Substance abuse evaluations are formal assessments conducted by licensed professionals to determine whether a person has a substance use disorder. Substance abuse evaluations are also used to recommend professional addiction treatments like medication, therapy, or inpatient rehab. [1] Substance abuse evaluations are sometimes court-ordered, like in cases of DUI’s, child welfare investigations, or other criminal trials. [2]
- Substance abuse evaluations may be used to determine a diagnosis of a substance use disorder, assess the severity of the disorder, and recommend specific treatments.
- Substance abuse evaluations are sometimes ordered by courts, child welfare agencies, or employers to mandate treatments.
- The cost, structure, length, and specific assessment tools used may vary depending on the type of substance abuse evaluation being conducted.
What is a substance abuse evaluation?
Substance abuse evaluations are formal assessments conducted by licensed professionals who are trained in addictive disorders. The purpose of the evaluation is to determine whether a person meets the criteria for a substance use disorder diagnosis. If a substance use disorder is present, the evaluation also helps determine its severity and identify the types of treatment that are most appropriate for the needs of the individual. [1]
Substance abuse evaluations that occur outside of treatment settings are often court-ordered for individuals involved in the criminal justice system. A variety of legal circumstances may lead to a court-ordered evaluation, including DUI or DWI charges, criminal cases involving drug-related offenses, and cases involving the child welfare system. When an evaluation is court-ordered, the results are shared with the court and may influence sentencing, probation requirements, or other legal outcomes. [2]
In some situations, substance abuse evaluations may also be required by employers. Examples of situations that may result in employer-mandated evaluations include workplace accidents or injuries involving insurance or disability claims. Employers may also require an evaluation when there is reasonable suspicion that an employee is using drugs or alcohol on the job.
In some cases, an employer-mandated evaluation occurs after an employee fails a workplace drug or alcohol screening. When substance abuse evaluations are required by an employer, the recommendations may be shared with the employer. If treatment is recommended, an employer may require the employee to complete treatment or comply with other recommendations as a condition of continued employment. [2]
Who performs substance abuse evaluations?
Substance abuse evaluations can only be completed by licensed medical, mental health, or addiction professionals. A professional license is required because during a substance abuse evaluation, a substance use disorder diagnosis may be given. There are a variety of different types of licensed professionals who are qualified to diagnose these disorders, including licensed counselors, social workers, psychologists, medical doctors, and physician assistants. [1]
Most of the time, licensed professionals who are performing substance abuse evaluations have specialized training, experience, or credentials in addiction. [1] In some cases, they may be working in clinics or rehab centers that provide addiction treatment on-site. In other cases, they are working in private practices or clinics that only provide assessments and refer patients out to other clinics for treatment.
In situations where a substance abuse evaluation is mandated by an employer, court order, or child welfare agency, there may be specific requirements about what kind of evaluations are accepted. For example, individuals needing a substance abuse evaluation for a DUI or DWI charge will need to find a licensed professional who has been specially trained and certified in this kind of assessment. When the assessment is being ordered by a court, psychological testing conducted by a licensed psychologist may be required, which can include substance abuse evaluations. [2]
Types of evaluations
There are a number of different types of substance abuse evaluations that differ based on the setting they’re conducted in and the purpose of the evaluation. Below is an overview of some of the most common types of substance abuse evaluations.
Routine health and medical screening
There are a number of health and medical centers that conduct brief screenings for mental health and substance use disorders. These are commonly administered online or electronically in the form of questionnaires or intake paperwork for a medical practice. For example, there may be questions about depression, substance use, and thoughts of suicide on a form your doctor asks you to complete before a routine check-up or physical.
In some situations, doctors will conduct brief screenings during medical appointments, particularly if these seem relevant to the patient’s current health issues. Routine screenings for substance abuse are not considered full substance abuse evaluations, but they can be used to help providers make appropriate referrals for patients they feel need a formal evaluation. The purpose of these screenings is not to diagnose a substance use disorder, but instead to flag patients who may be in need of a formal, more comprehensive substance abuse evaluation. [3]
Clinical assessments
Comprehensive clinical assessments normally screen for both mental health and addictive disorders. These assessments can vary, but are conducted by licensed professionals who are able to diagnose both mental health and substance use disorders. Comprehensive clinical assessments are normally conducted during the first intake appointment with a therapist, counselor, or psychologist. [1][3]
Psychological evaluations are another form of clinical assessment used to identify both mental health and substance use disorders. These evaluations are performed by licensed psychologists and are sometimes required in legal or child custody cases. In addition to providing diagnostic information, most psychological assessments provide insight into a person’s psychological makeup, personality traits, cognitive functioning, social skills and communication, and overall psychological health and stability.
Admissions assessments
Most addiction treatment centers offer on-site substance abuse evaluations, often as a part of the standard intake process. The purpose of these substance abuse evaluations is to verify a diagnosis of substance use disorders, assess the severity, and determine whether the individual is a good candidate for treatments offered at the clinic. [3]
During an admissions intake assessment, substance abuse evaluations sometimes result in referrals to outside agencies or clinics. This occurs when a person is identified as needing a more specialized type of treatment, or a different level of care than the facility offers. When an individual is determined to be a good candidate for the programs offered at the facility, the intake will also include a discussion about the scope of treatments offered as well as practical information about scheduling and finances.
Court-ordered substance abuse evaluations
Court-ordered substance abuse evaluations have a slightly different structure and objective than clinical assessments. Rather than determining a diagnosis and recommending treatment, results of court-ordered evaluations are often used to help determine the sentencing or outcome of a legal case. [2]
Sometimes, these assessments result in treatment recommendations that become conditions the person must meet in order to avoid certain legal consequences. For example, it is common for people who have received DUI or DWI charges to be required to complete whatever treatment is recommended by the professional completing the DUI assessment. [2]
Substance abuse evaluations can also be court-ordered for people involved in child welfare investigations. The results of the evaluation may be used to mandate certain treatments a person must complete in order to resolve their case or regain custody of their children.
Employer-mandated substance abuse evaluations
Employer-mandated substance abuse evaluations are sometimes required when an employer has reasonable suspicion that an employee’s work is being impaired by substance use. These concerns may come from a positive drug screen result, performance issues, or disciplinary action.
In other cases, employer-mandated substance abuse evaluations are a standard requirement after a workplace incident, accident, or injury is reported. This may be a part of an ongoing internal investigation into the cause of the incident, or as a requirement to approve insurance, disability, or paid leave requests. [2]
The substance abuse evaluation process
The substance abuse evaluation process can look a little different, depending on the type and setting where it is conducted. Commonly, the process involves a scheduled appointment with a licensed medical, mental health, or addiction professional. Normally, this appointment will last at least an hour. During this time, questions will be asked to gather information about: [1][3]
- Current medications and supplements: Information about prescribed medications, dose, and frequency of use, as well as any off-label supplements you are using.
- Substance use history: Information about what substances you have used (including alcohol), how often you used them, and what dose you used, including any current use.
- Treatment history: Information about prior addiction or psychiatric treatment, including dates of treatment, agency name, and how effective treatment was.
- Withdrawal and overdose risks: Information about past or current withdrawal symptoms you have experienced, as well as questions to assess your risk of overdose.
- Personal background: Information about you, your upbringing, family history (including any substance use disorders or mental health concerns they may have), current employment situation, and other important areas of life.
- Physical and mental health issues: Information about any current or historical medical or psychiatric diagnoses, as well as current symptoms or complaints.
- Functional impairment: Information will be requested about what areas of your life or daily functioning are being impaired by substance use.
- Legal history: Information about any past or current legal issues, criminal justice involvement, or past, present, or pending charges.
- Readiness and willingness to change: Questions that assess current levels of motivation and stage of change related to recovery.
- Strengths and risk factors: Information about the individual’s strengths, support, and protective factors as well as challenges and internal/external risk factors that could interfere with treatment or recovery.
How substance use disorders are diagnosed
Substance use disorder diagnoses can only be given by an appropriately licensed and trained medical, mental health, or addiction specialist. All substance use disorders are diagnosed based on standardized criteria in the DSM 5, which is the reference guide used by professionals to diagnose all mental health conditions, including addictions.
In order to be diagnosed with a substance use disorder, a person must report at least two of the following symptoms within a 12-month period: [4]
- Using more or more often than intended.
- Persistent desire or unsuccessful efforts to cut back or stop using.
- Spending a lot of time obtaining, using, or recovering from effects of a substance.
- Experiences strong cravings, urges, or frequent thoughts of using.
- Failure to fulfill major obligations at school, work, or home.
- Continued use despite known problems in important relationships.
- Giving up other important activities because of use.
- Continued use despite known health or mental health complications or problems.
- Using in situations where it is risky or dangerous.
- Developing a tolerance and needing to use more to get the same effects.
- Experiencing physical and/or psychological withdrawals when suddenly stopping.
Substance use disorders can be diagnosed as mild, moderate, or severe, depending on the number of symptoms and level of impairment reported during the evaluation. [4]
Screening tools used in evaluations
There are a number of formal assessments and informal screening tools that can be used to facilitate a substance use evaluation. Here are some of the more commonly used screening and assessment tools for substance use: [1][3]
- Cut Down, Annoyed, Guilty, & Eye-Opener (CAGE): A brief four-question screening for alcohol use disorder that asks questions that can be used to quickly screen for high-risk alcohol use.
- Alcohol Use Disorders Identification Test (AUDIT): A ten-question survey developed by the World Health Organization to identify problem drinking and associated risks.
- Tobacco, Alcohol, Prescription Medication, & Other Substance Use (TAPS): A screening tool developed by the National Institute on Drug Abuse (NIDA) that can help identify problem tobacco, alcohol, and drug use patterns.
- Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST): A tool developed by the World Health Organization (WHO) that can screen for risks associated with different types of substance use.
- American Society of Addiction Medicine (ASAM) Criteria Assessment Interview Guide: A questionnaire used to help determine the severity of a person’s addiction to recommend an appropriate level of care for addiction treatment.
- Addiction Severity Index (ASI): The ASI is a widely used tool that helps to determine the severity of a person’s substance use disorder.
- Drug Abuse Screening Test (DAST): An assessment commonly used in court-ordered evaluations that helps to detect problem use of illicit substances by examining consequences and patterns of use.
How level of care is determined
At the end of a substance abuse assessment, the evaluator will review some of the primary findings, including your diagnosis, as well as going over any treatment recommendations. Depending on the type of substance used, severity of use, and a variety of other factors, different levels of care may be recommended. [3]
Higher levels of care like inpatient detox or rehab may be recommended for people with more severe disorders who need help safely detoxing or getting stable in their recovery. Lower levels of care like outpatient rehab may be recommended for people who have already established their sobriety, or who have less serious or complex treatment needs.
Here are some of the other factors that can help determine which level of care is most appropriate: [3]
- Risk of harm.
- Functional status.
- Co-morbid medical or mental health disorders.
- Recovery environment and supports.
- Treatment and recovery history.
- Stage of recovery.
- Presence of withdrawal symptoms.
- Risk of relapse.
- Engagement in treatment.
- Financial and logistical constraints.
- Availability of treatments in a given geographic region.
How to get a substance abuse evaluation
Individuals seeking a substance abuse evaluation for the purpose of diagnosing or treating a substance use disorder can often find providers through local addiction treatment centers, behavioral health clinics, or private counseling practices.
Searching online for addiction treatment services in your area and contacting providers to ask about assessment services is a good place to start. Those with health insurance may also want to contact their insurance company or review their provider directory to find in-network options.
People who need a substance abuse evaluation for court, child welfare, employment, or other legal purposes may be required to obtain a specialized evaluation from an approved provider. In many cases, the court, employer, probation officer, or agency requesting the evaluation will provide instructions on where and how to schedule the assessment.
Unlike evaluations conducted for treatment purposes, these evaluations may not be covered by health insurance. Individuals should verify costs and payment requirements with the provider before scheduling an appointment.
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