What To Expect At A Substance Abuse Evaluation

When facing the possibility of substance abuse or addiction, it’s common to feel a mix of emotions. One may feel overwhelmed, afraid, or even hopeful for change. Addiction affects millions of people but can be difficult to navigate. It’s important to understand the many avenues of support that are here to help you or your loved one in finding recovery.

The first step toward a successful recovery is recognition of a problem. When someone begins engaging in drug-seeking behaviors that threaten their health or well-being, it’s time for them to seek help. Sometimes it takes an intervention or a court mandate to motivate someone suffering from an addiction. Regardless of the medium, this person will likely encounter what’s known as a substance abuse evaluation – a tool which will inform healthcare providers in creating a customized treatment plan for the person suffering.

What Is A Substance Abuse Evaluation?

A substance abuse evaluation is a clinical tool to determine what is going on with a person who may be struggling with addiction. Additionally, an evaluation may include questions that can identify any co-occurring issues, such as a mental health disorder or physical health issue. A substance abuse evaluation can also:

  • Assess the magnitude of a person’s drug or alcohol addiction
  • Determine if there are any co-occurring concerns
  • Evaluate the extent to which the substance abuse has affected everyday life
  • Impart a general idea of the person and their history, as it relates to drug use and general health concerns.

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What To Expect During An Evaluation

Substance abuse evaluations are typically divided into two parts: an initial screening followed by a more holistic assessment that helps to determine the next course of action.

Substance Abuse Evaluation Screening and assessment evaluations:

  • Screening: This step determines whether or not there is a possibility of a substance abuse problem. The results are a simple yes or no.
  • Assessment: This portion defines the type of problem, helps to determine any possible diagnosis, and provides recommendations for a customized treatment plan.

Both of these diagnostic steps can be administered by different types of professionals. While screening may be given by an entry-level professional, assessments require administration by a social worker, therapist, doctor, or nurse. Information in an assessment can be gathered and recorded through discussion, interview-style questions, or written responses. The person may be asked questions about their health, drug, and alcohol usage history, and history of possible treatment.

Screening For Substance Abuse Disorders

Screening is an initial evaluation that assists with a professional determining if the person’s current situation requires further action. This is a key element of the assessment, as it can lead to proactive care methods that could prevent the substance abuse disorder from progressing further. Some of the most commonly used screening tools can be given online or in person, and can include the following:

CAGE Questionnaire: Perhaps the most commonly used method, this questionnaire asks four questions in relation to a person’s drinking patterns. The questions form the acronym CAGE, and ask the following:

  • Have you ever felt you needed to Cut down on your drinking?
  • Have people Annoyed you by criticizing your drinking?
  • Have you ever felt Guilty about drinking?
  • Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?

SASSI (Substance Abuse Subtle Screening Inventory): An inventory that is defined as an “easily-administered psychological screening measure that … helps identify individuals who have a high probability of having a substance dependence disorder.” This screening instrument can predict the probability of a substance use disorder, as well as provide clinicians with evidence of any defensiveness or willingness in the admission of an issue. This inventory can also help a treatment team understand the significance of someone’s use, and if their usage surpasses social drinking or recreational drug use levels.

State Specific Inventories: Some states have specific screening tools that may be required either in addition to or instead of the aforementioned tools. Although some tools can be taken by the person themselves, it can be valuable to have a medical professional or addictions specialist review or administer the screening tool. Remember that this is but the first step in the recovery process, and a specialist’s expertise can provide the vital support and direction you may need.

Assessment For Substance Use Disorders

Assessments are a more in-depth evaluation of a person’s issues with addiction. Assessments identify patterns around someone’s substance-related behaviors, in order to find specific evidence of possible addiction and to make a diagnosis. Typically, a diagnostic interview will occur, wherein the interviewer asks questions related to the screening in order to draw a clear picture of the individual’s substance use. This can be achieved through two approaches, either a structured interview or a semi-structured interview.

What To Expect At A Substance Abuse Evaluation – Structured Interview

In a structured interview, the interviewer will be reading from a pre-determined and structured set of questions. This may be utilized by someone who does not have as long of professional history. The results, while informative, may not yield enough detail to create a personalized treatment plan. In a semi-structured interview, an expert in the field of psychology or addiction asks similarly structured questions but is also permitted to add questions based on their professional knowledge. This often results in a more detailed representation of a person’s drug or alcohol use.

Two of the most commonly used assessment tools are the following:

Diagnostic Interview Schedule-IV (DIS-IV): This fully structured assessment tool determines the presence of a diagnosis from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Some consider this tool to be restrictive, as its assessment is based on the DSM-IV and may not consider newer research or theories. This could affect the level of insight a clinician gains into the person’s circumstances.

Addiction Severity Index (ASI): This semi-structured interview examines seven potential areas of concern, including medical status, employment and support, drug use, alcohol use, legal status, family/social status, and psychiatric status. The interview collects data regarding drug or alcohol use in the past thirty days, as well as lifetime substance use patterns.

Court Ordered Drug And Alcohol Evaluations

When a legal case involves substance use, a judge may order a drug and alcohol evaluation through a state-certified agency. Some of the convictions that a judge may request an evaluation for are as follows:

  • DUI (driving under the influence)
  • DWI (driving while intoxicated)
  • MIP (minor in possession)
  • Public intoxication
  • Disorderly conduct
  • Possession of false identification

In this type of evaluation, a trained professional will review your drug or alcohol history with you, and determine if a substance use disorder is present. It’s important to be as honest as possible throughout this process, even if the truth feels uncomfortable. While you may experience feelings of shame or embarrassment, it’s important to understand that the interviewers and counselors are there to help you discover the path to recovery as quickly and as safely as possible.

Depending on the results of the case, you may be required to complete recovery-related programs, such as a Drug Use Risk Reduction Program, AA or NA meetings, or an inpatient or outpatient treatment program.

Substance Abuse Treatment Plan

If substance abuse has started to take control of your life or the life of someone you love, we encourage you to reach out for support. Diagnosing an addiction can be an overwhelming process. Please remember that there is ample support available to assist you and your loved one, as you take the first steps in rebuilding your life and the life of your family. Contact us today, with any questions or concerns you may have regarding addiction, substance abuse, or recovery.

Johns Hopkins Medicine - https://www.hopkinsmedicine.org/johns_hopkins_healthcare/downloads/CAGE%20Substance%20Screening%20Tool.pdf

SAMHSA - https://www.samhsa.gov/disorders

NIAAA - https://pubs.niaaa.nih.gov/publications/assessingalcohol/InstrumentPDFs/04_ASI.pdf

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