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Assessment of Warning Signs of Relapse Scale
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About Assessment of Warning Signs of Relapse Scale
Scale Name
Assessment of Warning Signs of Relapse Scale
Author Details
William R. Miller and Richard J. Harris
Translation Availability
English
Background/Description
The Assessment of Warning Signs of Relapse (AWARE) Scale, developed by Miller and Harris (2000), is a 28-item self-report scale designed to measure warning signs of relapse in individuals with alcohol use disorders, based on Gorski’s post-acute withdrawal syndrome (PAWS) model. Published in the Journal of Studies on Alcohol, the AWARE operationalizes 28 of Gorski’s 37 warning signs, assessing attitudes, behaviors, and emotional states (e.g., stress, denial, impulsivity, mood swings) that precede alcohol relapse. It was tested in a prospective study to evaluate its ability to predict slips (any drinking) and relapses (heavy drinking).
Participants rate the frequency of each warning sign over the past 2 months on a 7-point Likert scale (1 = “Never” to 7 = “Always”). Total scores range from 28–196, with higher scores indicating greater relapse risk. The scale was validated with 122 individuals (84 men, mean age ≈ 35–45 years, U.S.-based) entering alcohol treatment, followed at 2-month intervals for 1 year. About 33–46% higher relapse rates were observed for those with the highest AWARE scores compared to the lowest, after controlling for prior drinking. The scale correlates with psychological distress (r ≈ 0.40–0.60) and coping deficits (r ≈ 0.30–0.50). It is used in clinical psychology, addiction treatment, and research to identify relapse risk and guide prevention strategies. A drug-adapted version (DARPAS) exists for substance use disorders.
Administration, Scoring and Interpretation
- Obtain the scale from Miller and Harris (2000) or authorized sources (e.g., Journal of Studies on Alcohol), ensuring ethical permissions.
- Explain to participants (adults in alcohol treatment) that the questionnaire assesses thoughts and behaviors linked to relapse risk, emphasizing confidentiality and voluntary participation.
- Administer the 28-item scale in a clinical or research setting, using paper or digital formats, with instructions to rate experiences over the past 2 months.
- Estimated completion time is 5–8 minutes.
- Ensure a private, supportive environment; provide support resources (e.g., addiction helplines) and adapt for accessibility (e.g., oral administration) if needed.
Reliability and Validity
The AWARE demonstrates strong psychometric properties (Miller & Harris, 2000). Internal consistency is excellent (Cronbach’s alpha = 0.92–0.93), based on a sample of 122 treatment-seeking individuals. Test-retest reliability is robust (r ≈ 0.80 over 2-month intervals). Principal factor analysis supports a unidimensional structure, with 28 items clustering as a single factor explaining significant variance.
Convergent validity is evidenced by correlations with the Addiction Severity Index (r ≈ 0.40–0.60) and measures of psychological distress (r ≈ 0.40–0.60). Criterion validity is shown by its ability to predict slips and relapses (33–46% higher relapse rates for high scores). Discriminant validity is supported by weak correlations with unrelated constructs like general life satisfaction (r < 0.20). Pairing with measures like the Alcohol Use Disorders Identification Test (AUDIT) or Short Index of Problems (SIP) enhances comprehensive assessment.
Available Versions
28-Items
Reference
Miller, W. R., & Harris, R. J. (2000). A simple scale of Gorski’s warning signs for relapse. Journal of studies on alcohol, 61(5), 759-765.
Gorski, T. T. (1995). The phases and warning signs of relapse. Herald House/Independence Press.
Gorski, T. T., & Miller, M. (1982). The Phases and Warning Signs of Relapse. Independence, MO: Herald House/Independence Press.
Important Link
Scale File:
Frequently Asked Questions
What does the Assessment of Warning Signs of Relapse Scale measure?
It measures attitudes, behaviors, and emotional states signaling relapse risk in alcohol use disorders.
Who is the target population?
Adults in treatment for alcohol use disorders.
How long does it take to administer?
Approximately 5–8 minutes.
Can it inform interventions?
Yes, it identifies relapse risk to guide prevention and treatment planning.
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