Luborsky's concept of the "helping alliance" refers to a patient's experience of the treatment or relationship with a therapist as being helpful or potentially helpful. The quality of the patient-therapist relationship can be assessed by asking the patient, the therapist, or an (objective) observer. The Helping Alliance Questionnaire is part of the Penn Helping Alliance Scales and is a patient self-report measure which assesses the extent to which the patient experiences the therapist and the therapy as helpful. It contains two types of helping alliance: Type I -- Perceived Helpfulness -- defined as the patient's experience of the therapist as providing or being capable of providing the help that is needed; and Type II -- Collaboration or Bonding -- defined as the patient's experience of treatment as a process of working together with the therapist toward the goals of treatment. The HAQ contains 11 items rated on a 4-point scale (completely disagree, disagree, agree, and completely agree). There are two versions of the HAq -- a version for the patient, asking questions regarding their relationship with their therapist ("I feel I can depend upon the therapist," e.g.), and a version for the therapist, asking the same questions in reverse ("The patient feels he/she can depend upon me.") A revised version of the HAq, the HAq-II, was published by Luborsky et al. in 1996 (see Other References, below). The authors had become aware that the original HAQ was limited by the presence of items that were explicity assessing early symptomatic improvement and by the fact that all the items were worded positively. To address those limitations, they deleted the six items reflecting early improvement and added 14 new items that appeared to tap more fully the various aspects of the helping alliance. Five of the new items relate to the collaborative effort of patient and therapist ("The therapist and I have meaningful exchanges," e.g.); five additional items address the patient's perception of the therapist ("At times I distrust the therapist's judgement," e.g.). One of the other added items deals directly with the patient's motivation ("I want very much to work out my problems"), and one other relates to the patient's perception of the therapist's feelings about the patient ("I believe that the therapist likes me as a person"). In contrast to the original HAq, the HAq-II also includes five items that are worded negatively; for example, "The procedures used in my therapy are NOT well suited to my needs."

"The Heaviness of Smoking Index (HSI) was developed as a test to measure nicotine dependence by using two questions from the Fagerstrom Tolerance Questionnaire and the Fagerstrom Test for Nicotine Dependence: time to first smoking in the morning and number of cigarettes per day. It uses a six-point scale calculated from the number of cigarettes smoked per day (1-10, 11-20, 21-30, 31+) and the time to first cigarette after waking (less than/equal to 5, 6-30, 31-60, and 61+ minutes). Nicotine dependence is then categorized into a three-category variable: low (0-1), medium (2-4), and high (5-6). HSI as a measure for assessing nicotine dependence may have significant floor effects among lighter smokers seen in non-clinical populations and the validity of the measure for assessing dependence in a general population may be questioned. Nevertheless, HSI is commonly used in both clinical and population surveys to assess dependence, and may provide a simple way for clinicians prescribing dependency-based treatments to classify their patients."

The HAM-D was designed to measure the severity of depressive symptoms in patients with primary depressive illness, and is the most commonly used observer-rated depressive symptom rating scale. It is used for quantifying the results of an interview and its value depends entirely on the skill of the interviewer in eliciting the necessary information. The HAM-D is useful for monitoring changes in depressive symptoms with treatment and in comparing the efficacy of various interventions if the patient requires more than one type of treatment. The scale contains 17 variables measured on either a five-point or a three-point rating scale, the latter being used where quantification of the variable is either difficult or impossible. Among the variables are: depressed mood, suicide, work and loss of interest, retardation, agitation, gastrointestinal symptoms, general somatic symptoms, hypochondriasis, loss of insight, and loss of weight. It is useful to have two raters independently scoring a patient at the same interview. The scores of the patient are obtained by summing the scores of the two physicians. The reliability and validity are generally favorable. Completion time is 15-20 minutes.

This assessment includes questions about the days and quantities of substances used over the preceding 6 months. In addition, it includes questions about frequency and amount of use, including alcohol, methamphetamine, cocaine, heroin poppers, club-drugs, frequency and types of drugs injected, and sharing of drugs, needles, and other paraphernalia. It also includes questions about overdoses and any drug-related hospitalizations. Finally, the assessment includes questions to measure the point at which a participant is in his/her course of drug treatment.

This assessment focuses on vaginal and anal rather than oral sex behavior because vaginal and anal sex are far riskier behaviors for contracting HIV. Questions include total number of sex partners in prior 6 months; total number of vaginal sex partners and anal sex partners; total number of unprotected vaginal and total number of anal sex partners and total acts of unprotected vaginal and anal sex; and total number of unprotected vaginal/anal acts with HIV-positive, negative, and unknown serostatus partners.

The General Health & Traumatic Brain Injury Assessment is a structured interview adapted from the Ohio State University TBI Identification Method. It is used to assess for the presence or history of traumatic head or neck injury and any resultant loss of consciousness greater than 30 minutes. Information obtained from the interview will result in a dichotomous indicator as to whether or not the participant is likely to have suffered at least a moderate TBI.

The variable ratio schedule proposed includes an element of chance, and there is some concern that this will stimulate gambling behavior in those who have a problem with this type of impulsive behavior. It should be noted that there is no evidence to support such a concern. Further, the variable ratio incentive procedure itself could not be defined as gambling. It does not require the volunteers to put up their own money, nor is there any chance that volunteers could benefit excessively or lose their own money as a result of participating successfully in the incentive program. There is a chance that an individual with a gambling problem in remission could be stimulated to resume gambling. For this reason, compulsive gambling in remission has been added as a study exclusion criteria. There is also a chance that individuals who tend to engage in excessive gambling and who abstain from drug use during the study would have more disposable income to spend on gambling. For this reason, gambling behavior will be monitored at study follow-up points.

The FrSBe, formerly known as the Frontal Lobe Personality Scale (FLoPS; Grace, Stout, Malloy 1999), provides a brief, reliable, and valid measure of three frontal systems behavioral syndromes: apathy, disinhibition, and executive dysfunction. It also quantifies behavioral changes over time by including both baseline (retrospective) and current assessments of behavior.

The Family Environmental Scale (FES; Moos & Moos, 1986) is a widely used measure that was developed to measure social and environmental characteristics of families. This measure has been used in thousands of studies to capture critical aspects of family functioning. In this study, we will be using the cohesion and conflict subscales of the FES, administered to both parents and adolescents. Internal consistency reliability estimates for the subscales range from 0.61 to 0.78. Conflict and cohesiveness subscales will be administered to measure family functioning.

The Fagerstrom Test for Nicotine Dependence was designed to provide an ordinal measure of nicotine dependence related to cigarette smoking. It contains six items that evaluate the quantity of cigarette consumption, the compulsion to use, and dependence. It is useful as a screen for nicotine dependence and as a severity rating that can be used for treatment planning and prognostic judgments. The brevity and easy scoring of the FTND make it an efficient way to obtain clinically meaningful information. It can also be incorporated into general health and lifestyle screening questionnaires in clinical and nonclinical settings. This instrument is a revision of the Fagerstrom Tolerance Questionnaire (FTQ). It takes 2 minutes or less to administer the FTND and 2 minutes or less to score it. The Modified Fagerstrom Tolerance Questionnaire (mFTQ; Prokhorov et al., 1998) is an adapted version of a scale originally designed to assess behavioral indicators of physical dependence on nicotine among adult smokers (FTQ). It includes a modified set of adult symptoms for adolescents to address graded levels of smoking behavior, avoidance of the physiological effects of nicotine deprivation, and perceived difficulty refraining when prevented from smoking. It has been shown to predict continued smoking, quantity and frequencey of tobacco use, and shorter periods of abstinence from smoking over time.