Individuals with drug and alcohol problems are assessed using a combination of techniques that determine the extent and type of substance-related problems. The information obtained is used to create a comprehensive assessment. The results from this assessment are compared with pre-existing criteria to determine diagnoses and treatment recommendations. The assessment also screens for any psychiatric disorders that may exist along with the alcohol and drug problems. Medical and physical concerns are evaluated as well, along with environmental and relationship factors. Assessments must be comprehensive to generate a full and accurate clinical picture. And each step of the assessment must be completed in a fashion that is non-judgmental.
Assessing Individuals with Drug and Alcohol Problems
Step 1
Complete a diagnostic interview. This face-to-face interview gathers information from many domains, including moods, behavior, education, family and social support. The interview also should include information about legal consequences arising from drug or alcohol abuse. The interview must be conducted in an empathic manner to support open and honest disclosure.
Step 2
Complete a substance use and treatment history. These reports gather information about the individual's lifetime use of substances and treatment history. This report might be completed by the individual as a written questionnaire, or the assessor might ask the questions and record the information.
Step 3
Administer substance-related assessment instruments. These standardized tests help define the extent of the substance abuse problem. A commonly used assessment is the Substance Abuse Subtle Screening Inventory (SASSI).
Step 4
Administer psychiatric disorder screenings and measurement instruments. These are designed to provide valid and reliable information about signs and symptoms of psychiatric disorders. Screenings, such as the Beck Anxiety Inventory and the Beck Depression Scale, assist with identifying mood and anxiety disorders.
Step 5
Compare the results of testing instruments to established criteria. Use the results from substance related assessments to determine the level of care needed, using the American Society of Addiction Medicine (ASAM) patient placement criteria. Use information from mental health screenings to diagnose psychiatric disorders with the Diagnostic and Statistical Manual of Mental Disorders (DSM).
Step 6
After all the needed information has been obtained, summarize the results in a multi-axial report. The model for this report is found in the American Psychological Association's Diagnostic and Statistical Manual of Mental Disorders. The report consists of conclusions made about psychiatric disorders, substance-related problems, personality disorders, medical concerns, social and family problems, problems in the individual's environment, and a summary of overall functioning.
Step 7
Using the multi-axial assessment, identify appropriate interventions. Although the primary presenting problem might have been alcohol or drug abuse, each area should be assessed and recommendations made for each identified problem. Interventions frequently consist of treating or making referrals for multiple issues. Referrals are frequently made to a psychiatrist, who prescribes medications for psychiatric problems, and to medical doctors for further assessment and treatment.
References
- The Diagnostic and Statistical Manual of Mental Disorders; The American Psychological Association; 2000
- Treating Alcohol and Drug Problems in Psychotherapy Practice: Doing What Works; Arnold M. Washton, PhD and Joan E. Zweben PhD; 2008
- Substance Abuse and Mental Health Services Administration (SAMHSA); Brief Interventions and Brief Therapies for Substance Abuse; 2007
