About 15 million Americans every year meet the diagnostic criteria for substance abuse or dependence (US Department of Health and Human Services, 1993).  The evaluation and assessment of drug abuse can be easy or difficult. Some people will give you all the signs, such as drunk driving stops (DUI’s), positive screening tests, or inconsistent and suspicious stories.  Others completely deny use and make it difficult to distinguish between use and abuse.  Substance abuse is a serious problem that can lead to legal, financial and health problems.  Substance abuse is a modeled use of drug, in which the user consumes the substance in quantity or with methods that are harmful to oneself or others, in a form related to substance disorder.

The fact that certain substances such as alcohol, nicotine or over-the-counter medications are not considered a drug or alter their neurophysiological effects and can, therefore, be considered a true medicine.  The exact cause of drug abuse is not clear and of which the two prevailing theories are: either a genetic predisposition learned from other people, or a habit that manifests itself in addiction as a debilitating chronic disease.

With continued use, most substance cause the body to adapt quickly to its effects thereby requesting for more substance to obtain the same psychoactive effects; however, the drugs differ greatly in their tolerance potential. A distinction is often made between psychological and physical dependence.  Psychological dependence refers to the user who experiences desire or thirst for the substance.  The user may experience feelings of irritability, anxiety, and headaches if the medication cannot be taken at specific times.

Physical dependence may include all of these elements, in addition, the user experiences beyond a series of withdrawal symptoms related to mild severe physical disability, such as tremors, high fever, or muscle cramps.  An overdose of a drug can be described simply as the use of a drug at a dose that exceeds the level at which the body has become accustomed.  The results can range from mild illnesses (nausea, vomiting) to life-threatening illnesses (respiratory arrest, cardiac arrest).

Given the nature of drug abuse, it is not surprising that treating substance abuse is not an easy task. Many substances inhibit tolerance, that is, people who handle these substances need a higher dose to achieve the same effect.  Taking higher doses or using substances increases the risk of overdose. For this reason, many treatments emphasize abstinence or avoid the use of substances.   In addition, relapses in early recovery are quite likely.

There are number of steps to combat the risk of relapse and to ensure abstinence, which include the Screening and assessment of substance abuse.

Screening and Assessment

Screening is a preliminary evaluation of whether the main characteristics of substance abuse exist in a person.  The Screening indicates whether the problem of addiction is likely to be present.

Assessment is a comprehensive evaluation that can definitively establish the presence or absence of a diagnosable substance abuse problem.  The results of the assessment also suggest the most appropriate treatment for obvious drug problems.

Why are both necessary?

The purpose of the assessment is to identify potential perpetrators as early as possible to provide appropriate intervention services.  The process is twofold. Individuals are screened to identify the possible presence of a substance related problem, while the assessment phase goes further in the process and confirms the existence of a problem, identifies the nature of the problem and suggests appropriate forms of treatment.

There are hundreds of screening and assessment tools.  There are specialized tools to help physicians determine if further assessment is needed, the type and extent of the patient’s addiction disorder, whether a client has a mental disorder, what traumatic experiences the client has experienced and consequential consequences, and treatment factors.  This influences the client’s response to the interventions.

Screening can identify the use of alcohol and other drugs, the risk associated with drinking, and the associated problems.  Early detection of drug problems usually leads to better treatment outcomes.  Drug screening in health care settings, including primary care, mental health services, and emergency care, is the first step in determining behaviors that expose people at risk, including: development of a disorder of substance use and Identify patients with disorders of existing substances.

There are standardized tools for screening drug use and its severity in a person. The AUDIT (The Alcohol Use Disorder Identification Test) and CAGE screening sets cover a wide range of uses and resources for brief interventions.

How are assessments done?

Two types of interviews can be used during the assessment phase: structured and semi-structured.  Structured interviews provide a predefined sequence of questions that allows untrained people to assess reliably.  Semi-structured interviews are designed to help trained mental health professionals conduct in-depth patient reviews.  Although structured interviews provide reliable diagnoses, they do not provide as much information about treatment planning as semi-structured interviews that depend more on interviewer experience and professional training.

What Kinds Of Assessments Are Available?

Clinical screenings can be as simple as knowing how many times a person is abusing in all the substance lists, with answers ranging from never to every day, week, or month. If a person is involved in substance use at least once a day, it is considered to pose a high risk of substance abuse.

Some evaluations may be more in-depth and include a series of questions that are latter evaluated based on the responses; the risk of abuse is then based on the tabulated calculation.

Other assessments include personal history of substance abuse, health history, history of substance abuse in the family, age, and current psychiatric disorders. All of these factors can increase the risk of developing a substance abuse disorder.

What tools are available to assess drug abuse?

The Addiction Severity Index (ASI): is the measure of severity of the problem most commonly used by dependent clients under treatment. This interview was designed to serve as a standardized and reliable tool for assessing drug-dependent clients.  The interview is often used both in traditional research contexts and as a measure of performance in clinical settings.  It has spread to specialized populations such as cocaine-abusing mothers, opiate addicts, federal prisoners and homeless people.

The ASI covers the client’s medical status, employment and support status, drug use, alcohol consumption, legal status, family and social relationships and psychiatric status.  Individuals are invited to answer specific questions about issues that have occurred in the past 30 days and throughout their lives; therefore, urgent and chronic problems are identified by ASI.  Client responses to ASI requests are summarized in composite assessments and used to measure changes over time in response to treatment.

In addition to these client-related reviews, the interviewer will conduct an independent assessment of the severity of each problem, based on the interviewer’s experience with the client during the interview.  This qualification starts at 0 (no problem exists) and ends at 9 (there is an extreme problem and the treatment is necessary).

ASI-F: The ASI-F is an improved version of ASI. Some elements relating to family, social relations and psychiatric areas were added.  Additional points refer to lack of housing; Sexual harassment; emotional, physical and sexual abuse; and eating disorders. Additional questions will be asked after the administration of ASI.

Drinker Inventory of Consequences (DrInC): DrInC is a self-administered questionnaire of 50 questions designed to measure the harmful effects of alcohol abuse in five domains: interpersonal, physical, social, impulsive and intrapersonal.  Each scale provides a measure of life span and adverse consequences over the last three months, and can be combined to assess overall adverse consequences.

Substance abuse assessments can be the first step in detecting a substance abuse disorder, and treatment is the first step in recovery.  There are assessments in place to aid in preventing substance abuse; however, time and place can be important factors in taking this conversation into account. People affected by addiction experience changes in brain chemicals that force them to constantly look for drugs and change their lives to adapt to addiction; therefore, it is possible that an addict does not want to talk about addiction, but it is the first step to getting the right help.

If you are struggling with substance abuse and ready to make the life-changing decision, the best possible path is to get in touch with professionals to assess and help find the treatment plan


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