Chapter 4
Screening and Assessment of
Alcohol/Drug Problems
Chapter Objectives
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Identify the three elements in the behavioral
definition of addiction.
Establish guidelines for parents in trying to
discourage initial use of alcohol/drugs by
their children.
Describe factors that can decrease
alcohol/drug use by adolescents.
Define and describe the impact of set and
setting on alcohol/drug use.
Chapter Objectives
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Describe the stages and progressive cycle of
alcohol/drug use.
Explain the different types of alcoholism
Jellinek identified and the behavioral
characteristics of the progression of the
disease.
Outline the stages of alcohol/drug recovery.
Identify three diagnostic criteria for both
substance abuse and substance dependence
based on the diagnostic and statistical
manual (DSM-IV).
Chapter Objectives
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Describe the role of family in assessment and
recovery from alcohol/drugs.
Identify the tests for the screening and
assessment of alcohol/drug problems.
Identify two or three questions about the
physical, psychological, sexual,
relationships, job, financial, and legal
consequences of substance abuse.
Identify some physical, psychological, and
emotional responses that might indicate a
problem with the use of marijuana.
Chapter Objectives
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Identify some physical, psychological, and
emotional responses that might indicate a problem
with the use of cocaine.
Explain how denial is an obstacle to an accurate
alcohol/drug assessment.
Identify and describe 11 common areas that may
help identify an adolescent alcohol/drug problem.
Identify several assessment questions for suicide.
Describe how individual, family, and societal
denial contribute to problems in alcohol/drug
assessment.
Addiction - The Three Cs

Compulsion
– obsessive thinking and compulsive
doing of the drug

Control
– inability to control drug use

Consequences
– continued use of drugs despite
significant consequences
Stages of Drug Use

Non-use
 Initial contact
 Experimental
– situation or
circumstantial use

Integrated use

Periodic excessive
use
 Excessive use
 Addiction
Jellinek’s Alcoholic Types

Alpha
– psychological dependence
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Beta
– physical problems
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Gamma
–
–
–
–
physical addiction
loss of control to regulate use
severe damage to life
periods of abstinence
Jellinek’s Alcoholic Types

Delta
– similar to gamma, however the individual
can control intake in given situations
– high degree of physical and psychological
dependence, making abstinence
impossible

Epsilon
– periodic, unpredictable drinking binges
Diagnostic Criteria of Substance Abuse

A maladaptive pattern of substance abuse, leading
to clinically significant impairment or distress, as
manifested by one or more of the following,
occurring within a 12 month period:
– Recurrent substance use, resulting in failure to fulfill
major role obligations.
– Recurrent substance use in situations in which it is
physically hazardous.
– Recurrent substance-related legal problems.
– Continued substance use despite persistent or
recurrent social or interpersonal problems caused by
the substance.
Diagnostic Criteria of Substance Dependence

A maladaptive pattern of use, leading to
clinically significant impairment or distress, as
manifested by three or more of the following,
occurring at any time in the same 12-month
period:
– Tolerance
• a need for increased amounts of the substance
• diminished effect with continued use of the same
amount of the substance
Diagnostic Criteria of Substance Dependence
– Withdrawal
• characteristic withdrawal syndrome
• the same substance is taken to relieve
withdrawal symptoms
– The substance is taken in larger amounts or
over a long period than intended.
– Persistent desire or unsuccessful efforts to cut
down or control substance use.
– A great deal of time is spent in activities
necessary to obtain, use, or recover from
effects of the substance.
Diagnostic Criteria of Substance Dependence
– Important social, occupational, or recreational
activities are given up or reduced because of
substance use.
– Substance use is continued despite knowledge of
having a persistent or recurrent physical or
psychological problem that is likely to have been
caused or exacerbated by the substance.
Vulnerability to Relapse

Individuals are vulnerable to relapse at
each of the stages of recovery.
 Most relapses occur within 30 to 120 days
of treatment.
Family and Recovery
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Alcohol and drug history
– It is important to take a good family
history to determine genetic at-risk, and
age of onset of drinking to periods of
excessive use.
• Assess any significant periods of
abstinence or sobriety from drugs/alcohol.
Denial - Problems in Accurate Assessment

The major denial system or defense
mechanisms of drug problems are
rationalizations, and minimalizations.
Identifying Adolescent Alcohol/Drug Problems

It is often hard to assess an adolescent
alcohol/drug problem because many of
the signs and symptoms may mimic
natural development, and age appropriate
problems.
 A continued pattern of negative
consequences or problems should lead
parents and adults to suspect a problem
and seek family counseling earlier rather
than later.
Identifying Adolescent Alcohol/Drug Problems

11 Questions to Help Identify a Problem
– Has the child been extremely moody or upset?
– Are there significant changes in choice of friends,
dress, grades, hygiene, and responsibilities?
– Is the child more irresponsible about commitments?
– Is there a noticeable decrease in motivation, interest,
or activity?
– Are there signs of problems at school?
– Is the child engaging in unhealthy activities?
– Is money, household objects, or personal property
missing?
Identifying Adolescent Alcohol/Drug Problems
– Has the child been in trouble with neighbors,
storekeepers, or other community members?
– Has the child been involved in an activity that
has caused investigation or charges by
police?
– Are there physical signs of alcohol or drug
use?
– Do you find yourself justifying your child’s
behavior?
Alcohol/Drug Screening Inventories

The purpose of a screening inventory is to
determine if an alcohol/drug problem
exists.
Assessment
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Once screening has established that a
substance abuse problem exists, the next
step is to assess the nature, scope, and
severity of the problem.