What Is A Substance Abuse Assessment Or Evaluation?
Treatment is available for anyone who is struggling with substance abuse or addiction. Many of these services are designed to be tailored to individual needs. Providers need to have an evaluative process that can be used to create individualized, evidence based treatment, and that process includes a substance abuse assessment.
There are many feelings a person experiences when standing face to face with their own substance misuse, abuse or addiction. All too often, shame and embarrassment keep a person from reaching out for treatment. Sometimes, nervousness and fear over not knowing what to expect can make reaching out for treatment seem even more impossible. Knowing how the process starts and what to expect early on can help a person finally accept the help they need.
When exploring treatment options for substance abuse and addiction, obtaining a substance abuse evaluation is typically how that journey begins. Substance abuse assessments and evaluations are used to explore addiction, degree of addiction, and additional potential diagnosis (co-occurring disorders or conditions). Using the results of the assessment can help form the foundation for an individual’s substance abuse treatment.
The Motivation Behind A Substance Abuse Evaluation
The purpose of a substance abuse evaluation is to explore the following:
- establish if the person meets criteria for a substance misuse disorder (drug or alcohol abuse or addiction)
- find out the degree or severity of the substance misuse disorder
- explore the possibility of a co-occurring disorder or poly-drug use
- discover how much substance use is affecting the life of the individual
All of the information obtained during the substance abuse evaluation is used to gain understanding and insight into the individual being assessed. Being able to see the circumstances connecting substance abuse and the person can help providers develop individualized treatment plan options with a solid baseline and focus on recovery.
Substance Abuse Evaluation Expectations
Substance abuse evaluations are divided into two seperate sections. According to the Substance Abuse and Mental Health Services Administration (SAMHSA) , the sections of a substance abuse evaluation are screening and assessment.
Substance Abuse Screening
Substance abuse screening evaluates if a persons substance use may need further exploration for potential of an abuse disorder. There are different types of screening and the result of a screening is usually yes (positive) or no (negative). If the answer is yes (positive), it is used to indicate that a closer look is needed to determine if the substance use may warrant treatment. Different types of screenings for substance abuse include:
- Substance Abuse Subtle Screening Inventory (SASSI) – a self-report that is easy to take, administer, and score. This screening tool has scientific evidence that supports that it has 93 percent accuracy when diagnosing substance dependence.
- CAGE questionnaire – This screening tool assesses alcohol misuse in four simple questions. Because it is brief and non-invasive, it is important that the person answering the questions be honest, and not make attempts to cover their use.
- BSTAD (Brief Screener for Alcohol, Tobacco, and other Drugs) – For use in teens and adolescents, this self assessment can be taken online with or without a clinician present. Results should only be interpreted by a professional.
- TAPS (Tobacco, Alcohol, and other Drugs – a versatile screening tool that offers a more indepth screen, online or face to face administration, explores recent and past substance use habits. Results still need to be reviewed with a professional.
Screenings are also available for specific substance use, including alcohol, opioids, as well as specific demographics, teens, adults, pain management patients. Some states have specific screenings that the prefer to be used when conducting a screening for substance abuse and addiction.
It is important to understand that a screening tool is not an assessment. A screening for substance use is one of many tools that is used to determine if further assessment is needed. The results of all screenings and assessments should always be analyzed by a qualified individual.
Substance Abuse Assessment
The assessment process is more in-depth. This is a way to further define and explore the results of the screening. These results can be used to diagnose and create recommendations for treatment services.
Assessments involve obtaining a thorough history of the patient. They explore previous substance use, mental health, physical health, medical history, family history, and personal history. The interview process is conducted either by a structured interview or a semi-structured interview, and most professionals in the field use the following resources when conducting an assessment
Structured Clinical Interview for DSM-IV (SCID-5) uses structured questions to explore the potential diagnoses that are within the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The DSM-IV was updated in 2013, and contains all mental health diagnoses, including substance use disorders. This manual also provides questions to provide a range (mild, moderate, severe) of substance misuse. The diagnostic criteria from this manual is accepted by medical and substance abuse facilities. This method is very structured and it is not recommended that the person interviewing deviate very far from the questions as they are written.
Addiction Severity Index (ASI) uses a semi-structured interview process. Because the person being assessed is asked questions about both recent and past substance use, a pattern of abuse can be documented. This index also provides a thorough assessment of seven areas that tend to be affected by substance abuse and addiction. Individuals using this index tend to use their expertise in the field to further understand the depth of the clients addiction.The results of this assessment can be used to focus treatment goals and build a plan or service for the patient.
It is common for more than one person to assess a person during this assessment process. This is to make sure that the facility gathers as much information as possible. Additionally, a provider may ask to speak with friends or family members to better understand how substance abuse is affecting the life of the person being assessed.
Co-Occurring Diagnoses And Evaluation Results
It is not uncommon for a person who is struggling with substance abuse to also be struggling with a mental health issue as well. Depression, anxiety, and even mood disorders can sometimes happen at the same time as a substance abuse disorder, called co-occurring disorders. While it isn’t always clear if the mental health issue is a result of the substance abuse, or if the substance abuse is an attempt to self-medicate the mental health issue, it is important to treat both conditions at the same time to help increase the likelihood of long-term sobriety.
Co-Occurring diagnoses are not limited to mental health issues. There are physical conditions that can occur alongside substance use disorders. Liver disease, infections, STDs, diseases associated with intravenous drug use, are among a few co-occurring physical issues associated with substance abuse
Who Conducts A Substance Abuse Evaluation
The people conducting these evaluations are professionals who have been educated in the substance abuse or mental health fields and are trained to administer these assessments. Substance abuse counselors, mental health counselors, therapists, psychologists, psychiatrists, medical professionals, and psychometrists are just a few of the professionals who are qualified to give these types of assessments.
The results of a substance abuse evaluation and assessment are confidential. The results should only be used to help evaluate addiction and explore treatment options that meet the needs of the person being assessed. There are some circumstances when results may be requested by the court or legal system, but only the relevant documentation is provided. If there is any question about information that may be disclosed, the person giving the assessment should be able to answer those questions or find the answers.
How A Substance Abuse Evaluation Helps In Substance Abuse Treatment
Substance abuse evaluations determine how substance abuse is affecting the life of the person struggling with substance abuse. The assessment will gather enough information to provide a thorough history, which shows patterns of abuse, triggers, substances that are being abused, substances that have been used previously, and problems that have occurred as a result of substance abuse.
These evaluations also allow the the treatment facility to explore what is important to the person seeking treatment and discover what the person wants to see as a result of treatment. In this way, the rehab center determine if they can meet the needs of the patient and, if so, then develop a treatment program that is uniquely designed with the patient in mind.
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- National Institute on Drug Abuse — Chart of Evidence-Based Screening Tools and Assessments for Adults and Adolescents
- American Psychiatric Association — Structured Clinical Interview for DSM-IV (SCID-IV)