Form 1 Transmissible Liability Index (TLI) Survey

Attachment 4
TLI Survey
Transmissible Liability
Index (TLI) Survey

Rapid Throughput Standardized Evaluation of
Transmissible Risk for Substance Use Disorder in Youth
(NIDA)

xx/xx/xxxx

In the past six months, have you destroyed things that belonged to others?

In the past six months, have you broken rules at school, work, or elsewhere?

In the past six months, have you acted without thinking?

In the past six months, have you been biting your fingernails?

In the past six months, have you picked your skin or other parts of your body?

In the past six months, have you stolen something?

In the past six months, have you had trouble finishing assignments?

In the past six months, have you had trouble concentrating or paying attention?

In the past six months, have you had trouble sitting still?

In the past six months, have you been honest?

In the past six months, have you been getting into a lot of fights?

In the past six months, have you had a hot temper?

In the past six months, have you threatened to hurt people?

In the past six months, have you failed to pay back money you owe or meet other financial
responsibilities?

Have you interrupted people when they are speaking?

In the past year, have you frequently done things without first thinking about the
consequences?

In the past year, have you stolen things?

In the past year, have you had a bad temper?

In the past year, have you threatened to hurt people?

In the past year, have you frequently done risky or dangerous things?

In the past year, have you gotten into more fights than most people your age?

In the past year, have you had trouble concentrating?

In the past year, have people stared at you?

In the past year, have you gotten tired quickly during activities?

Have you ever gotten into trouble for talking in school (without permission) or for bothering
others?

Have you ever thought about a specific plan to commit suicide?

Have you ever done things to annoy people like grabbing other's hats?

Have you annoyed people on purpose to get revenge?

Have you had difficulty staying in line at a store or waiting for your turn while playing with
others?

Have you ever blurted out an answer before the person had finished asking the question?

Have you ever talked too much in such a way that your teachers, parents, or friends complained
about it?

Have you ever gotten into trouble for doing things without thinking about them first?

Have you experienced bone pain?

Have you experienced joint pain?

Have you experienced muscle pain?

Have you had headaches?

Have you ever run away from home?

Have you ever taken your parent's car without permission?

Have you ever stolen something from a store or from someone else?

Have you ever been in a physical fight on school property?

Have you ever threatened someone with violence?

Have you ever had violent outbursts at school or been physically aggressive with others?

Have you ever stolen a car?

Have you ever resisted arrest?

Have you ever assaulted someone?

Have you ever assaulted someone with a deadly weapon?

Have you been in a lot of physical fights (3 or more) or have you physically assaulted someone?
Do not answer "yes" if the fights were self defense or protection of a family member.

Have you felt that your future looks bright?

When faced with a decision, have you taken time to consider and weigh all aspects?

Have you acted without thinking?

Have you frequently stopped to think things over before doing them?

When you stand in line, have you ever tried to get ahead of others?

Has it been easy for you to see the bright side of things?

Have you ever taken pleasure in hurting someone physically?

Have others thought you use force to get your way?

Have you ever felt that life has handed you a raw deal?

Have you made up your mind through careful reasoning?

Have people spread rumors about you?

Have people avoided taking advantage of you?

Have you ever worried about terrible things that might happen?

Have you often been lied to?

Have you found it easy to enjoy life?

Have you ever just wanted to hit someone?

Have you always had something pleasant to look forward to?

Have people opposed you for no good reason?

Have you ever told a lie?

Are your table manners better in a restaurant than at home?

Do you ever feel that you want to swear?

Have you ever felt tempted to steal something?

Does your mood ever change?

Do you ever get angry?

Do you ever put things off that you need to do?

Are you more happy if you win than lose a game?

Have you ever been talked into doing something you didn't want to do?

Have you ever bought anything that you did not need?

In the past 6 months, have you had friendly talks with your father?

In the past 6 months, has your father found time to listen to you when you wanted to talk to
him?

In the past 6 months, on weekend days, have you done something together with your father,
like making something, playing a game, talking, or going out together?

In the past 6 months, have you liked spending time with your father?

In the past 6 months, have you thought your father was really good?

In the past 6 months, have you wished that you had a different father?

In the past 6 months, has your father given you problems?

In the past 6 months, have you felt that your father loved you?

In the past 6 months, have you felt that your father was too strict or hard on you?

In the past 6 months, have you liked being your father's kid?

In the past 6 months, have you felt that when your father punished you, you got the punishment
that you deserved?

Over the past six months, how well have you gotten along with your father?

Has your father been a good listener?

If you were in trouble, could you have told your father?

Have you openly shown your father that you like him?

When you asked your father questions, have you gotten honest answers from him?

Has it been easy for you to express all of your true feelings to your father?

Have you told your father about your personal problems?

Can you let your father know what has been bothering you?

Have you thought that your father feels close to you?

Have you felt close to your father?

Does your father accept what you expect of him in the family?

Do you know what your father means when he says something?

Is your father reasonable when you make a mistake?

Do you and your father have the same views about right and wrong?

Has your father taken what you said the wrong way?

When you were upset, does your father know why?

When you were upset, does your father care?

Even when you admit you are wrong, has your father not forgiven you?

When you have a problem, has your father helped you solve it?

If your father is angry with you, have you heard about it from someone else?

Has your father still liked you even when you argue with him?

When there was a problem between you and your father, has he found a way of working it out?

Has your father ruined things for you?

When your father has gotten angry with you, has he stayed upset for days?

Does your father get too involved in things in your life?

Does your father give you a chance to explain when you make a mistake?

Is your father right about the importance of education?

Does your father expect too much of you?

If your father disagrees, does he still listen to your point of view?

Does your father take it out on you when he has had a bad day?

Does your father really trust you?

Is your father always on your back or nagging you?

Is there a big difference between what your father expects of you and how he behaves?

Can you count on your father to help in a crisis?

Is your father right about the importance of being successful?

In the past 6 months, have you had friendly talks with your mother?

In the past 6 months, has your mother found time to listen to you when you wanted to talk to
her?

In the past 6 months, have you and your mother done things together at home?

In the past 6 months, on weekdays, have you done something together with your mother, like
made something, played a game, talked, or went out together?

In the past 6 months, on weekend days, have you done something together with your Mom, like
made something, played a game, talked, or went out together?

In the past 6 months, have you liked spending time with your mother?

In the past 6 months, have you thought your mother was really good?

In the past 6 months, has your mother really bugged you a lot?

In the past 6 months, has your mother given you problems?

In the past 6 months, have you felt that your mother was easy to get along with?

In the past 6 months, have you liked being your mother's kid?

How many things would you like to change about your mother?

Over the past six months, how well have you gotten along with your mother?

Can you discuss your beliefs with your mother without feeling afraid or embarrassed?

Can you openly show your mother that you like her?

Is it easy for you to express all of your true feelings to your mother?

Does your mother nag or bother you?

Do you avoid telling your mother how you really felt about some things?

Have you told your mother about your personal problems?

Does your mother accept what you have expected of her in the family?

Do you known what your mother means when she says something?

Do you and your mother have the same views about right and wrong?

Does your mother take her share of family responsibilities?

When you were upset, have you known your mother really cares?

When you have a problem, does your mother help solve it?

Has your mother gotten too involved in things in your life?

Is your mother right about the importance of education?

Does your mother expect too much of you?

Even if your mother disagrees with you, does she still listen to your point of view?

Does your mother really trust you?

Do you know where people in your neighborhood or school get marijuana or other drugs?

Have any of your friends hurt someone seriously?

Have you personally known anyone who traded or sold drugs?

Are there any friends in your group whom your parents disapprove of?

Have any of your friends stolen something?

Have you ever driven a car without a license?

Have any of your friends purposely damaged property that did not belong to them?

Have you ever gotten into a physical fight with another kid?

In the past 6 months, how many of your friends have stolen something worth less than $5?

In the past 6 months, how many of your friends hit someone with the idea of hurting that
person?

In the past 6 months, how many of your friends used a weapon, force or forceful ways to get
money or things from people?

In the past 6 months, how many of your friends used alcohol?

In the past 6 months, how many of your friends used marijuana or hashish?

In the past 6 months, how often have your friends said you should go drinking with them?

In the past 6 months, how often have your friends put pressure on you to drink?

In the past 6 months, how often have your friends said you have to get drunk to have a good
time?