alcohol in the past 30 days. 0::6 0 = Never; 1 = Once; 2 = Two or three times; 3 = Four to six times; 4 = Seven to nine times; 5 = Ten to twelve times; 6 = More than twelve times
auti_05 Integer Recommended [Baseline only] Please indicate which services you have used in the past 30 days. [all other timepoints] Please indicate which services you have used since we last spoke on <date>. 0::9 0 = None; 1 = Talked with a substance use counselor; 2 = Talked with another type of counselor for my alcohol use; 3 = Day treatment or partial day treatment; 4 = Residential (live-in) treatment; 5 = Hospitalization for alcohol use; 6 = 12 step meetings, like Alcoholics Anonymous; 7= Called the United Way 2-1-1 hotline to find help for my alcohol use; 8 = Called the SAMHSA National Helpline 1-800-662-HELP (4357); 9 = Used the online National Treatment Locator (SAMHSA)
auti_06 Integer Recommended [Baseline only] Please indicate whether or not you talked to a doctor, nurse, or other medical provider about your alcohol use in the past 30 days. Check all that apply. [all other timepoints] Please indicate whether or not you talked to a doctor, nurse, or other medical provider about your alcohol use since we last spoke on <date>. Check all that apply. 0::3 0 = None; 1 = Yes, with my doctor; 2 = Yes, with my nurse; 3 = Yes, with another medical provider
auti_07 Integer Recommended Please indicate whether or not you talked to a doctor, nurse, or other medical provider about your alcohol use - If any checked, who initiated the conversation? 0::2 0 = I did; 1 = My medical provider; 2 = We both did
auti_08 Integer Recommended Please indicate whether or not you talked to a doctor, nurse, or other medical provider about your alcohol use - If any checked, how many times have any health professionals talked with you about alcohol during this pregnancy? 0::4 0 = None; 1 = 1; 2 = 2; 3 = 3; 4 = 4 or more
drugs30_heroin Integer Recommended In the past 30 days, how many days have you used Heroin? For example smack, black tar, poppy, opium (including fentanyl) drugs30_heroinforexamplesmackbla
drugs30_painkillers Integer Recommended In the past 30 days, how many days have you used Painkillers? For example methadone, codeine, Demerol, Vicodin, OxyContin, oxy, Percocet, Dilaudid, Percodan, or morphine drugs30_painkillersforexamplemet
Data Structure

This page displays the data structure defined for the measure identified in the title and structure short name. The table below displays a list of data elements in this structure (also called variables) and the following information:

  • Element Name: This is the standard element name
  • Data Type: Which type of data this element is, e.g. String, Float, File location.
  • Size: If applicable, the character limit of this element
  • Required: This column displays whether the element is Required for valid submissions, Recommended for valid submissions, Conditional on other elements, or Optional
  • Description: A basic description
  • Value Range: Which values can appear validly in this element (case sensitive for strings)
  • Notes: Expanded description or notes on coding of values
  • Aliases: A list of currently supported Aliases (alternate element names)
  • For valid elements with shared data, on the far left is a Filter button you can use to view a summary of shared data for that element and apply a query filter to your Cart based on selected value ranges

At the top of this page you can also:

  • Use the search bar to filter the elements displayed. This will not filter on the Size of Required columns
  • Download a copy of this definition in CSV format
  • Download a blank CSV submission template prepopulated with the correct structure header rows ready to fill with subject records and upload

Please email the The NDA Help Desk with any questions.