Assessment

Pretreatment Assessment

The goals and objectives of the assessment process need to be well defined. In this regard, the Institute of Medicine (IOM) differentiated among three levels of assessment of substance use disorders: (1) screening, (2) problem assessment, and (3) personal assessment. In this listing, screening is the least comprehensive and, accordingly, the least expensive assessment, whereas personal assessment is the most comprehensive and the most costly. The goals of these three levels of assessment differ significantly.

Screening is designed to identify, quickly and inexpensively, individuals who may be at risk for a substance use disorder. This process is sometimes referred to as "case identification." Because substance use and abuse put people at risk for physical, psychological, legal, and social problems, it is important for primary health care professionals to identify individuals who are heavy users of alcohol and other drugs and to initiate early intervention. It is also the case that heavy substance use often interferes with efforts to treat mental, cognitive, and physical disorders, so substance use problems should be identified and evaluated even if the target disorder is not substance abuse.

Unfortunately, substance use disorders are still associated with social stigma, making it difficult for some clients to admit to a problem with alcohol or other drugs until or unless they have lost control over their alcohol or drug use. In addition, the heavy use of psychoactive substances can lead to memory problems, which makes it difficult for those afflicted to provide accurate information. Health care professionals need to be sensitive to these issues and ask about the use of alcohol, tobacco, over-the-counter drugs, and recreational drugs in as nonthreatening a way as possible.

Screening methods are often used in general medical settings, in emergency room settings, and in employee assistance programs. The aim of screening is to determine whether or not the client requires a more in-depth assessment for a substance use disorder, is in immediate need of medical detoxification or psychiatric treatment, or needs advice on how to cut down on the use or abuse of alcohol or other drugs. There are three ways to screen for psychoactive substance use and abuse: (1) laboratory tests, which are often used in medical settings (e.g., blood or urine analysis); (2) self-report screening methods, which are easy to administer, require minimal training, and are easy to incorporate into a comprehensive health assessment; and (3) brief screening interviews.

...