Personal History of Alcohol Abuse

No personal history of alcohol abuse+0Yes — personal history of alcohol abuse (+3 pts male / +1 pt female; use 3 if male, 1 if female)+1

Personal History of Alcohol Abuse — Sex Adjustment

Female-sex patient (no additional pts)+0Male-sex patient with personal alcohol abuse (+2 pts vs. female)+2

Personal History of Illegal Drug Abuse

No personal history of illegal drug use+0Yes — personal history of illicit drug use (+4 pts male / +4 pts female)+4

Personal History of Prescription Drug Abuse

No personal history of prescription drug abuse+0Yes — personal misuse of prescription drugs (+5 pts male / +5 pts female)+5

Family History of Alcohol Abuse

No family history of alcohol abuse+0Family history of alcohol problems (+3 pts male / +1 pt female; use 3 if male, 1 if female)+1

Family History of Alcohol Abuse — Sex Adjustment

Female-sex patient (no additional pts)+0Male-sex patient with family alcohol history (+2 pts vs. female)+2

Family History of Illegal Drug Use

No family history of illicit drug use+0Family history of illicit drug use (+1 pt male / +2 pts female; use 1 if male, 2 if female)+1

Family History of Illegal Drug Use — Sex Adjustment

Male-sex patient (no additional pts)+0Female-sex patient with family illicit drug history (+1 pt vs. male)+1

Family History of Prescription Drug Abuse

No family history of prescription drug abuse+0Family history of prescription drug abuse (+4 pts male / +4 pts female)+4

History of Preadolescent Sexual Abuse

No history of preadolescent sexual abuse+0History of preadolescent sexual abuse (+0 pts male / +3 pts female; add 3 if female)+0

Preadolescent Sexual Abuse — Female-Sex Scoring

Not applicable (male sex or no sexual abuse history)+0Female-sex patient with preadolescent sexual abuse (+3 pts)+3

Psychological Disease (Diagnosis of ADD, OCD, Bipolar, or Schizophrenia)

No significant psychological diagnosis+0ADD, OCD, bipolar disorder, or schizophrenia (+2 pts)+2

History of Depression

No depression history+0History of depression (+1 pt)+1

Age 16–45 Years

Age < 16 or > 45 years+0Age 16–45 years (+1 pt)+1

Opioid Risk Tool (ORT)