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Center for Substance Abuse Treatment. Detoxification and Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2006. (Treatment Improvement Protocol (TIP) Series, No. 45.)

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Detoxification and Substance Abuse Treatment.

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Appendix C: Screening and Assessment Instruments

Please note that this list of screening and assessment instruments has been divided into two sections. The first section comprises those instruments used for patients with suspected alcohol abuse or dependence only; the second lists instruments used to screen and assess for abuse of or dependence on any substances. Thus those tools that screen for all substances of abuse are listed in section II.

Section I: Screening and Assessment for Alcohol Abuse

This section of the appendix lists common screening and assessment instruments specifically used in cases where abuse of or dependence upon alcohol is in question.

The Alcohol Use Disorders Identification Test (AUDIT)

Purpose: The purpose of the AUDIT is to identify persons whose alcohol consumption has become hazardous or harmful to their health.

Clinical utility: The AUDIT screening procedure is linked to a decision process that includes brief intervention with heavy drinkers or referral to specialized treatment for patients who show evidence of more serious alcohol involvement.

Groups with whom this instrument has been used: Adults, particularly primary care, emergency room, surgery, and psychiatric patients; DWI offenders; offenders in court, jail, and prison; enlisted men in the armed forces; workers receiving help from employee assistance programs and in industrial settings.

Norms: Yes, heavy drinkers and people with alcohol use disorders

Format: A 10-item screening questionnaire with 3 questions on the amount and frequency of drinking, 3 questions on alcohol dependence, and 4 on problems caused by alcohol.

Administration time: Two minutes

Scoring time: One minute

Computer scoring? No

Administrator training and qualifications: The AUDIT is administered by a health professional or paraprofessional. Training is required for administration. A detailed user's manual and a videotape training module explain proper administration, procedures, scoring, interpretation, and clinical management.

Fee for use: No

Available from: Can be downloaded from Project Cork Web site: http://www.projectcork.org/clinical_tools/index.html

Brief Michigan Alcoholism Screening Test (BMAST)

Purpose: Used to screen for alcoholism with a variety of populations.

Clinical utility: The BMAST can save clinicians time when integrated with instruments used to screen for other behavioral health problems (Pokorny et al. 1972).

Groups with whom this instrument has been used: Adults

Norms: N/A

Format: Ten-item questionnaire; interview or paper-and-pencil

Administration time: Five minutes

Scoring time: Two to 3 minutes

Computer scoring? No

Administrator training and qualifications: No training required.

Fee for use: No

Available from: Can be downloaded from Project Cork Web site: http://www.projectcork.org/clinical_tools/index.html

CAGE Questionnaire

Purpose: Used to detect alcoholism.

Clinical utility: The CAGE Questionnaire is a very useful bedside, clinical desk instrument and has become the favorite of many family practice and general internists and among nurses.

Groups with whom this instrument has been used: Adults and adolescents (over 16 years old)

Norms: Yes

Format: Very brief, relatively nonconfrontational questionnaire for detection of alcoholism, usually directed “have you ever” but may be focused to delineate past or present use.

Administration time: Less than 1 minute

Scoring time: Instantaneous

Computer scoring? No

Administrator training and qualifications: No training required for administration; it is easy to learn, easy to remember, and easy to replicate.

Fee for use: No

Available from: Can be downloaded from Project Cork Web site: http://www.projectcork.org/clinical_tools/index.html

Clinical Institute Withdrawal Assessment (CIWA-Ar)

Purpose: Converts DSM-III-R items into scores to track severity of withdrawal; measures severity of alcohol withdrawal.

Clinical utility: Aid to adjustment of care related to withdrawal severity

Groups with whom this instrument has been used: Adults

Norms: N/A

Format: A 10-item scale for clinical quantification of the severity of the alcohol withdrawal syndrome.

Administration time: Two minutes

Scoring time: Four to 5 minutes

Computer scoring? No

Administrator training and qualifications: Training is required; the CIWA-Ar can be administered by nurses, doctors, research associates, and detoxification unit workers.

Fee for use: No

Available from: Center for Substance Abuse Treatment. A Guide to Substance Abuse Services for Primary Care Clinicians. Treatment Improvement Protocol (TIP) Series 24. DHHS Publication No. (SMA) 97-3139. Rockville, MD: Substance Abuse and Mental Health Services Administration, 1997.

Michigan Alcoholism Screening Test (MAST)

Purpose: Used to screen for alcoholism with a variety of populations.

Clinical utility: A 25-item questionnaire designed to provide a rapid and effective screen for lifetime alcohol-related problems and alcoholism.

Groups with whom this instrument has been used: Adults

Norms: N/A

Format: Consists of 25 questions

Administration time: Ten minutes

Scoring time: Five minutes

Computer scoring? No

Administrator training and qualifications: No training required.

Fee for use: Fee for a copy, no fee for use

Available from: Can be downloaded from Project Cork Web site: http://www.projectcork.org/clinical_tools/index.html

TWEAK

Purpose: Screens for heavy drinking and alcohol dependence in the past year in male and female samples of the general household population and hospital clinic outpatients (Chan et al. 1993).

Clinical utility: The TWEAK provides a quick and easy method of targeting outpatients and inpatients in need of more thorough assessments of their alcohol use patterns and problems to determine whether treatment is needed. The TWEAK has also been used to screen for periconceptional risk drinking among obstetric outpatients (Russell et al. 1994), which may improve pregnancy outcome among high-risk drinkers.

Groups with whom this instrument has been used: Adults

Norms: Yes

Format: Five items; pencil and paper self-administered, administered by interview, or computer self-administered.

Administration time: Less than 2 minutes

Scoring time: Approximately 1 minute

Computer scoring? No

Administrator training and qualifications: No training required.

Fee for use: No

Available from: Can be downloaded from Project Cork Web site: http://www.projectcork.org/clinical_tools/index.html

Section II: Screening and Assessment for Alcohol and Other Drug Abuse

This section of the appendix lists common screening and assessment instruments used in cases where abuse of or dependence upon substances (including alcohol) is in question.

Addiction Severity Index (ASI)

Purpose: The ASI is most useful as a general intake screening tool. It effectively assesses a client's status in several areas, and the composite score measures how a client's need for treatment changes over time.

Clinical utility: The ASI has been used extensively for treatment planning and outcome evaluation. Outcome evaluation packages for individual programs or for treatment systems are available.

Groups with whom this instrument has been used: Designed for adults of both sexes who are not intoxicated (on illicit drugs or alcohol) when interviewed. It is also available in Spanish.

Norms: The ASI has been used with males and females with substance use disorders in both inpatient and outpatient settings.

Format: Structured interview

Administration time: Fifty minutes to 1 hour

Scoring time: Five minutes for severity rating

Computer scoring? Yes

Administrator training and qualifications: A self-training packet is available as well as onsite training by experienced trainers.

Fee for use: No cost; minimal charges for photocopying and mailing may apply

Available from: A. Thomas McLellan, Ph.D., Building 7, PVAMC, University Avenue, Philadelphia, PA 19104, Phone: (800) 238-2433

Cocaine Selective Severity Assessment (CSSA)

Purpose: Measures early cocaine abstinence signs and symptoms.

Clinical utility: The CSSA is able to predict a patient's response to treatment and could be used to identify patients at greater risk for treatment failure so that these patients could be targeted for additional interventions. This instrument could also be used to evaluate the effectiveness of medications intended to treat cocaine abstinence symptoms.

Groups with whom this instrument has been used: Adults

Norms: N/A

Format: Eighteen items

Administration time: Less than 10 minutes

Scoring time: N/A

Computer scoring? No

Administrator training and qualifications: Requires little training; clinician-administered

Available from: Kampman, K.M., Volpicelli, J.R., McGinnis, D.E., Alterman, A.I., Weinrieb, R.M., D'Angelo, L., and Epperson, L.E. Reliability and validity of the Cocaine Selective Severity Assessment. Addictive Behaviors 23(4):449–461, 1998.

Objective Opiate Withdrawal Scale (OOWS)

Purpose: Used to record symptoms of opiate withdrawal.

Clinical utility: Allows staff to share information about a client's withdrawal, especially objective signs observed by staff.

Groups with whom this instrument has been used: Adults

Norms: N/A

Format: Thirteen manifestations of withdrawal; observer scores

Computer scoring? No

Administrator training and qualifications: Staff must be familiar with withdrawal signs (e.g., registered nurse, physician) or trained.

Available from: Handelsman, L., Cochrane, K.J., Aronson, M.J., Ness, R., Rubinstein, K.J., and Kanof, P.D. Two new rating scales for opiate withdrawal. American Journal of Alcohol Abuse. 13:293–308, 1987.

Structured Clinical Interview for DSM-IV Disorders (SCID)

Purpose: Obtains Axis I and II diagnoses using the DSM-IV diagnostic criteria for enabling the interviewer to either rule out or to establish a diagnosis of “drug abuse” or “drug dependence” and/or “alcohol abuse” or “alcohol dependence.”

Clinical utility: A psychiatric interview

Groups with whom this instrument has been used: Psychiatric, medical, or community-based normal adults.

Norms: No

Format: A psychiatric interview form in which diagnosis can be made by the examiner asking a series of approximately 10 questions of a client.

Administration time: Administration of Axis I and Axis II batteries may require more than 2 hours each for patients with multiple diagnoses. The Psychoactive Substance Use Disorders module may be administered by itself in 30 to 60 minutes.

Scoring time: Approximately 10 minutes

Computer scoring? No. Diagnosis can be made by the examiner after the interview.

Administrator training and qualifications: Designed for use by a trained clinical evaluator at the master's or doctoral level, although in research settings it has been used by bachelor's level technicians with extensive training.

Fee for use: Yes

Available from: American Psychiatric Publishing, Inc., 1400 K Street, N.W., Washington, DC 20005, www.appi.org/

Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES)

Purpose: Designed to assess client motivation to change drinking- or drug-related behavior. Consists of five scales: precontemplation, contemplation, determination, action, and maintenance. Separate versions are available for alcohol and illicit drug use.

Clinical utility: The SOCRATES can assist clinicians with necessary information about client motivation for change, an important predictor of treatment compliance and outcome, and aid in treatment planning.

Groups with whom this instrument has been used: Adults

Norms: N/A

Format: Forty items; paper-and-pencil

Administration time: Five minutes

Computer scoring? No

Administrator training and qualifications: No training required.

Fee for use: No

Available from: Center for Substance Abuse Treatment. Enhancing Motivation for Change in Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series 35. DHHS Publication No. (SMA) 99-3354. Rockville, MD: Substance Abuse and Mental Health Services Administration, 1999.

Subjective Opiate Withdrawal Scale (SOWS)

Purpose: Used to record client's impressions or complaints of opiate withdrawal symptoms.

Groups with whom this instrument has been used: Adults

Norms: N/A

Format: Sixteen-item questionnaire; interview or paper-and-pencil

Computer scoring? No

Available from: Handelsman, L., Cochrane, K.J., Aronson, M.J., Ness, R., Rubinstein, K.J., and Kanof, P.D. Two new rating scales for opiate withdrawal. American Journal of Alcohol Abuse. 13:293–308, 1987.

University of Rhode Island Change Assessment (URICA)

Purpose: The URICA operationally defines four theoretical stages of change (precontemplation, contemplation, action, and maintenance), each assessed by eight items.

Clinical utility: Assessment of stages of change/readiness construct can be used as a predictor, and for treatment matching and determining outcome variables.

Groups with whom this instrument has been used: Both inpatient and outpatient adults

Norms: Yes, for an outpatient alcoholism treatment population

Format: The URICA is a 32-item inventory designed to assess an individual's stage of change located along a theorized continuum of change.

Administration time: Five to 10 minutes to complete

Scoring time: Four to 5 minutes

Computer scoring? Yes, using computer scannable forms

Administrator training and qualifications: N/A

Fee for use: No—the instrument is in the public domain

Available from: Center for Substance Abuse Treatment. Enhancing Motivation for Change in Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series 35. DHHS Publication No. (SMA) 99-3354. Rockville, MD: Substance Abuse and Mental Health Services Administration, 1999.

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