Diagnosing Substance use disorders Substance use disorders occur from mild to severe, based on symptomology and fluctuation of the disease process (APA, 2013). Individuals demonstrating a problematic pattern of substance use that leads to significant impairment as manifested by two or more criteria over 12 months meet the criteria for substance use disorder. Table 1. SUD Symptoms and Categories in the DSM-5 SUD Symptoms Categories
Individuals who demonstrate a chronic loss of control or compulsive use of substances and a wide range of adverse effects (mental, physical, and social well-being) meet the criteria for substance-related disorders (Boland & Verduin, 2022). Standardized screening is essential to determine the stage of substance use, its consequences, and functional impairment (Paxos & Teter, 2019). The chronic nature of substance use disorders involves a repetitive cycle of abstinence and relapse. Relapse is best defined as a return to a previous level of substance use after a period of reduction or abstinence (Moe et al., 2021). However, this description is too simple for this complex phenomenon, which includes diverse pathways to attain and maintain recovery. Relapse is a departure from the treatment plan and should be viewed as a disease process. Nonadherence to substance use disorders is comparable to diseases such as hypertension or asthma (Walters, 2021). Implementing evidence-based screening tools like SBIRT can promote recovery for individuals who are in relapse: (S) screening tools to identify those at risk; (BI) gauge willingness to change and increase motivation; (RT) referrals to the appropriate level of treatment (Walters, 2021). The initial action is to screen all individuals over age 18 for SUD or relapse, recommended by Substance Abuse and Mental Health Services (SAMHSA). Components of the ideal intervention include (1) reflective listening, (2) readiness to change, (3) change talk, (4) motivational interviewing, and (5) follow-up.
• Using more of a substance or using for longer than intended • Wanting to limit or stop using but unable to • Spending a lot of time recovering from the use • Craving • Failing to fulfill duties in social roles (work, home) • Continuing use despite substance- related social problems • Giving up activities because of substance use • Continuing to use despite substance-related mental or physical problems • Using in dangerous situations to self or others
Impaired control
Social impairments
Risky use
• Developing tolerance • Experiencing withdrawal
Pharmacologic criteria
(APA, 2013)
Table 2: Clinical Tools Evaluating Substance Use Disorders (abbreviated) Instrument Purpose
Interpretation
Addiction Severity Index
Assessment tool The clinician-administered, a semi- structured interview Screening tool Clinician/self-administered. Evaluates the quantity and frequency of drinking Screening tool Clinician/self-administered. Identifies the presence of problematic drinking Assessment tool Clinician administered *Gold standard for alcohol withdrawal assessment Assessment tool Clinician administered Used to follow the course of opiate withdrawal and effectiveness of medication regimen-no standard cutoff Comprehensive, integrated public health approach to early intervention and treatment for persons with or at risk for substance use disorders
200 items, normed national data
Alcohol Use Disorders Identification Test (AUDIT) Alcohol Use Disorder Identification Test- Consumption (AUDIT-C)
10 items
Cage Questionnaire
4 items; positive score ≥ 2
Clinic Institute Withdrawal Assessment- Alcohol revised (CIWA-Ar)*
10 items <10, mild withdrawal 10-18, moderate withdrawal >18 severe withdrawal
Clinical Opiate Withdrawal Scale (COWS)
5-12 mild withdrawal 13-24 moderate withdrawal 25-36 moderately severe withdrawal >36 severe withdrawal Universal screening 5-10 minutes; Scored low to severe risk Scored at moderate risk; brief intervention implemented For use in alcohol and tobacco with growing evidence of illicit drug use
Screening, brief intervention, and referral to treatment (SBIRT)
(Paxos & Teter, 2019; SAMSHA, 2022b).
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Book Code: AUS3024
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