Assessment

           When attempting to determine the appropriate screening or assessment tool it is imperative to take into consideration 1) the population being served, and 2) the professional scope of service. Considering that a client referred to an addiction treatment professional typically present with directly or indirectly relatable problems, the proper substance use assessment will depend on the objective (Samet, et al, 2007) and the scope of service provided. The interview also needs to capture sufficient information and possess the reliability and validity to obtain a comprehensive and objective picture (Samet, et al, 2007) allowing for the identification of, or the need for auxiliary or referral services to meet the complete needs of the individual being screened or seeking treatment (Larimer, et al, 2004/2005; Samet, et al, 2007). 

           Addiction screening or assessment tools such as the CAGE, MAST, CAPS-r, and the AUDIT that identify drinking problems experienced over the course of a person’s lifetime are beneficial to the identification process of at risk levels of use, for harmful consequences and providing brief interventions appropriate for the population being surveyed (Larimer, et al, 2004/2005). These tools are different from a clinical assessment because they are not typically administered by an addiction treatment professional and do not conclude with a diagnosis. Often these assessments are presented as an anonymous survey on a school campus for research and development for implementation of education and awareness programs (Larimer, et al, 2004/2005). Or, in times of distress they are self-administered and reviewed with a medical professional, school counselor, or even a peer (Larimer, et al, 2004/2005).

           In a community based addiction treatment program that does not specialize or employ professionals capable of treating comorbid psychiatric disorders it is important that the intake assessment contains the ability to assess for these underlying conditions (Samet, et al, 2007). In this consideration, a facility not equipped to diagnose or treat psychiatric disorders, they must choose a structured assessment instrument appropriate for their treatment planning needs and the intervention needs of their clientele (Samet, et al, 2007). An effective assessment tool, and one that is widely used in this specific type of scenario is the Addiction Severity Index (ASI) (Samet, et al, 2007). The ASI evaluates medical conditions (organic, contracted, and induced), employment and monetary support (or the lack of), use of alcohol and drugs (abuse and dependence), legal issues (past and pending), family history (including interpersonal difficulties), family and social relationships (productive, lacking, or abusive) and psychiatric disorders (previous diagnoses, or presenting behavior) (Samet, et al, 2007). The clients are also prompted to provide numerical self-ratings in each domain, thus allowing the administrator to identify levels of distress over the past 30 days on a range of none to extreme and treatment needs form none to treatment needed to intervene. The ASI provides reliable and valid information that facilitates the development of a comprehensive treatment plan that may or may not include a collaborative/multidisciplinary treatment team that includes the use of referral or auxiliary services from the appropriate professional (ie psychiatrist, psychologist, trauma therapist etc.).

           For the treatment facility equipped to diagnose and treat both substance use disorders and psychiatric disorders there are standardized assessment instruments developed by the American Psychiatric Association that are fully integrated and either structured or semi-structured (Samet, et al, 2007) for clinical diagnosing. “The Composite International Diagnostic Interview (CIDI) assesses for 22 DSM-IV diagnoses, including mood, anxiety, and substance use disorders” (Samet, et al, 2007). It is a fully structured, integrated assessment available on paper and in computerized forms (Samet, et al, 2007). The PRISM (Psychiatric Research Interview for Substance and Mental Disorders) is a semi-structured, fully integrated, diagnostic interview that has been designed specifically with the need to assess for comorbid psychiatric disorders in people who abuse or misuse substances (Samet, et al, 2007). The substance use disorder sections are completed first, the information is not coded for data entry, it is used to develop a timeline with the purpose of “differentiating primary versus substance-induced symptoms in later diagnostic sections” (Samet, et al, 2007). Both instruments have good to excellent reliability rating, are available in English and Spanish, and take approximately 120 minutes to administer (Samet, et al, 2007).

           In addiction practice it may be suggested that a pre-assessment screening for substance use patterns and mental health status is performed before choosing which type of assessment is appropriate. Often it is appropriate to begin with a thorough substance abuse assessment, such as the ASI, that screens for comorbid or underlying conditions and utilizing a psychiatric assessment after a period of stabilization if the need arises. However, there are cases that at the pre-screening process present with high levels of indicators that provide validity for using the integrated assessment to ensure that the client receives the level of care they need; whether on site at the facility, or through auxiliary/referral systems. The key is having the ability to identify the clients’ symptomology and having the appropriately trained staff to effectively administer the assessment.

Resources

Larimer, M. E., Cronce, J. M., Lee, C. M., & Kilmer, J. R. (2004/2005). Brief intervention in college settings. Alcohol Research & Health, 28(2), 94–104.

Retrieved from the Walden Library databases.

Samet, S., Waxman, R., Hatzenbuehler, M., & Hasin, D. S. (2007). Assessing addiction: Concepts and instruments. Addiction Science & Clinical Practice, 4(1), 19–31. Retrieved from http://archives.drugabuse.gov/pdf/ascp/vol4no1/Assessing.pdf


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