This form structure is an organized set of data definitions for a copyrighted form

 General Details

Title:
Drug Abuse Screening Test (DAST-10)
Short Name:
DAST10
Description:
A10-item brief screening tool that can be administered by a clinician or self-administered. Each question requires a yes or no response, and the tool can be completed in less than 8minutes. This tool assesses drug use, not including alcohol or tobacco use, in the past 12 months. Copyright 1982 by the Addiction Research Foundation. References: Skinner HA (1982). The Drug Abuse Screening Test. Addict Behav 7(4):363-371. Yudko E, Lozhkina O, Fouts A (2007). A comprehensive review of the psychometric properties of the Drug Abuse Screening Test. J Subst Abuse Treatment 32:189-198. To use this tool, please contact Dr. Harvey Skinner at hskinner@yorku.ca
Disease:
Traumatic Brain Injury
Organization:
Virginia Commonwealth University
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2015-12-14
Version:
1.2
Date Created:
2015-07-02
Owner:
Number of Data Elements:
26
eForms:
N

 Documentation


 Groups & Attached Data Elements

Logically grouped data elements with defined frequency at which they repeat.

# Title Short Description Variable Name Required? Type
1 GUID   Global Unique ID which uniquely identifies a subject GUID Required CDE
2 Subject identifier number   An identification number assigned to the participant/subject within a given protocol or a study. SubjectIDNum Optional CDE
3 Age in years   Value for participant's subject age recorded in years. AgeYrs Recommended CDE
4 Vital status   Status of participant/subject as alive or dead VitStatus Optional CDE
5 Visit date   Actual interview or visit date VisitDate Recommended CDE
6 Site name   The name of the site for the study SiteName Recommended CDE
7 Days since baseline   The number of days since baseline DaysSinceBaseline Optional CDE
8 Case control indicator   Indicator of whether subject is in the case or control arm of the study CaseContrlInd Optional CDE
9 General notes text   General notes GeneralNotesTxt Optional CDE

Additional Element Groups

Listed below are your additional element groups.

Form Administration (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 Context type  The context to which the questions were answered ContextType Recommended CDE
2 Context type other text  The free-text related to ContextType specifying other text ContextTypeOTH Recommended CDE
3 Data source  Source of the data provided on the case report form DataSource Recommended CDE
4 Data source other text  The free-text field related to Data source specifying other text. Source of the data provided on the case report form DataSourceOTH Recommended CDE

Drug Abuse Screening Test (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 Drug Abuse Screening Test (DAST-10) - Non-medical other drug use score  Score for whether the subject has used drugs other than those required for medical reasons, as part of the Drug Abuse Screening Test (DAST-10) DAST10UsedDrugsNotMedReasScore Recommended CDE
2 Drug Abuse Screening Test (DAST-10) - Drug abuse multiple concurrent use score  Score for whether the subject abuses more than one drug at a time, as part of the Drug Abuse Screening Test (DAST-10) DAST10AbuseMore1DrugTimeScore Recommended CDE
3 Drug Abuse Screening Test (DAST-10) - Drug abuse easy stop use score  Score for whether the subject is always able to stop using drugs when they want to, as part of the Drug Abuse Screening Test (DAST-10) DAST10StopDrugsWhenWantScore Recommended CDE
4 Drug Abuse Screening Test (DAST-10) - Drug abuse blackout flashback result score  Score for whether the subject has had "blackouts" or "flashbacks" as a result of drug use, as part of the Drug Abuse Screening Test (DAST-10) DAST10BlackoutFlashbackScore Recommended CDE
5 Drug Abuse Screening Test (DAST-10) - Drug abuse guility bad feeling score  Score for whether the subject ever feels bad or guilty about drug use, as part of the Drug Abuse Screening Test (DAST-10) DAST10FeelBadGuiltDrugUseScore Recommended CDE
6 Drug Abuse Screening Test (DAST-10) - Drug abuse spouse partner complaint score  Score for whether the subject's spouse (or parents) ever complain about their involvement with drugs, as part of the Drug Abuse Screening Test (DAST-10) DAST10ComplnSpouseAbtDrugScore Recommended CDE
7 Drug Abuse Screening Test (DAST-10) - Drug abuse family neglect cause score  Score for whether the subject has ever neglected their family because of use of drugs, as part of the Drug Abuse Screening Test (DAST-10) DAST10NeglectFamDrugUseScore Recommended CDE
8 Drug Abuse Screening Test (DAST-10) - Drug abuse illegal activity obtain score  Score for whether the subject has engaged in illegal activities in order to obtain drugs, as part of the Drug Abuse Screening Test (DAST-10) DAST10IllegalActObtnDrugsScore Recommended CDE
9 Drug Abuse Screening Test (DAST-10) - Drug abuse withdrawal symptom score  Score for whether the subject has ever experienced withdrawal symptoms (felt sick) when they stopped taking drugs, as part of the Drug Abuse Screening Test (DAST-10) DAST10WithdrawalStopDrugsScore Recommended CDE
10 Drug Abuse Screening Test (DAST-10) - Drug abuse cause medical problem score  Score for whether the subject has had medical problems as a result of drug use (e.g., memory loss, hepatitis, convulsions, bleeding, etc.), as part of the Drug Abuse Screening Test (DAST-10) DAST10MedProbResltDrugUseScore Recommended CDE
11 Drug Abuse Screening Test (DAST-10) - Total score  The subject's total score, as part of the Drug Abuse Screening Test (DAST-10) DAST10TotalScore Recommended CDE
12 Drug Abuse Screening Test (DAST-10) - Total score description range  The subject's scale of problems related to drug abuse, as part of the Drug Abuse Screening Test (DAST-10) DAST10Scale Recommended CDE
13 Drug Abuse Screening Test (DAST-10) - Total score action suggestion type  The suggested action related to the subject's scale of problems relaeted to drug abuse, as part of the Drug Abuse Screening Test (DAST-10) DAST10SuggestedActionTyp Recommended CDE

 Change History

 Administrative Change History