Addiction Behaviors Checklist (ABC)

Addition Behaviors Checklist (ABC)
Instructions: Code only for patients prescribed opioid or sedative analgesics on behaviors exhibited "since last visit" and "within the current visit" (NA = not assessed).

Addiction behaviors - since last visit
Patient used illicit drugs or evidences problem drinking*	Y	N	NA
Patient has hoarded meds	Y	N	NA
Patient used more narcotic than prescribed	Y	N	NA
Patient ran out of meds early	Y	N	NA
Patient has increased use of narcotics	Y	N	NA
Patient used analgesics PRN when prescription is for time contingent use	Y	N	NA
Patient received narcotics from more than one provider	Y	N	NA
Patient bought meds on the streets	Y	N	NA
Addiction behaviors - within current visit
Patient appears sedated or confused (eg, slurred speech, unresponsive)	Y	N	NA
Patient expresses worries about addiction	Y	N	NA
Patient expressed a strong preference for a specific type of analgesic or a specific route of administration	Y	N	NA
Patient expresses concern about future availability of narcotic	Y	N	NA
Patient reports worsened relationships with family	Y	N	NA
Patient misrepresents analgesic prescription or use	Y	N	NA
Patient indicates she or he "needs" or "must have" analgesic meds	Y	N	NA
Discussion of analgesic meds is the predominant issue of visit	Y	N	NA
Patient exhibits lack of interest in rehab or self-management	Y	N	NA
Patient reports minimal/inadequate relief from narcotic analgesic	Y	N	NA
Patient indicates difficulty with using medication agreement	Y	N	NA
Other
Significant others express concern over patient's use of analgesics	Y	N	NA

ABC SCORE:
Score of ≥3 indicated possible inappropriate opioid use and should flag for further examination of specific signs of misuse and more careful patient monitoring (ie, urine screening, pill counts, removal of opioid).

Designed to track behaviors characteristic of addiction related to prescription opioid medications in chronic pain patients. Items are focused on observable behaviors noted both during and between visits. ABC is focused on longitudinal assessment and tracking of problematic behaviors.

PRN: As needed
* Item 1 original phrasing: ("Patient used ETOH or illicit drugs"), had a low correlation with global clinical judgment. This is possibly associated with difficulty in content interpretation, in that if a patient endorsed highly frequent alcohol use, he or she would receive a positive rating on this item, but not be considered as using the prescription opioid medications inappropriately. Therefore, we include in this version of the ABC a suggested wording change for this item that specifies problem drinking as the criterion for alcohol use.

Originally published in: Wu SM, Compton P, Bolus R, et al. The addiction behaviors checklist: validation of a new clinician-based measure of inappropriate opioid use in chronic pain. J Pain Symptom Manage 2006; 32:342. Reproduced with permission. Copyright © 2006 Bruce D. Naliboff, PH.D. All rights reserved.

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