Screening and Assessing for Drug Abuse

When presented with a patient who has a potential drug problem, a medical professional must screen, assess, and diagnose before a treatment plan can be put in place. The amount of time and effort needed for each of these tasks will vary depending on the patient and level of addiction.

An abuse screening instrument is used to pinpoint patients who have an increased likelihood of drug addiction; it is also used to determine whether a more formal diagnostic instrument is needed. Many addiction professionals use the CAGE questionnaire. It contains four questions and has a very high rate of validity. Others may use the Substance Abuse Subtle Screening Inventory (SASSI). Both of these screening tools are short and easy to administer, providing a quick answer as to whether additional investigation is needed.

Once the presence of an addiction has been confirmed, an assessment will be conducted. The addiction assessment is a multidimensional evaluation that looks at the severity and stage of the addiction and identifies a patient’s strengths, weaknesses, and needs. This assessment often becomes the backbone of the treatment plan.

The addiction assessment for placement in a drug rehab program starts with a diagnostic evaluation contained in the DSM-IV. In addition to interviewing the patient, addiction professionals may also need to glean information from family or friends to make a good diagnosis. To be diagnosed with substance dependence (negative pattern of substance use that leads to impairment or distress), three or more criteria must be present within a twelve-month period: tolerance (the need for increased amounts of substance for desired effect), withdrawal (the need to keep taking the same substance to relieve negative symptoms), taking more of the substance than instructed or for longer than it was prescribed, persistent wish to reduce or stop use, investing increasing amounts of time in trying to obtain the substance or recover from using it, giving up important activities in order to use the substance, or continuing to use the substance despite negative consequences.

When assessing a patient for drug addiction, an addiction professional determines the initial level of care required and identifies the patient’s problems. However, assessment is an ongoing process that will require the professional to also outline future treatment intensity modifications, fix treatment goals and benchmarks for assessing progress, and identify patient changes after intervention or treatment.

Addiction professionals must be trained in the assessment process and should pay particular attention to whether a patient will likely exhibit withdrawal symptoms or other medical or psychiatric symptoms during treatment. Assessors also need to determine which patients need medical or psychiatric assessment.

A properly conducted assessment provides the foundation for the selection of an individual’s treatment plan, typically in the form of quantitative, reliable, valid, recordable and standardized measurements.

When assessing patients for inclusion in an intensive outpatient program, addiction professionals should focus on acute intoxication or withdrawal potential, physical conditions, emotional or behavioral conditions, level of resistance to treatment, potential for relapse and the appropriate venue for recovery. By focusing on these issues, the level of care can be assigned, problems can be identified and treatment can begin.

Drug addicts who are experiencing or are likely to experience severe withdrawal symptoms typically need to be treated in an inpatient drug rehab facility, unless the intensive outpatient program has the necessary medical staff on hand. Patients who have serious medical issues, in addition to drug addiction, will also need inpatient treatment; however many intensive outpatient drug rehabs can handle minor or moderate medical issues. For patients with emotional or behavioral issues, intensive outpatient drug rehab is only appropriate when there is little danger of the patient harming herself or others.

Many people addicted to drugs will not readily admit that they have a problem. Intensive outpatient treatment is only for those patients who have agreed to enter treatment, whether or not they are actually committed to their own recovery. In the same vein, some patients will experience such intense cravings for drugs that they must be placed in an inpatient setting. Those that are left to manage cravings as outpatients are taught relapse prevention techniques – learning to identify triggers and implement effective coping mechanisms.

One of the most important aspects of any drug treatment assessment will be determining the appropriate recovery environment. When considering placing a patient in outpatient treatment, the assessor must pay very close attention to the level of chaos at home, his relationships with other family members, whether other family members are using drugs or alcohol, and whether there is any sort of abuse taking place (emotional, sexual or physical). Further, those who lack transportation or childcare will often do poorly in an outpatient setting.