Evaluating Substance Use Disorder (Abbreviated)
Instrument
Purpose
Interpretation
Addiction Severity Index
• Assessment tool. • The clinician administers the 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. • Achieved at moderate risk; brief intervention implemented. • For use in alcohol, tobacco with growing evidence of illicit drug use.
Screening, brief intervention, and referral to treatment (SBIRT)
Note . Paxos & Teter, 2019; SAMSHA, 2022.
SUBSTANCE USE INTOXICATION
Substance intoxication is associated with and without substance use disorders. The most common changes with intoxication in- clude disturbances in wakefulness, attention, thinking, judgment, psychomotor, and interpersonal behaviors (APA, 2013). Specific routes of administration produce rapid absorption into the blood- stream, escalating intoxication effects and likelihood of patterns Diagnosing substance use disorders Substance use disorders occur from mild to severe, based on symptomology and fluctuation of the disease process (APA, 2013). Individuals demonstrate a problematic pattern of substance use that leads to significant impairment as manifested by two or more criteria over 12 months for substance use disorder: ● Substance taken in more significant amounts over a more ex - tended period than was intended. ● Persistent desire or unsuccessful efforts to cut down or control the use of the substance. ● A great deal of time spent in activities to obtain the substance. ● Craving or strong desire to use the substance. ● Recurrent substance use failing to fulfill significant role obliga - tions at work, school, or home. ● Continued substance use despite having persistent or recur- rent social or interpersonal problems caused or exacerbated by the effects of the substance. ● Important social, occupational, or recreational activities are given up or reduced because of substance use. ● Recurrent substance use in situations in which it is physically hazardous.
of use. Intoxication often begins in the teens and is the first sub - stance-related experience. Withdrawal is usually, but not always, associated with substance use disorders but can occur at any age. Short-acting substances have a higher potential for withdrawal than longer-acting substances. The substance's half-life parallels withdrawal (APA, 2013). ● Continued substance use despite knowledge of having a per- sistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by substance. ● Tolerance: ○ A need for markedly increased amounts of the substance to achieve intoxication or desired effect. ○ A markedly diminished effect with continued use of the same amount of the substance. ● Withdrawal: ○ The characteristic substance withdrawal syndrome. ○ The substance is taken to relieve or avoid the withdrawal symptoms. (Levin et al., 2014) Individuals who demonstrate a chronic loss of control or compul- sive use of substances and a wide range of adverse risks (mental, physical, and social well-being) meet the criteria for substance- related disorders (Boland & Verduin, 2022). Standardized screen- ing is important to determine the stage of substance use, conse- quences, and functional impairment (Paxos & Teter, 2019).
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