Exhibit 19 - Brief Addiction Monitor.pdf

OPS.XXX-XXX (Dev. 01/2026)

DEPARTMENT OF PUBLIC SAFETY & CORRECTIONAL SERVICES

Substance Use Disorder Treatment Services

First Name Last Name SID# DOC#

Administration Method: Self-administered Clinician-administered

Brief Addiction Monitor (BAM) This is a standard set of questions about several areas of your life such as your health, alcohol and drug use, etc. The questions generally ask about the past 30 days.

Instructions: Please consider each question and answer as accurately as possible.

1. In the past 30 days, would you say your physical health has been:

Excellent (0)

Very Good (1)

Good (2)

Fair (3)

Poor (4)

2. In the past 30 days, how many nights did you have trouble falling asleep or staying asleep?

0 (0)

1-3 (1)

4-8 (2)

9-15 (3)

16-30 (4)

3. In the past 30 days, how many days have you felt depressed, anxious, angry or very upset throughout most of the day?

0 (0)

1-3 (1)

4-8 (2)

9-15 (3)

16-30 (4)

4. In the past 30 days, how many days did you drink ANY alcohol?

0 (Skip to #6) (0)

1-3 (1)

4-8 (2)

9-15 (3)

16-30 (4)

5. In the past 30 days, how many days did you have at least 5 drinks (if you are a man) or at least 4 drinks (if you are a woman)? (One drink is considered one shot of hard liquor (1.5 oz) or 12-ounce can/bottle of beer or 5 oz glass of wine)

0 (0)

1-3 (1)

4-8 (2)

9-15 (3)

16-30 (4)

6. In the past 30 days, how many days did you use any illegal/street drugs or abuse any prescription medications?

0 (Skip to #8) (0)

1-3 (1)

4-8 (2)

9-15 (3)

16-30 (4)

7. In the past 30 days, how many days did you use:

A. Marijuana (cannabis, pot, weed)?

1-3 4-8 9-15 16-30

B. Sedatives/Tranquilizers (e.g., “benzos”, Valium, Xanax, Ativan, Ambien, “barbs”, Phenobarbital, downers, etc.)?

1-3 4-8 9-15 16-30

C. Cocaine/Crack?

1-3 4-8 9-15 16-30

D. Other Stimulants (e.g., amphetamine, methamphetamine, Dexedrine, Ritalin, Adderall, “speed”, “crystal meth”, “ice”, etc.)?

1-3 4-8 9-15 16-30

E. Opiates (e,g., Heroin, Morphine, Dilaudid, Demerol, Ocycontine, oxy, codeine, Tylenol 2,3,4, Percocet, Vicodin, Fentanyl, etc.)?

1-3 4-8 9-15 16-30)

F. Inhalants (glues/adhesives, nail polish remover, paint thinner, etc.)?

1-3 4-8 9-15 16-30

DPDS -SUDTS (Pre-Trial) Solicitation #: BPM055260 Exhibit 19.

First Name Last Name SID/DOC#

OPS.XXX-XXX (Dev. 01/2026)

Brief Addiction Monitor (BAM) - Continued

G. Other drugs (steroids, non-prescription 14. Do you have enough income (from legal sources) to pay for necessities such as housing, transportation, food and clothing for yourself and your dependents?

No (0)

Yes (4)

15. In the past 30 days, how much have you been bothered by arguments or problems getting along with any family members or friends?

Not at all (0)

Slightly (1)

Moderately (2)

Considerably (3)

Extremely (4)

16. In the past 30 days, how many days were you in contact or spent time with any family members or friends who are supportive of your recovery?

0 (0)

1-3 (1)

4-8 (2)

9-15 (3)

16-30 (4)

17. How satisfied are you with your progress toward achieving your recovery goals?

Not at all Slightly Moderately Considerably Extremely

Current Score Risk:

Use:

Protective:

Previous Score Risk:

Use:

Protective:

sleep/diet pills, Benadryl, Ephedra, other over-the-counter/unknown medications)?

1-3 4-8 9-15 16-30

8. In the past 30 days, how much were you bothered by cravings or urges to drink alcohol or use drugs?

Not at all (0)

Slightly (1)

Moderately (2)

Considerably (3)

Extremely (4)

9. How confident are you in your ability to be completely abstinent (clean) from alcohol and drugs in the next 30 days?

Not at all (0)

Slightly (1)

Moderately (2)

Considerably (3)

Extremely (4)

10. In the past 30 days, how many days did you attend self-help meeting like AA or NA to support your recovery?

0 (0)

1-3 (1)

4-8 (2)

9-15 (3)

16-30 (4)

11. In the past 30 days, how many days were you in any situations or with any people that might put you at an increased risk for using alcohol or drugs (i.e., around risky “people, places or things”)?

0 (0)

1-3 (1)

4-8 (2)

9-15 (3)

16-30 (4)

12. Does your religion or spirituality help support your recovery?

Not at all (0)

Slightly (1) Scoring Moderately (2)

Considerably (3)

Extremely (4)

Risk = sum of items 1, 2, 3, 8, 11, 15 Protective = sum of items 9, 10, 12, 13, 14, 16 Use = sum of items 4, 5, 6

13. In the past 30 days, how many days did you spend (Items 7a–g and 17 are not included in any composite.)

much of the time at work, school, or doing volunteer work?

0 (0)

1-3 (1)

4-8 (2)

9-15 (3)

16-30 (4)

Reference:

Cacciola, J. S., Alterman, A. I., DePhilippis, D., Drapkin, M. L., Valadez, C., Fala, N. C., … & McKay, J. R. (2013). Development and initial evaluation of the Brief Addiction Monitor (BAM). Journal of substance abuse treatment, 44(3), 256-263.

DPDS -SUDTS (Pre-Trial) Solicitation # - BPM055260 Exhibit 19.