CHAPTER 28
The Assessment of Suspected Substance Use Disorders
LEARNING OBJECTIVES
After studying this chapter, students should be able to:
•
28.2: Distinguish between screening for and assessment of substance use
disorders
•
28.4: Review various ways to assess substance use disorders
•
28.6: Understand the purpose of diagnosis
CHAPTER OUTLINE
The Theory Behind Substance Use Assessments
Screening
Verbal Screening Aids
Paper-and-Pencil/Computerized Screening Instruments
Section Summary
Assessment
Standardized Tests
Section Summary
The Assessment Format
Circumstances of Referral
Substance Use Patterns
Past Treatment History
Legal History
Past Military History
Educational/Vocational History
Developmental/Family History
Psychiatric History
Medical History
Real Versus Pseudo-Personality Disorders
Section Summary
The Assessor and Data Privacy
Diagnostic Rules
Other Sources of Information: Medical Test Data
Diagnosis: The Outcome of the Assessment Process
Treatment Referrals
CHAPTER OVERVIEW
There is a great deal of confusion surrounding the assessment process. The average person
often equates substance use with the existence of a substance use disorder (SUD). In the legal
arena, equating selling drugs with SUDs as a mitigating factor to protect the accused from at
least some of the consequences of his or her behavior is not uncommon. It is the purpose of this
chapter to explore the process of assessing a client who is suspected of having a substance use
disorder, in order to help the student understand what is involved in this process.
Break-Out Discussion # 1:
Data privacy: The privilege of confidentiality remains with the client, except under special
circumstances, as noted in your text. But imagine a situation in which a client refuses to sign a
release of information authorization to the courts until he or she is able to review your
assessment to make sure that it is favorable. How would you handle such a situation? (One way
to address the problem would be to note in the body of the assessment the fact that the client
refused to release a copy of the report to the court (probation officer, employer, and so on)
until after he or she had a chance to review it to make sure that it was favorable to them.) Can
you think of other ways to handle the situation?
It is important to remember that the client’s motivation for treatment, evidenced in part by past
and present behavior, may be included in the body of the assessment. The observation that the
client refused to provide a copy of the assessment to the court until he or she had reviewed it is
Moving on, imagine that you are a counselor at a substance rehabilitation facility, and you
receive a telephone call in which a woman identifies herself as a social worker for a specific
county, and asks for a treatment update on a certain individual. You are not familiar with the
caller’s voice. Should you provide the requested information? The answer to this question is a
resounding no. It would be quite appropriate to tell the caller that it was not a convenient time
to talk and ask for a telephone number at which she might be reached in 10–30 minutes. During
that time every effort should be made to identify both the caller’s identity and whether there is
a release of information authorization from the client allowing the release of patient treatment
information to that social worker. Make sure that the telephone numbers listed on the release
of information authorization and provided by the caller are the same!
On other occasions, the author has received calls from persons who claimed to be a client’s
attorney, the judge hearing the case, or a county’s social worker, and requesting a progress
report on the client (who was separated and would soon be divorced, but who was involved in a
bitter child custody battle). Again, the caller was told that it was not a convenient time to talk on
the phone and asked whether the therapist could call back in 10–30 minutes. After obtaining a
telephone number where the caller might be reached later, the author called the appropriate
county’s sheriff’s office, and explained why it was necessary to obtain the location where the
call originated. A few moments later it was revealed that the telephone number provided by the
“social worker” was actually that of the estranged spouse or the attorney representing the
estranged spouse!
Finally, a situation could arise in which the client inquires whether the assessor has received
referral information from the court. If the assessor should answer in the affirmative, there is a
chance that the client will then ask either (a) to review the referral records or (b) for a copy of
the records for his or her own use. Should the assessor allow the client access to these records?
Again, the answer is no! It is important to keep in mind the fact that the records were released
Which of these scenarios surprised you? Which were the ones you expect may happen in the
future for you? How will you make sure to be prepared for contact from those who do or do not
have rights to the information you have?
Break-Out Discussion # 2:
Those in need of treatment: It is often the case that those who have an SUD do not agree that
such is the case, and do not agree that treatment is necessary. Many who have SUDs never seek
help, while as some seek help in ways that do not fit as “treatment” per se.
Questions
1. Consider: do you have an alcohol use disorder or substance use disorder? Why or why not?
Does your neighbor have a substance use disorder? Again, on what are you basing this
assessment?
2. Does society have the right to force persons into a rehabilitation program? Would your
answer be different if you were the one that society deemed as being in need of treatment,
even if you did not want it?
References
Madras, B. K. (2010). Screening: Brief intervention, and referral to treatment: An idea whose
time has come. Paper presented at the “Addictions in 2010” seminar, hosted by the Division of
Alcohol and Drug Abuse of the McLean Hospital, Boston, MA, April 30, 2010.
KEY CONCEPTS AND TERMS
Screening: Process used to identify those patients who might have a certain disease or condition
Assessment: Process used to determine the specifics related to a certain disease or condition
for an individual
LO/STANDARDS CORRELATION CHART
A-head
LO
Standard—CACREP
The Theory Behind
Substance Use
Assessments
28.1:
Understand the
theory behind
substance use
assessments
3d: theories and etiology of addictions
and addictive behaviors
7a: historical perspectives concerning
the nature and meaning of
assessment and testing in counseling
Screening
Assessment
28.2:
Distinguish
between
screening for
and assessment
of substance
use disorders
7e: use of assessments for diagnostic
and intervention planning purposes
Screening
28.3: Review
various ways to
screen for
substance use
disorders
7e: use of assessments for diagnostic
and intervention planning purposes
Assessment
28.4: Review
various ways to
assess
substance use
disorders
7e: use of assessments for diagnostic
and intervention planning purposes
7l: use of assessment results to
diagnose developmental, behavioral,
and mental disorders
The Assessment Format
28.5: Describe a
potential
format for
writing an
assessment
7b: methods of effectively preparing
for and conducting initial assessment
meetings
7e: use of assessments for diagnostic
Diagnostic Rules
Diagnosis: The Outcome of
the Assessment Process
28.6:
Understand the
purpose of
diagnosis
7e: use of assessments for diagnostic
and intervention planning purposes
7l: use of assessment results to
diagnose developmental, behavioral,
and mental disorders