When trying to determine if someone is likely to use substances, experts must craft a full picture of their lives. This includes everything from the history of use in their families, instances of neglect and abuse at a young age, as well as intrinsic factors like genetic predispositions. It takes a carefully devised evaluation that mixes the perspective of the person who uses and scientific research in equal measure.
Deciding to take an evaluation for symptoms of substance abuse is a valuable first step toward getting help. The decision can be made by the individual who is using, concerned family members or, in certain cases, by court order.
Evaluations take different forms, but all of which intend to uncover the same information. First and foremost being if someone has a substance use problem at all. From here, physicians can use assessments to determine the extent of the issue at hand, the effect it has on the person’s life, and begin the process of crafting a substance abuse treatment plan if necessary.
Each type of evaluation fits into two overreaching categories: screenings or assessments. The screening process is helpful for both identifying those who are abusing drugs and alcohol, as well as those who may potentially do so in the future. Screens are preliminary attempts at pinpointing whether a full assessment is vital for a given individual. They are an identification tool, not a decision-making tool.
This procedure is dependent on likelihoods of substance abuse, as such, the end result of these screenings is often a straightforward answer of yes or no.
Three such screening tools are put into practice: the CAGE questionnaire, Alcohol Use Inventory (AUI), and the Substance Abuse Subtle Screening Inventory (SASSI). A brief description of each can be found below.
Even though it is considered a questionnaire, at only four questions in length, it hardly qualifies. The answers are not required to be long either; yes-or-no responses will suffice. Though this method is concise, it only works if the person is willing to divulge their substance use behavior. This can be a serious hindrance if they are not seeking treatment voluntarily. If they are not upfront and honest, the CAGE questionnaire becomes virtually useless.
This screening tool is intended for supposed alcohol abuse only. This approach is more in-depth than CAGE, in that the questions take feelings, attitudes, behaviors, and lifestyle into consideration. Despite the more robust line of questioning, AUI is also plagued by the same potentially fatal flaw: the need for transparency.
A SASSI screen delves deeper into the psychological side of substance use. It measures the responses as well as how the responses are given, i.e. openness, defensiveness, aggressiveness, and the like to determine if someone may be abusing substances.
A substance abuse assessment is the follow-up step to screenings. Therefore, it only takes place if there is a clear substance abuse likelihood identified. While screenings outline whether substance abuse was a possibility, assessments establish if it is present or not. And, if so, what can be done about it. The system becomes more formal at this point, with a diagnostic interview often performed in a face-to-face setting. There are two types of possible interviews: structured or semi-structured. Each is attempting to determine the extent of the problem, all while trying to answer a fundamental question: is this abuse? Structured interviews are excellent for diagnosing substance abuse, but lack the ability to establish what to do next. Semi-structured ones, on the other hand, have less structured questions but allow medical professionals to determine appropriate treatment and craft a substance abuse treatment planafterward.
The most widely used assessment tools include the Addiction Severity Index (ASI) and the Diagnostic Interview Schedule-IV (DIS-IV).
Addiction Severity Index:
An ASI is a semi-structured interview which helps brings to light recent and lifetime use habits. This form is extensive and is thus used as a standardized measurement tool to assess those entering rehabilitation. Throughout the interview, the administrator will be able to touch upon considerations of medical history, substance use, time in custody if any, whether the person has a job, their relationship and familial statuses, and mental health.
Diagnostic Interview Schedule-IV:
If ASI is semi-structured, it should come as no surprise that the DIS-IV is the structured alternative. All questions administered from this interview are created by knowledge acquired from the Diagnostic and Statistical Manual of Mental Disorders. While thorough in its own right, it may lack the most recent research into substance abuse. The questions may suffer as a result.
As established, an evaluation can be inherently flawed due to nothing other than the human element. Self-interest and self-preservation, especially when buffered by an addiction, can often come into play. Individuals might want to hide their use for myriad reasons. They find it embarrassing to confront. They wish to maintain relationships, employment, or simply a sense of normalcy that acknowledging a problem can disrupt. These are all understandable rationales.
In this way, personal evaluations may not be enough. Onsite substance abuse testing removes all subjectivity for an objective measurement. Urinalysis is a preferred method of determining whether someone has taken a substance with the last three days — or up to 30 days for cannabis. The time frame of such tests make them effective for identifying short-term use, but they lack the foresight of whether abuse is a longstanding issue or not. Put simply, there is no laboratory test for dependence or addiction.
Once it is concluded that treatment is the next logical step, physicians and counselors will lay out a tailor-made substance abuse treatment plan for their new patient. These are much more than blueprints; each will outline the needs, challenges, and goals from the first day of treatment onward. After they have completed a detox of drugs or alcohol from their system, they are truly ready to take in all the knowledge and empowerment their stay will afford them. Generally speaking, a continuum of care encompasses several back-to-back stages. Patients will begin with an inpatient program in the rehabilitation setting and progress to partial hospitalization, intensive outpatient, outpatient programs, and then, hopefully, a lifetime of happiness with substance use in the past.
The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.