Severity of Alcohol Dependence Questionnaire (SADQ)

The severity of Alcohol Dependence Questionnaire (SADQ, SAD-Q) was first published in the British Journal of Addiction.

The SADQ is sometimes used to to predict the levels of medication needed during alcohol detoxification.

The test is divided into 5 sections:

1. Physical withdrawal symptoms
2. Affective withdrawal symptoms
3. Craving and relief drinking
4. Typical daily consumption
5. Reinstatement of dependence after a period of abstinence.

Each item is scored on a 4-point scale, giving a possible range of 0 to 60.  A score of over 30 indicates severe alcohol dependence.

The SADQ Test

1. The day after drinking alcohol, do you wake up feeling sweaty?
   (1) Almost never
   (2) Sometimes
   (3) Often
   (4) Nearly always
2. The day after drinking alcohol, do your hands shake first thing in the morning?
   (1) Almost never
   (2) Sometimes
   (3) Often
   (4) Nearly always
3. The day after drinking alcohol, does your body shake violently first thing in the morning if you don't have a drink?
   (1) Almost never
   (2) Sometimes
   (3) Often
   (4) Nearly always
4. The day after drinking alcohol, do you wake up drenched in sweat?
   (1) Almost never
   (2) Sometimes
   (3) Often
   (4) Nearly always
5. The day after drinking alcohol, do you dread waking up?
   (1) Almost never
   (2) Sometimes
   (3) Often
   (4) Nearly always
6. The day after drinking alcohol, are you frightened of meeting people first thing in the morning?
   (1) Almost never
   (2) Sometimes
   (3) Often
   (4) Nearly always
7. The day after drinking alcohol, do you feel at the edge of despair when you wake up?
   (1) Almost never
   (2) Sometimes
   (3) Often
   (4) Nearly always
8. The day after drinking alcohol, do you feel frightened when you wake up?
   (1) Almost never
   (2) Sometimes
   (3) Often
   (4) Nearly always
9. The day after drinking alcohol, do you like a drink in the morning?
   (1) Almost never
   (2) Sometimes
   (3) Often
   (4) Nearly always
10. The day after drinking alcohol, do you gulp your first few drinks down as fast as possible?
    (1) Almost never
    (2) Sometimes
    (3) Often
    (4) Nearly always
11. The day after drinking alcohol, do you drink to get rid of the shakes?
    (1) Almost never
    (2) Sometimes
    (3) Often
    (4) Nearly always
12. The day after drinking alcohol, do you have a strong craving for drink when you wake up?
    (1) Almost never
    (2) Sometimes
    (3) Often
    (4) Nearly always
13. During a heavy drinking period, do you drink more than 1/4 bottle of spirits (or 1 bottle of wine, or 4 pints of beer) each day.
    (1) Almost never
    (2) Sometimes
    (3) Often
    (4) Nearly always
14. During a heavy drinking period, do you drink more than half a bottle of spirits per day (8 pints of beer, 2 bottles of wine).
    (1) Almost never
    (2) Sometimes
    (3) Often
    (4) Nearly always
15. During a heavy drinking period, do you drink more than a bottle of spirits per day (3 bottles of wine, 5 litres of cider or 10 pints of lager)
    (1) Almost never
    (2) Sometimes
    (3) Often
    (4) Nearly always
16. During a heavy drinking period, do you drink more than 2 bottles of spirits per day (7 bottles of wine, 9 litres of cider, 20 pints of beer).
    (1) Almost never
    (2) Sometimes
    (3) Often
    (4) Nearly alwaysFOR THE NEXT 4 QUESTIONS:
    Imagine you have been abstinent for a few weeks, then drink heavily for a couple of days.
17. The morning after would you start to sweat?
    (0) Not at all
    (1) Slightly
    (2) Moderately
    (3) Nearly always
    (4) I haven't been abstinent for that long, so it's hard to say
18. ...would your hands shake?
    (0) Not at all
    (1) Slightly
    (2) Moderately
    (3) Nearly always
    (4) I haven't been abstinent for that long, so it's hard to say
19. ...would your body shake?
    (0) Not at all
    (1) Slightly
    (2) Moderately
    (3) Nearly always
    (4) I haven't been abstinent for that long, so it's hard to say
20. ...would you be craving for a drink?
    (0) Not at all
    (1) Slightly
    (2) Moderately
    (3) Nearly always
    (4) I haven't been abstinent for that long, so it's hard to say

Scoring the Test

The test is scored by totaling the numbers in the parenthesis next to the answers given by the participant.

• A score of less than 3 indicates no alcohol dependence.
• A score between 4 and 20 indicates mild dependence.
• A score between 20 and 30 indicates moderate dependence.
• A score of over 30 indicates severe dependence.

12 Step Fellowships

12 Step Fellowships such as Alcoholics Anonymous are widely recognized as one of the best community resources available for recovering from alcoholism, drug addiction, and other compulsive disorders.

The 12 Steps of Alcoholics Anonymous and the AA Fellowship are a complete program of recovery for people suffering from alcoholism and drug addiction.

12 Step meetings are traditionally open to anyone who wants to attend.  They offer peer support in one-on-one and group settings, as well as other social and recreational activities.  12 Step Fellowships such as Al-Anon are also available for family, friends, and colleagues of the recovering person.

12 Step programs for people recovering from chemical dependence:

Alcoholics Anonymous (AA)
Alcoholics Anonymous is the original 12 Step Fellowship, founded in 1935 by its first two members Bill Wilson and Dr. Bob Smith.  AA membership is estimated to be near 2 million people, with meetings in nearly every country.

Cocaine Anonymous (CA)
Cocaine Anonymous is a fellowship of recovering cocaine addicts based on the principles of Alcoholics Anonymous.

Crystal Meth Anonymous
Crystal Meth Anonymous is a fellowship of recovering from drug addicts, particularly crystal meth addicts, based on the principles of Alcoholics Anonymous.

Dual Recovery Anonymous
Dual Recovery Anonymous is a fellowship of people who are chemically dependent and are also affected by an emotional or psychiatric illness.

Marijuana Anonymous (MA)
Marijuana Anonymous is a fellowship of recovering marijuana addicts based on the principles of Alcoholics Anonymous.

Narcotics Anonymous (NA)
Narcotics Anonymous is a fellowship of recovering drug addicts based on the principles of Alcoholics Anonymous.

Nicotine Anonymous
Nicotine Anonymous is a fellowship of recovering nicotine addicts based on the principles of Alcoholics Anonymous.

Pills Anonymous
Pills Anonymous is a fellowship of people recovering from prescription drug addiction based on the principles of Alcoholics Anonymous.

12 Step programs for family, friends, and colleagues of people recovering from chemical dependence:

Al-Anon
Al-Anon helps families and friends of alcoholics recover from the effects of living with the problem drinking of a relative or friend.

Alateen
Alateen is Al-Anon for young people.  Alateen groups are sponsored by Al-Anon members.

Narcotics Anonymous Youth Committee (NAYC)
Narcotics Anonymous Youth Committee is Narcotics Anonymous for young people.  NAYC groups are sponsored by NA members.

Nar-Anon
Nar-Anon helps families and friends of drug addicts recover from the effects of living with the problem drinking of a relative or friend.

12 Step programs for people recovering from compulsive behaviors:

Debtors Anonymous (DA)
Debtors Anonymous is a fellowship of recovering compulsive debtors based on the principles of Alcoholics Anonymous.

Gamblers Anonymous (GA)
Gamblers Anonymous is a fellowship of recovering compulsive gamblers based on the principles of Alcoholics Anonymous.

Overeaters Anonymous (OA)
Overeaters Anonymous offers a program of recovery from compulsive overeating using the Twelve Steps and Twelve Traditions of OA.

Sex Addicts Anonymous (SAA)
Sex Addicts Anonymous is a fellowship of people recovering from sexual addiction or dependence based on the principles of Alcoholics Anonymous.

12 Step programs for people recovering from mental and emotional problems:

Depressed Anonymous
Depressed Anonymous is a fellowship of people recovering from depression based on the principles of Alcoholics Anonymous.

Emotional Health Anonymous (EHA)
Emotional Health Anonymous is a fellowship of people recovering from emotional illnesses based on the principles of Alcoholics Anonymous.

Emotions Anonymous (EA)
Emotions Anonymous is a fellowship of people recovering from emotional problems based on the principles of Alcoholics Anonymous.

Obsessive Compulsive Anonymous
Obsessive Compusive Anonymous is a fellowship of people recovering from Obsessive Compulsive Disorder (OCD)based on the principles of Alcoholics Anonymous.

12 Step programs for people recovering from marriage, romantic relationship, sexual, and related problems:

Co-Dependents Anonymous (CoDA)
Co-Dependents Anonymous is a fellowship of people developing healthy and loving relationships based on the principles of Alcoholics Anonymous.

Domestic Violence Anonymous
Domestic Violence Anonymous is a fellowship of people recovering from domestic violence based on the principles of Alcoholics Anonymous.

Recovering Couples Anonymous
Recovering Couples Anonymous is a fellowship of people recovering from dysfunctional patterns in relationships based on the principles of Alcoholics Anonymous.

Sex and Love Addicts Anonymous (SLAA)
Sex and Love Addicts Anonymous is a fellowship of people recovering from sex and love addiction based on the principles of Alcoholics Anonymous.

Sexual Compulsives Anonymous
Sexual Compulsives Anonymous is a fellowship of people recovering from sexual compulsion based on the principles of Alcoholics Anonymous.

Survivors of Incest Anonymous
Survivors of Incest Anonymous is a fellowship of people recovering from the effects of surviving incest based on the principles of Alcoholics Anonymous.

Borderline Personality Disorder (BPD)

Borderline personality disorder (BPD) is defined "as a prolonged disturbance of personality characterized by depth and variability of moods."  The disorder typically involves unusual levels of instability in mood; black and white thinking, or splitting; chaotic and unstable interpersonal relationships; unstable self-image, identity, and behavior; and a disturbance in the individual's sense of self.

In extreme cases, this disturbance in the sense of self can lead to periods of dissociation, or mental breakdown.

Borderline personality disorder can have a long-term negative impact on many aspects of a person's life.  This includes sometimes extreme difficulties in relationships at work, home, and in social situations. Self-harming is also a symptom, with attempted (or complete) suicide a possibility, especially without proper care and effective therapy.

The negative emotional states of BPD are grouped into four categories:

• Destructive or self-destructive feelings,
• Extreme feelings in general,
• Feelings of fragmentation or lack of identity, and
• Feelings of victimization.

Individuals suffering from BPD tend to view the world generally as dangerous and malevolent, and tend to view themselves as powerless, vulnerable, and unacceptable.

They can be very sensitive to the way others treat them, reacting strongly to perceived criticism or hurtfulness.  Their feelings about others often shift from positive to negative, generally after a disappointment or perceived threat of losing someone.

Self-image can also change rapidly from extremely positive to extremely negative.  Impulsive behaviors are common, including alcohol or drug abuse, unsafe sex, gambling and recklessness in general.

Individuals with BPD engage in high levels of intimacy- or novelty-seeking, and yet are very alert to signs of rejection or not being valued.  They tend toward insecure, avoidant or ambivalent, or fearfully preoccupied patterns in relationships.

It is very important to locate professionals who are experienced and qualified in the treatment of borderline personality disorder.

Many professional studies recommend against the use of medication for treating BPD.  Antidepressants, antipsychotics and mood stabilizers such as lithium are often used to treat co-occurring symptoms such as depression.

Dialectical Behavior Therapy (DBT) has been show to be very effective in the treatment of borderline personality disorder.

Several types of psychotherapy for BPD have developed in recent years. Studies suggest that people with BPD can benefit on at least some outcome measures.  Supportive therapy alone may enhance self-esteem and mobilize the existing strengths of individuals. Psychotherapy can often be conducted either with individuals or with groups. Group therapy can aid the learning and practice of interpersonal skills and self-awareness by individuals with BPD.

Dual Diagnosis/Co-Occurring Disorder

Borderline personality disorder often occurs together with substance abuse and substance dependence disorders.  Often the substance use is the result of an attempt to "self-medicate" but just as often substance dependence is the primary disorder with BDP being secondary.  In either case, both disorders must be treated simultaneously to achieve an effective outcome.

Non-Governmental Organizations

The organizations and links below are simply resources for you to find more information, research and statistics about drugs, drug abuse, drug addiction and recovery, so that you can make your own informed and educated conclusions.

Addiction Treatment Forum

• An educational site focusing on addiction issues, especially opiate addiction and treatment.

American Council on Alcoholism

• Dedicated to educating the public about the effects of alcohol, alcoholism and treatment.

Do It Now Foundation

• Publisher of prevention literature.

Dual Diagnosis Website

• Mental Illness, Drug Addiction and Alcoholism, MIDAA(R), MICA.

Focus Adolescent Services

• Internet Clearinghouse of resources, support and information.

Heroin Information Website

Institute of Alcohol Studies

• Information on alcohol and the social and health consequences of its misuse.

Join Together Online

• National resource center and meeting place for communities working to reduce substance abuse and gun violence.

Learn-About-Alcoholism.com

• Educational resource covering all aspects of alcoholism.

Mental Health Matters

• Directory of mental health resources.

Methadone Anonymous

• Website that answers questions about methadone and has Methadone Anonymous support.

Mothers Against Drunk Driving (MADD)

National Center on Addiction and Substance Abuse at Columbia University (CASA)

• Information on the cost of substance abuse throughout society and its impact on our lives.

National Council on Alcoholism and Drug Dependence, Inc. (NCADD):

• Provides education, information, help and hope in the fight against substance abuse.

The National Council on Sexual Addiction and Compulsivity

• Dedicated to promoting public and professional recognition, awareness and understanding of Sexual Addiction, Sexual Compulsivity, and Sexual Offending.

National Inhalant Prevention Coalition (NIPC)

• A resource for parents, educators and professionals on inhalant abuse.

Recovery Connection

• A website and that helps people locate addiction treatment centers and drug rehabilitation programs.

StrugglingTeens.com:

• Woodbury Reports presents resources for parents and professionals trying to help at-risk teenagers.

Teen Drug Abuse

• Educational site about why teens begin using, what they are using, and how those drugs are affecting teens physically, socially, and mentally.

Web of Addictions

• Provides accurate information about alcohol and other drug addictions. Resource for anyone needing factual information about abused drugs.

Over 80 Hours of Therapy per Client, per Month

Summit Malibu clients receive over 80 hours of therapy per month, personally conducted by Doctorate and Masters level therapists - a standard that most other treatment centers fail to achieve.

Other treatment centers claim to provide high-level therapy, but in actual practice therapy sessions are often conducted by non-degreed counselors working “under the supervision of” a therapist.

If you are considering another treatment center, find out how often their therapy sessions are personally conducted by Doctorate and Masters level therapists.

Problem Drinking

The term "problem drinking" is commonly used to indicate that a person may be developing a drinking problem, but may or may not have reached the stage of alcohol dependence.  Problem drinking can be viewed as similar to alcohol abuse, which is defined as "the recurring use of alcoholic beverages despite negative consequences."

If someone is having problems that are related to their drinking, and they are continuing to drink, then they are by definition a "problem drinker."

Whether a problem drinker is simply using alcohol to help deal with their problems, has reached the stage of alcohol abuse, or has reached the stage of alcohol dependence (alcoholism) depends on the extent to which they have developed a pathological dependence.

Alcohol abuse is characterized by "continuing to drink despite negative consequences" such as failing to meet obligations at work, school, or home, drinking while driving or using machinery, legal problems from drinking, or social and relationship problems from drinking.

Alcohol dependence includes all the above symptoms, but also includes symptoms such as tolerance (needing to drink more to achieve the same effect) and withdrawal (distress such as craving a drink, anxiety, tremors, and even seizures and hallucinations when not drinking).

Once a problem drinker begins experiencing the symptoms of tolerance and withdrawal they have probably reached the stage of alcohol dependence.

Periodic Drinking

Periodic drinking is defined as alcohol abuse that occurs in periodic intervals rather than on a regular basis.  For example, a periodic drinker may not drink during the work week, but may drink abusively over the weekend.

Contrary to popular opinion, periodic drinking does not exclude the drinker from developing problems of alcohol abuse or alcohol dependence (alcoholism).

Binge drinking is just one form of periodic drinking.  Periodic drinking can take the form of controlled drinking for short periods, rather than intense drinking all at once, such as drinking slowly and steadily over a weekend.

Periodic drinking is often cited by problem drinkers and alcoholics as evidence that they still have control over their drinking.  They believe that if they can stop or regulate their drinking for any period of time, that this means they have control.  On deeper examination, however, this defense often breaks down.  One way to test if a periodic drinker has reached the stage of alcohol abuse or alcohol dependence is to have them attempt to stop drinking for an extended period.

If a periodic drinker has difficulty not drinking for a longer period than they are used to, this may indicate a problem of alcohol abuse or alcohol dependence.

The Diagnostic and Statistical Manual (DSM IV) of the American Psychiatric Association defines Alcohol Abuse as "the recurring use of alcoholic beverages despite negative consequences."  This definition can be applied just as easily to periodic drinkers.

If a period drinker is experiencing negative consequences due to drinking and is continuing to drink - even periodically - then by definition they have a drinking problem.

Binge Drinking

Binge Drinking is defined as very heavy drinking over a short period of time.  Drinkers who engage in binge drinking generally want to maximize the effect of alcohol as much as possible in as short a time as possible.

Binge drinking is very popular among young people, with over 7 million people aged 12 to 20 engaging in binge drinking.

42% of college students report binge drinking.

75% of the alcohol consumed by college students is consumed by binge drinkers.

A popular misconception of binge drinking is that it is somehow different from alcohol abuse or alcoholic drinking.  This idea rises from the misconception that alcoholics are all daily drinkers, and that anyone who "only drinks on weekends" or "only drinks at parties" is somehow exempt from alcohol dependence.

Alcohol dependence (alcoholism) can develop whether or not the drinker is a daily drinker, a periodic drinker, or a binge drinker.

Binge drinking can be very dangerous.  The following health problems are associated with binge drinking:

• Liver disease.
• High blood pressure, stroke, and other forms of cardiovascular disease.
• Neurological damage.
• Sexually transmitted diseases.
• Unintentional pregnancy.
• Fetal Alcohol Syndrome (if pregnant women binge drink).
• Unintentional injuries (such as car accidents, falls, etc.).
• Intentional injuries (such as injuries from firearms, domestic violence, etc.).
• Alcohol poisoning.

Alcohol poisoning can occur during binge drinking.

Alcohol poisoning is a serious condition that can occur when the blood alcohol concentration rises too high.  Symptoms include severe vomiting, depressed respirations, and seizures.  It can result in coma and can be fatal.  Alcohol poisoning requires immediate medical attention and often hospitalization in order to stabilize the patient.

Alcoholism and Alcohol Dependence

Alcoholism is our nation's number one drug addiction problem.  There are approximately 12 million alcoholics in the United States, with alcoholism and alcohol abuse now the third leading cause of death.

Alcoholism affects spouses, children, friends and colleagues, making the actual number of people in the U.S. adversely affected by alcoholism number as many as 50 million.

Contrary to popular opinion, only 6% of the alcoholic population are of the "skid row" variety.  The vast majority of alcoholics are well-educated, highly-functioning people.  Studies now indicate that people with higher education and who earn a high level of income are actually more likely to drink.

Alcoholism now costs us over $60 billion per year in health care costs, accidents, and alcohol-related social programs.

The Diagnostic and Statistical Manual (DSM IV) of the American Psychiatric Association makes a distinction between Alcohol Abuse and Alcohol Dependence (Alcoholism).  The main difference is that with Dependence the conditions of tolerance and withdrawal are present.

Tolerance: needing greater amounts of the substance to achieve the same effect.

Withdrawal: distress and craving when use of the substance is reduced or stopped.

For the Alcoholic, the conditions of tolerance and withdrawal are very common.  Consistent morning drinking, drinking at work, or drinking to relieve the symptoms of a hangover are all signs of withdrawal.  Drinking more than other people in the same social situation, daily drinking, and secretive drinking are all signs of tolerance.

Once a drinker has reached the stage of Alcohol Dependence, medical and psycho-social treatment is usually required.

Alcohol Abuse

The Diagnostic and Statistical Manual (DSM IV) of the American Psychiatric Association defines Alcohol Abuse as "the recurring use of alcoholic beverages despite negative consequences."

While it is a less serious condition than Alcohol Dependence (Alcoholism, Alcohol Addiction) it is a very serious condition in its own right.  For most people, if Alcohol Abuse continues, it will eventually lead to a condition of Alcohol Dependence.

Early intervention and treatment of Alcohol Abuse is extremely important to prevent the abusive drinker from reaching the stage of Alcohol Dependence.

Unlike Alcoholics, Alcohol Abusers still have some ability to set limits on their drinking.  However, Alcohol Abusers are still behaving self-destructively and may be dangerous to themselves or others.

Common signs and symptoms of alcohol abuse include:

• Repeatedly neglecting your responsibilities at home, work, or school because of your drinking.
  • For example, performing poorly at work, flunking classes, neglecting your kids, or skipping out on commitments because you’re hung over.
• Using alcohol in situations where it’s physically dangerous.
  • For example, drinking and driving, operating machinery while intoxicated, or mixing alcohol with prescription medication.
• Experiencing repeated legal problems on account of your drinking.
  • For example, getting arrested for driving under the influence or drunk and disorderly conduct.
• Continuing to drink even though your alcohol use is causing problems in your relationships.
  • For example, getting drunk with your buddies even though you know your wife will be upset, or fighting with your family because they dislike how you act when you drink.

Alcohol Abuse differs from Alcohol Dependence by its lack of symptoms of tolerance and withdrawal.

Tolerance: needing greater amounts of alcohol to achieve the same effect.

Withdrawal: distress and craving when alcohol use is reduced or stopped.

If the person who is drinking is experiencing symptoms of tolerance or withdrawal then they may have reached the stage of Alcohol Dependence.

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