Screening and Assessment in Alcohol and Drug Counseling R. Lyle Cooper, Ph.D., LCSW, ICADAC II Assistant Professor University of Tennessee College of Social Work

Screening Issues  Importance to practice  Various approaches: structured interview self-report instruments/questionnaires, clinical laboratory tests  Screening versus diagnosis

Screening Accuracy Specificity  Ability of a screening tool to avoid false positives; accuracy in not including non-affected persons.  False Positive— Subject does not have problem; incorrectly identified as having the problem. Sensitivity  Ability of a screening tool to avoid false negatives; accuracy in including all who have the problem.  False Negative—Subject has problem; incorrectly identified as not having the problem.

Discussion Questions 1. Why might you choose a sensitive measure? 2. Why might you choose a specific measure? 3. Think about who you work with, should you use a sensitive or specific measure? Why? 4. What are the ethical implications regarding a screening choice?

Screening for Alcohol Problems First Rule… ASK

Ask “Do you drink alcohol?”

Ask “On average, how many days a week do you drink?”

Ask “On a day when you drink alcohol, how many drinks do you have?” “What is the maximum number of drinks you consumed on any given occasion during the past month?”

Relationship Between Alcohol Use and Alcohol Problems... None Light Moderate Heavy None Small Moderate Severe Alcohol Problems Alcohol Use Low Risk At Risk Problem Dependent

Why Ask?  We ask questions about the quantity and frequency of alcohol consumption because it is: Common Sensitive Based on epidemiological research Related to a continuum of risk

Standard Drink Measure

Assessment Outline A.Background B.What We Measure C.Sequential and Functional Approaches D.How We Diagnose, Classifications E.Assessment Tools F.Multidimensional Assessment G.Readiness Stages of Change H.Conclusions

Background  Remember… Client motivation and commitment to treatment begins with the diagnosis and assessment phase. © 2002 Microsoft Corporation.

What We Measure  Assessment needs to be sufficiently broad to capture the extent and complexity of the many factors that accompany, potentially maintain, and are affected by drug use. © 2002 Microsoft Corporation.

What We Measure (continued) What to Assess Physiology Behavior Pychology Social elements Motivation/Readiness to change Sources of Information: Who to Ask Client Clinician Social Network

What We Measure (continued) –Etiology –Course –Severity –Client readiness –Relationship of drugs and other life problems –Strengths, resources –Relapse risk © 2002 Microsoft Corporation.

Sequential Approach  Screening  Assessment  Diagnosis  Treatment Planning  Motivating  Treatment  Evaluation and Follow-up © 2002 Microsoft Corporation.

Functional Analysis  Identify determinants (root causes) of drug use – both interpersonal and intrapersonal  Decision tree and treatment matching  Selection and prioritization of treatment goals © 2002 Microsoft Corporation.

Exercise 1  In small groups review the criteria for drug abuse and dependence  Develop some concrete examples of behaviors and symptoms that would clearly fit each criteria  Discuss examples that might be ambiguous as well

DSM-IV Limitations  Over-reliance on clinician judgment  Diagnostic criteria are less valid with certain populations  Does not capture levels of drug involvement  Provides little help with motivation or treatment planning

Reliability, Validity and Therapeutic Relationship Reliability and validity are affected by practice: “The interviewer is responsible for the integrity of the information collected and must be willing to repeat, paraphrase, and probe until he/she is satisfied that the patient understands the questions and that the answer reflects the best judgment of the patient, consistent with the intent of the question.” (ASI Manual)

Multidimensional Assessment Assessment DomainExample Instrument Drug Use ProblemsAddiction Severity Index (ASI) Relapse Risk SituationAssessment of Warning Signs of Relapse (AWARE) Coping ResourcesDrug Taking Confidence Questionnaire (DTCQ) Motivational ResourcesStages of Change Readiness and Treatment Eagerness Scale (SOCRATES)

Exercise 2  In small groups think of a population group you may need to assess  Chose an element needed to be assessed  Identify any cultural or other considerations that should be addressed by the tool  You have 15 minutes!

Exercise 2 Continued  Share your population and element of the multidimensional assessment with the trainer  We will use the ADAI assessment website to find an appropriate tool

Transtheoretical Model Action Pre contemplation Contemplation Planning Maintenance Relapse

Choosing an Assessment Instrument  Time  Cost  Scoring and interpretation  Clinical utility  Target population  Reliability and validity  Ease of administration Factors to consider…