TABLE 2.

Chronic Abstinence Symptom Severity Scale-Revised

Name:____________________				Date:__________
Circle the number that best indicates the severity of each symptom you are experiencing today (zero indicates the absence of the symptom, 10 represents an extreme intensity level). Answer each question as honestly as possible. If you do not understand the meaning of the symptom listed, ask the doctor or nurse.
			Low Level					High Level
1.	Craving/drug or alcohol hunger	0	1	2	3	4	5	6	7	8	9	10
2.	Sense of emptiness/incompleteness	0	1	2	3	4	5	6	7	8	9	10
3.	Anxiety	0	1	2	3	4	5	6	7	8	9	10
4.	Internal shakiness	0	1	2	3	4	5	6	7	8	9	10
5.	Restlessness	0	1	2	3	4	5	6	7	8	9	10
6.	Impulsiveness/act before thinking	0	1	2	3	4	5	6	7	8	9	10
7.	Difficulty concentrating/focusing	0	1	2	3	4	5	6	7	8	9	10
8.	Memory problems	0	1	2	3	4	5	6	7	8	9	10
9.	Depression	0	1	2	3	4	5	6	7	8	9	10
10.	Irritability	0	1	2	3	4	5	6	7	8	9	10
11.	Problems getting to or staying asleep	0	1	2	3	4	5	6	7	8	9	10
12.	Fatigue/lack of energy	0	1	2	3	4	5	6	7	8	9	10
13.	Hypersensitivity to stress	0	1	2	3	4	5	6	7	8	9	10
14.	Hypersensitivity to noise/sight/touch	0	1	2	3	4	5	6	7	8	9	10
15.	Pain intensity	0	1	2	3	4	5	6	7	8	9	10
	TOTAL