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Substance abuse screening and assessment are utilized in a range of clinical settings to help determine the presence and severity of substance use issues and to inform diagnosis and treatment needs. Different types of screening tools can be used to help clinicians decide if further assessment and intervention are required.
- Screening and assessment processes help determine if an individual has alcohol or drug use issues, provide information to inform diagnosis, and guide treatment and intervention implementation.
- Screening is the initial process to determine the risk or presence of substance use issues. An assessment will follow a positive screening to gather detailed information about the individual.
- Screening tools include AUDIT, CAGE, and DAST.
Understanding substance abuse screening and assessment
Substance abuse screening and assessment includes ascertaining whether a substance use issue is present and to what degree. First, a screening will be conducted, followed by an assessment if required.
The purpose of the screening process is to determine if an individual is at high risk of developing an alcohol or drug use issue or to identify current issues that require intervention. Assessment can then provide more details about the individual and their substance use issues. [1]
Screening and assessment can be conducted in any clinical setting, including hospitals, emergency departments, psychiatric care, primary care, or other non-clinical settings, such as prisons, schools, and workplaces. Individuals can also conduct screenings at home using online screening tools.
Different types of screening tools are available that can be used by clinicians or individuals, which typically ask about the frequency of drug or alcohol use, the impact on life and functioning, and the opinions or reactions of others. [2]
Results of substance abuse screening and assessment can help inform the next actions, which might include education about substance use, referral to specialist services, or brief interventions. [3]
Screening vs. Assessment: Key differences
The key differences between screening and assessment include: [1][3][4]
- Purpose: Screenings take place before assessments and are used simply to determine whether or not an individual is high-risk or has an identifiable issue. Assessments follow positive screenings and are used to gather more information about the severity of the substance use issue.
- Time: Most screening tools are very quick to administer, often taking up to a few minutes to complete. Assessments will take much longer.
- Detail: Screening might include only a few questions, often including only a small amount of detail, while assessments can help gather much more detail about the individual, their substance use issues, and any additional mental or physical health issues.
- History: Screening tools typically ask about recent use within the last year, while assessments will often ascertain historical information about the individual’s substance use.
- Training: Screening tools can be administered by trained and untrained clinicians and other individuals, while a trained healthcare professional should complete assessments.
The screening and assessment process
The screening and assessment process helps identify substance use issues and guide appropriate interventions through the following steps.
Identifying the need for screening
The screening and assessment process begins when a potential issue or risk is suspected. This might be an individual at home considering the impact and severity of their own alcohol and drug use.
Alternatively, it can also begin when an individual contacts a healthcare provider, such as while they are in a hospital or by visiting their primary care physician. The professional might consider a screening to be necessary if they suspect a substance use issue or they may utilize a screening tool as a part of an overall health assessment. [3]
In Texas, individuals can access Outreach, Screening, Assessment, and Referral (OSAR) services, which provide free screenings to help connect people with appropriate treatment options based on their substance use concerns.
Administering a screening tool
The clinician will ensure that the individual understands how to answer the questions in the screening tool. For example, they might specify that the questions should be answered ‘yes’ or ‘no’ or that they should be answered with a number from 0 to 5, according to the frequency of the behavior or the degree to which the individual agrees or disagrees with the statement.
Interpreting the screening results
When the test is complete, the clinician will add up the total score and evaluate the results. Tests will often include information to help interpret scores. This might include information, such as that a score over 7 indicates a severe substance use issue.
The individual taking this test at home can then use their score to decide whether to consult a professional. A clinician administering the test can use the information to determine whether a substance use issue is present and if further assessment is needed. [1]
Conducting a comprehensive assessment
If the individual is deemed to be high risk or has screening results that suggest the presence of substance use issues, a further assessment should be conducted by a professional. This is likely to include a full mental and physical health history, details about the history of substance use, current frequency, type, and amount of substance use, and the impact of substance use on life, functioning, and other areas. [5]
Identifying appropriate interventions
Following the assessment, the professional can use the information gathered to inform the individual of the appropriate interventions that are necessary. This might include brief interventions, such as education or motivational counseling, or it may include a more comprehensive treatment plan. The professional can make referrals to help the individual access necessary services. [4]
Screening and assessment sample tools
Alcohol and drug use screening and assessment tools include: [1][2][3][6]
- Alcohol Use Disorders Identification Test (AUDIT)
- The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST)
- Screening, Brief Intervention, and Referral to Treatment (SBIRT)
- Drug Abuse Screening Test (DAST)
- CAGE questionnaire
- Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS)
- Michigan Alcohol Screening Test (MAST)
Gambling addiction screening tools include: [7]
- Early Intervention Gambling Health Test (EIGHT Screen)
- South Oaks Gambling Screen (SOGS)
- Brief Biosocial Gambling Screen (BBGS)
Screening and assessment tools for mental health symptoms and conditions include: [6]
- Beck Anxiety Inventory
- Beck Depression Inventory
- Mini International Neuropsychiatric Interview (MINI)
- Mental State Examination (MSE)
Challenges in screening and assessment
Some challenges and considerations in the screening and assessment process include: [1][3]
- How honestly individuals answer the questions can impact the accuracy of the test results.
- Tests might give a false positive answer.
- Quick tests take little time to administer but provide less detail.
- Longer assessment tools gather more detailed information but take a long time to administer.
- Assessment interviews might feel intrusive or difficult for the individual.
What to do: Next steps following self-screening
After taking a self-administered screening test, scores can help individuals to decide the next steps to take. Low scores may not require any further action, or they could be used to highlight minor issues that could be managed at home.
People with moderate to high scores might want to consult a professional about their score, which can provide helpful information to inform possible interventions. They may wish to conduct a further screening test or a comprehensive assessment.
Some people might benefit from treatment for their substance use issues. They may be referred to specialist services by a healthcare professional or might wish to research available treatment options themselves. [1]
Recovered has details about different treatment and intervention options and offers a directory of treatment facilities.
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