Problem Identification and Referral

According to the Substance Abuse and Mental Health Services Administration's (SAMHSA's) Center for Substance Abuse Prevention (CSAP), there are six interpersonal domains that contribute toward a person's potential for substance abuse or dependence: individual, peer, family, school, community, and societal influences. Not only are risk factors for substance abuse potentially found within each of these six experiential domains, but there are also protective factors within each domain that may reduce the probability of substance use. One of the primary aims of early problem identification and referral is to amplify the protective factors within an individual via education and targeted intervention and to reduce the risk factors within those six domains wherever feasible.

Problem identification and referral is one of the six substance abuse prevention strategies identified by CSAP. In contrast to the other prevention strategies, problem identification and referral targets those individuals who have already begun to use tobacco, alcohol, or other drugs or who demonstrate behaviors that often are indicative of a potential problem with alcohol or other drugs. For example, a young adolescent who is caught smoking, a chronically truant student, or a worker with sudden performance problems might be targeted for problem identification and referral. Student assistance programs and employee assistance programs are the most common ways that problem identification and referral occurs in the school or work environment.

A core assertion of problem identification and referral is that a successful intervention will address the source of a client's problem, not merely the manifestation of debilitating symptoms. In addiction treatment, this ethos translates to not merely treating the substance abuse or dependence issue, but seeking to determine the events and behaviors that led to choosing to use the substance in the first instance. One effective way to make these determinations is to fully explore and assess both the risk and protective factors within each of the six characteristic domains.

Within the individual domain, core substance abuse risk and dependence assessments examine genetic predispositions, based on family history and use patterns, and gauge the potential for increased risk of dependence garnered from research on gender and first age of use. Although these potential risk characteristics are demographic, other intrapersonal attitudes and predispositions are more pliable. These include factors such as an individual's sense of alleged risk when using a substance, a desire to rebel against social norms, feelings of alienation, or impairments in social skills.

Within the family domain, risk factors for substance use increase with greater levels of conflict, chronic spousal disputes, experiences of abuse and neglect, and poor discipline and problem-solving skills. Tolerant parental attitudes toward substance use as well as familial modeling are also correlated with a greater likelihood of transgenerational recurrence of substance dependence. From a cultural perspective, a family's level of acculturation or disenfranchisement can also increase the risk factors for use.

For adolescents and young adults, failure to achieve competency in school, both academically and [Page 715]socially, is a significant risk factor in the probability of choosing illicit substance usage. Among those individuals with an external locus of worth, such that peer approval significantly outweighs any consistent, internal sense of positive self-esteem, substance use is also widespread. These developmental risks are further amplified when such individuals align with others who engage in a wide variety of problematic behaviors in addition to drug and alcohol consumption.

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