Substance Use Disorders: Assessment and Treatment, 2nd Edition _ ___________________________________
(SCID-5) or the timeline followback to determine substance use and substance use disorders. Table 1 presents the most frequently used instruments. These screening tools can be administered by any level of practitioner—physician assistants, dentists, psychologists, pharmacists, nurses, social workers, counselors, interns or students, and physicians—and some of the tools can be self-administered by the client. Included in screening is the concept of prescreening , in which a reduced set of validated questions are universally asked to eliminate those individuals who would prove negative on the full screening tools (Berger & Di Paolo, 2015). Clinicians may also add the timeline followback (Sobell & Sobell, 2001) to their assessment protocols. The timeline followback assesses daily drinking or substance use, employing a calendar over a specific period of up to 12 months. Anchors within each month are used to help individuals determine their use on each day, including birthdays, holidays, and any other events important to the individual. Clinicians can use this assessment as a tool to assist with helping individuals increase their motivations for change. During the past decade, there has been a growing recogni- tion of the need for universal screening for substance use in all healthcare settings. Consequently, the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model is rapidly being introduced throughout the United States, spurred by federal funding. The SBIRT is an approach to the identification, early intervention, and, if necessary, referrals for treatment to services for substance use problems (Berger & Di Paolo, 2015).
SBIRT consists of three major components: 1.
Screening: Which is the assessment of risky substance use behaviors using standardized screening tools. During screening, the severity of substance use is assessed, and the appropriate level of treatment is determined. Brief Intervention, which consists of a brief face-to-face discussion with a client, pointing out his or her risky substance use behaviors and providing feedback and advice about it. During brief intervention, the focus is on increasing a client’s insight and awareness about his or her substance use, and the goal is to assess and increase the client’s motivation for behavioral change. These discussions use the techniques of motivational interviewing to assist individuals in overcoming ambivalence about considering treatment. The specific techniques are summarized in the anagram OARS: open-ended questions, affirmations, reflective listening, and summaries. Brief interventions are one to five sessions in length and typically last anywhere from a few minutes to an hour. Referral to Treatment, which is the facilitation of access to culturally competent care for those clients whose screening indicates the need for additional services and specialty care. (SAMHSA, 2021b)
2.
3.
COMMON STANDARDIZED SCREENING AND ASSESSMENT TOOLS
CAGE and CAGE-AID Brown & Rounds, 1995; Mayfield et al., 1974 Substance Abuse Subtle Screening Inven- tory (SASSI) Miller, 1997 Michigan Alcohol Screening Test (MAST) Selzer, 1971 Alcohol Use Disorders Identification Test (AUDIT) Babor et al., 1992 Drug Abuse Screening Test (DAST) Maisto et al., 2000; Skinner, 1982 Addiction Severity Instrument (ASI) McLellan et al., 2005
The CAGE assesses alcohol use-related problems. The CAGE-AID includes other drugs.
SASSI is a brief self-report designed to identify individuals who likely have sub- stance use disorders.
MAST is a lengthier self-administered tool designed to assess for problems with alcohol use. Versions of this tool include the SMAST, the shorter version of MAST, and the MAST-G for use with geriatric populations. AUDIT is a 10-item screening tool to identify the early signs of hazardous and harmful alcohol use, identify mild dependence, and determine the individual’s level of risk for hazardous alcohol use problems. DAST identifies individuals abusing psychoactive substances and provides informa- tion about the specific consequences or problems the individual has experienced because of his or her substance use. ASI is a general screening tool for use during intake. It collects information on domains of the individual’s life that may contribute to substance abuse problems.
From Western Schools, 2018.
Table 1
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