Substance Abuse Assessments
By: Lakyn Bendle
Did you know?
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In United States of America, the root cause for 25% of the total
deaths can be attributed to drug or alcohol abuse
65% of addicts get access from their family and friends
Drug or alcohol withdraw can bring in hallucinations, paranoia,
seizures or even be proven fatal
Medication cost of a drug or alcohol addict is almost 2 times the
medication cost for a clean individual
Drug abuse is the most common problem among food service
and construction workers
75% of domestic violence is caused by people with addictions
A drink is…
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One small 8 ounce or ½ pint of beer
One single shot of liquor
One glass of wine
Who and where do you assess?
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Medical patients/primary care clinics
Accident victims/emergency room
Psychiatric patients/hospitals
DWI offenders and violent criminals/prison
People with impaired social or occupational functioning/mental
health facilities
Enlisted men and officers/military services
Workers/employee assistants programs
Self Report or Interview?
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Self report allows for analysis of measure
Could use alcohol or drug measures among other types of
measures to keep defensiveness down
Interviewing is less suspicious and you may get more
information from verbal responses
The C.A.G.E.
Dr. John Ewing, founding director of the Bowles Center for Alcohol
Studies, University of North Carolina at Chapel Hill developed the
CAGE for identifying alcohol related problems.
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C Have you ever felt you ought to CUT down on your drinking?
A Have people ANNOYED you by criticizing your drinking?
G Have you ever felt bad or GUILTY about your drinking?
E Have you ever had a drink first thing in the morning (EYE OPENER) to
steady your nerves or get rid of a hangover?
The C.A.G.E. (cont.)
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Screening test for alcohol abuse
Two positive responses are considered a positive test and indicate
further assessment is warranted
Most widely used in emergency department (ED) settings
High test-retest reliability (0.80-0.95), and adequate correlations (0.480.70) with other screening instruments and the DSM-III for alcohol
dependence
Advantage = denial
Disadvantage = most accurate for white middle aged men
The T-ACE
The T-ACE was originally designed by an obstetrician from the
CAGE to screen for pregnancy risk drinking.
T Tolerance: How many drinks does it take to make you feel high?
 A Have you ever been annoyed by people's criticism of your drinking?
 C Have you ever felt you ought to cut down on your drinking?
 E Eye opener: Have you ever had a drink first thing in the morning to steady
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your nerves or get rid of a hangover?
The T-ACE
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Identifies women’s prenatal alcohol consumption and pregnancy risk
drinking (defined as more than two drinks per drinking day)
Affirmative answers to questions A, C, or E = 1 point each. Reporting
tolerance to more than two drinks (the T question) = 2 points
A score of 2 or more is considered positive
Recent studies have found it accurate for men (3 drinks) and women
now
More superior to the CAGE
The Drug Abuse Screening Test
(DAST)
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Includes 28 true/false questions
Questions refer to the last 12 months and does not include alcohol
Includes non-medical use of drugs and use of prescribed or “over the
counter” drugs in excess of directions
85 percent overall accuracy in classifying clients according to DSM-III
diagnosis
Michigan Alcoholism Screening Test
(MAST)
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The MAST is a 22 item true/false test which asks specific questions
about alcohol use and its impact on life situations
The MAST is particularly useful for identifying alcohol dependence
Most widely used measure
Correlates with the AUDIT and CAGE
Advantage = lifetime use
Disadvantage = vague
Alcohol Use Disorders Identification
Test (AUDIT)
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Includes questions about the quantity and frequency of alcohol use, as
well as binge drinking, dependence symptoms, and alcohol related
problems.
Its strength lies in its ability to identify people who have problems with
alcohol but who may not be dependent.
Especially useful when screening women and minorities.
Promising results when tested in adolescents and young adults
Less accurate in older patients
The AUDIT (cont.)
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A score of 8 or more in men (7 in women) indicates a strong likelihood
of hazardous or harmful alcohol consumption. A score of 15 or more in
men (13 in women) is suggestive of alcohol dependence
Advantage = addresses alcohol abuse, dependence, and
consequences
Disadvantage = easier to see extremes
SADRI Substance Abuse Symptoms
Checklist
Several or more of these symptoms in combination may suggest that issues
related to substance abuse should be explored at greater length.
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Frequent Intoxication
Atypical Social Settings
Intentional Heavy Use
Symptomatic Drinking
Psychological Dependence
Health Problems
Job Problems
8)
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Problems With Significant Others
Problems With Law Or Authority
Financial Problems
Belligerence
Isolation
“Handicapism”
Resources
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http://www.nida.nih.gov/nidahome.html
http://www.samhsa.gov/
http://www.daodas.state.sc.us/
Substance Abuse, Disability and Vocational Rehabilitation Handbook