Substance Abuse Evaluation: What to Expect
Whether by choice or by force, a substance abuse evaluation is one of the first steps in addiction treatment. There are four goals of a drug and alcohol abuse assessment:
- Determine the types of substances abused
- Determine the severity of substance abuse
- Assess co-occurring mental health disorders
- Make a treatment recommendation, if necessary
During a substance abuse evaluation, what to expect varies by facility and assessor, but usually includes the following components.
Substance Use Questionnaires
Clinicians will ask you a variety of questions to inventory your substance use behaviors and attitudes, your physical and mental health, as well as your family’s use of substances. Developed by addiction and mental health experts, these assessment tools may include:
A four-question survey, the CAGE questionnaire assesses your alcohol use. The acronym stands for: Cut Down, Annoyed, Guilty and Eye Opener. Question content centers around your ability to curb drinking on your own, guilt about drinking, others’ perceptions of your alcohol use, and if you need a drink to feel normal.
The Alcohol Use Disorders Identification Test (AUDIT)
Meant to determine attitudes and behaviors around alcohol, this self-report survey includes questions about frequency and quantity of alcohol use as well as if alcohol interferes with normal activities like work, school and social and family obligations.
Substance Abuse Subtle Screening Inventory (SASSI)
The SASSI helps assess whether you meet the diagnostic criteria for a substance use disorder. It also gauges your readiness for change and willingness to get treatment.
You’ll likely be asked a series of questions about your past and present physical and mental health as well as those of your family members. These questions are similar to the assessment sheets you fill out prior to an initial appointment with a physician or other health care provider.
Drug and Alcohol Screenings
A substance abuse evaluation will include laboratory tests to determine the types of substances in your system. Usually done through urine, blood or saliva samples, these screenings test for blood alcohol content level (BAC) as well as the presence of a number of illicit substances and prescription drugs.
Mental Health Evaluation
Almost half of people with addiction issues also suffer from mental health disorders. Alcoholics are almost four times more likely to have clinical depression than people who do not abuse alcohol. That’s why it’s common for an alcohol and drug abuse evaluation to include a mental health component.
Some common mental health assessment tools include:
- Mini-Mental State Examination (MMSE)
- Mental Health Screening Form-III
- Millon Clinical Multiaxial Personality Inventory – III (MCMI-III)
- Symptom Distress Scale (SDS)
- Minnesota Multiphasic Personality Inventory – II (MMPI-II)
- University of Rhode Island Change Assessment Scale (URICA)
Mental health practitioners also use the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to evaluate mental illness symptoms and determine a diagnosis.
Often physical exams are part of substance abuse evaluations. Physical exams commonly include assessment of blood pressure, weight and general health. They may include blood tests and a urinalysis. Physicians may check dental health, which can be poor in people who abuse substances. They may look for skin abrasions and infections in cases of intravenous drug use.
Your danger of self-harm or suicide risk may also be assessed. These screening tools often include:
- ASI and Global Appraisal of Individual Needs (GAIN) LOCUS – Evaluates the severity of self-harm risk and what type of treatment is appropriate.
- ASAM PPC-2R – Evaluates immediate danger of self-harm.
Court-Ordered Substance Abuse Evaluation: What to Expect
If you’ve received a DUI or found yourself in other legal trouble due to substance use, the judge may require you take part in a court-ordered substance abuse evaluation. With a court-ordered substance abuse evaluation, what to expect is similar to the above, with the addition of a risk assessment. Usually the judge will ask for a determination of potential risk of repeating an offense or causing more harm to yourself or the public. Risk assessments typically include:
- Level 1: minimal risk
- Level 2: moderate risk
- Level 3: high risk
The court will then base treatment requirements on your risk level. For instance, a minimal risk may only require you attend a class on substance abuse while a high riskwill likely mandate inpatient alcohol or drug rehab and a continuing care program.
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