title: Predicting relapse among young adults: psychometric validation of the Advanced WArning of RElapse (AWARE) scale.
abstract: OBJECTIVE
  Failure to maintain abstinence despite incurring severe harm is perhaps the key defining feature of addiction. Relapse prevention strategies have been developed to attenuate this propensity to relapse, but predicting who will, and who will not, relapse has stymied attempts to more efficiently tailor treatments according to relapse risk profile. Here we examine the psychometric properties of a promising relapse risk measure-the Advance WArning of RElapse (AWARE) scale (Miller & Harris, 2000) in an understudied but clinically important sample of young adults.
  
  
  METHODS
  Inpatient youth (N=303; Ages 18-24; 26% female) completed the AWARE scale and the Brief Symptom Inventory-18 (BSI) at the end of residential treatment, and at 1-, 3-, and 6-months following discharge. Internal and convergent validity was tested for each of these four timepoints using confirmatory factor analysis and correlations (with BSI scores). Predictive validity was tested for relapse 1, 3, and 6 months following discharge, as was incremental utility, where AWARE scores were used as predictors of any substance use while controlling for treatment entry substance use severity and having spent time in a controlled environment following treatment.
  
  
  RESULTS
  Confirmatory factor analysis revealed a single, internally consistent, 25-item factor that demonstrated convergent validity and predicted subsequent relapse alone and when controlling for other important relapse risk predictors.
  
  
  CONCLUSIONS
  The AWARE scale may be a useful and efficient clinical tool for assessing short-term relapse risk among young people and, thus, could serve to enhance the effectiveness of relapse prevention efforts.
authors.affiliation: Center for Addiction Medicine, Massachusetts General Hospital, Department of Psychiatry, 60 Staniford Street, Boston, MA 02114, USA. jkelly11@partners.org
authors.forename: John F
authors.initials: JF
authors.lastname: Kelly
authors.forename: Bettina B
authors.initials: BB
authors.lastname: Hoeppner
authors.forename: Karen A
authors.initials: KA
authors.lastname: Urbanoski
authors.forename: Valerie
authors.initials: V
authors.lastname: Slaymaker
mesh_terms: D000293:Adolescent; D016739:Behavior, Addictive / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D011594:Psychometrics / Q000379:methods*; D012008:Recurrence; D015203:Reproducibility of Results; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000517:prevention & control / Q000523:psychology*; D011795:Surveys and Questionnaires / Q000592:standards*; D055815:Young Adult