Substance Use Disorder Evaluations
Learn About the Many SUD Assessment Tools
Comprehensive Diagnostic Evaluations at J. Flowers Health Institute
What is a Substance Use Disorder?
Table of Contents
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What are the Symptoms of Substance Use Disorder?
- Taking the substance in larger amounts or for longer than you're meant to.
- Wanting to cut down or stop using the substance but not managing to.
- Spending a lot of time getting, using, or recovering from use of the substance.
- Cravings and urges to use the substance.
- Not managing to do what you should at work, home, or school because of substance use.
- Continuing to use, even when it causes problems in relationships.
- Giving up important social, occupational, or recreational activities because of substance use.
- Using substances again and again, even when it puts you in danger.
- Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.
- Needing more of the substance to get the effect you want (tolerance).
- Development of withdrawal symptoms, which can be relieved by taking more of the substance.
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What are the Risk Factors of Substance Use Disorder?
- Family history of substance use disorder
- Mental disorders or psychiatric illnesses
- Problems at school or work can indicate substance use disorder
Specific Assessment Tools
Substance Use Disorder Evaluation Tools:
- CAGE
- ASSIST
- AUDIT
- AUDIT-C
- CRAFFT
- MAST
- DAST
- Fagerstrom Test
- TWEAK
- NIDA Drug Screening Tool
CAGE Substance Use Disorder Evaluation
- Have you ever felt you ought to Cut down on your drinking or substance use?
- Have people Annoyed you by criticizing your drinking or substance use?
- Have you ever felt bad or Guilty about your drinking or substance use?
- Have you ever had a drink or used substances first thing in the morning (Eye opener) to steady your nerves or get rid of a hangover (or to get the day started)?
ASSIST Evaluation
Question 1
Which substances have you used in your lifetime?
Question 2
What is the frequency of substance use in the past three months?
Question 3
What is the frequency of experiencing cravings or urges to use in the last three months?
Question 4
What is the frequency of health, social, legal, or financial problems experienced in relation to substance use in the past three months?
Question 5
What is the frequency with which substance use has interfered with your responsibilities in the past three months?
Question 6
Has anyone ever expressed concern about your substance use? If so, when?
Question 7
Have you ever tried to cut down or stop the use of substances and failed? If so, when?
Question 8
Have you ever injected any substances, and if so, when?
What Substances Does ASSIST Screen For?
- Tobacco
- Alcohol
- Cannabis
- Cocaine
- Amphetamines
- Sedatives
- Amphetamines
- Hallucinogens
- Inhalants
- Opioids
- Others
AUDIT Substance Use Disorder Evaluation
- Alcohol intake
- Dependence on alcohol
- Alcohol-related harm
10 Questions
- 1. How often do you have a drink containing alcohol?
- 2. How many drinks containing alcohol do you have on a typical day when you are drinking?
- 3. How often do you have six or more drinks on one occasion?
- 4. How often during the last year have you found that you were not able to stop drinking once you had started?
- 5. How often during the last year have you failed to do what was normally expected of you because of drinking?
- 6. How often during the last year have you needed a drink first thing in the morning to get yourself going after a heavy drinking session?
- 7. How often during the last year have you felt guilty after drinking?
- 8. How often during the last year have you been unable to remember what happened the night before because of your drinking?
- 9. Have you or someone else been injured due to your drinking?
- 10. Have your friends, family, or doctor expressed concern about your drinking or suggested you cut down?
Scoring
AUDIT-C Evaluation
How often do you drink alcohol?
- Never
- Monthly or less
- 2-4 times a month
- 2-3 times a week
- 4 or more times a week
How many standard drinks containing alcohol do you have on a typical day?
- 1-2
- 3-4
- 5-6
- 7-9
- 10+
How often do you have six or more drinks on one occasion?
- Never
- Less than monthly
- Monthly
- Weekly
- Daily/almost daily
CRAFFT Substance Use Disorder Evaluation
CRAFFT Questionnaire
Part A
- In the past 12 months, did you drink any alcohol? (do not count sips of alcohol taken during family/religious events)
- In the past 12 months, did you smoke any marijuana or hashish?
- In the past 12 months, did you use anything else to get high? (e.g., illegal substances, over-the-counter prescription drugs, inhalants, etc.)
Part B
- Have you ever ridden in a Car driven by someone (including yourself) who was “high” or had been using alcohol or drug?
- Do you ever use alcohol or drugs to Relax, feel better about yourself, or fit in?
- Do you ever use alcohol or drugs while you are by yourself, or Alone?
- Do you ever Forget things you did while using alcohol or drugs?
- Do your Family or Friends ever tell you that you should cut down on your drinking or drug use?
- Have you ever gotten into Trouble while you were using alcohol or drugs?
CRAFFT Screening Tool for Adolescent Substance Abuse
MAST Evaluation
Question Directed at Your Drinking
Questions About Family and Work
- Has drinking ever created problems between you and a near relative or close friend?
- Has any family member or close friend gone to anyone for help about your drinking?
- Have you ever lost friends because of your drinking?
- Have you ever gotten into trouble at work because of drinking?
- Have you ever lost a job because of drinking?
- Have you ever neglected your obligations, family, or work for two or more days in a row because you were drinking?
- Do you drink before noon fairly often?
Questions About the Consequences of Your Drinking
- Have you ever been told you have liver trouble, such as cirrhosis?
- After heavy drinking, have you ever had delirium tremens (DTs), severe shaking, visual or auditory (hearing) hallucinations?
- Have you ever gone to anyone for help with your drinking?
- Have you ever been hospitalized because of drinking?
- Has your drinking ever resulted in your being hospitalized in a psychiatric ward?
- Have you ever gone to any doctor, social worker, clergyman, or mental health clinic for help with any emotional problem in which drinking was part of the problem?
- Have you been arrested more than once for driving under the influence of alcohol?
- Have you ever been arrested, or detained by an official for a few hours, because of other behavior while drinking?
MAST Scoring
DAST Substance Use Disorder Evaluation
Questions About Your Relationships and Work
- Does your spouse (or parents) ever complain about your involvement with drugs?
- Do your friends or relatives know or suspect you abuse drugs?
- Has drug abuse ever created problems between you and your spouse?
- Has any family member ever sought help for problems related to your drug use?
- Have you ever lost friends because of your use of drugs?
- Have you ever neglected your family or missed work because of your use of drugs?
- Have you ever been in trouble at work because of drug abuse?
- Have you ever lost a job because of drug abuse?
- Have you gotten into fights when under the influence of drugs?
Questions About Family and Work
- Has drinking ever created problems between you and a near relative or close friend?
- Has any family member or close friend gone to anyone for help about your drinking?
- Have you ever lost friends because of your drinking?
- Have you ever gotten into trouble at work because of drinking?
- Have you ever lost a job because of drinking?
- Have you ever neglected your obligations, family, or work for two or more days in a row because you were drinking?
- Do you drink before noon fairly often?
Questions About Effects of Substance Use
- Have you ever been arrested because of unusual behavior while under the influence of drugs?
- Have you ever been arrested for driving while under the influence of drugs?
- Have you engaged in illegal activities to obtain drugs?
- Have you ever been arrested for possession of illegal drugs?
- Have you ever experienced withdrawal symptoms as a result of heavy drug intake?
- Have you had medical problems as a result of your drug use (e.g., memory loss, hepatitis, convulsions, bleeding, etc.)?
Questions About Trying to Stop
- Have you ever gone to anyone for help for a drug problem?
- Have you ever been in a hospital for medical problems related to your drug use?
- Have you ever been involved in a treatment program specifically related to drug use?
- Have you been treated as an outpatient for problems related to drug abuse?
DAST-A
Fagerstrom Test
Question 1
How soon after waking do you smoke your first cigarette?
- Within 5 minutes (3 points)
- 6-30 minutes (2 points)
- 31-60 minutes (1 point)
- After 60 minutes (0 points)
Question 2
Do you find it difficult to refrain from smoking in places where it is forbidden?
- Yes (1 point)
- No (0 points)
Question 3
Which cigarette would you hate to give up?
- The first in the morning (1 point)
- Any other (0 points)
Question 4
How many cigarettes a day do you smoke?
- 10 or less (0 points)
- 11-20 (1 point)
- 21-30 (2 points)
- 31 or more (3 points)
Question 5
Do you smoke more frequently in the morning?
- Yes (1 point)
- No (0 points)
Question 6
Do you smoke even if you are sick in bed most of the day?
- Yes (1 point)
- No (0 points)
Scoring
- 1-2 points = low dependence
- 3-4 points = low to moderate dependence
- 5-7 points = moderate dependence
- 8+ = high dependence
TWEAK Substance Use Disorder Evaluation
- How many drinks does it take for you to feel high? (Tolerance) (2 or more drinks = 2 points)
- Does your partner (or do your parents) ever Worry or complain about your drinking? (yes = 2 points)
- Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover? (Eye-opener) (yes = 1 point)
- Have you ever awakened the morning after some drinking the night before and found that you could not remember part of the evening? (yes = 1 point)
- Have you ever felt that you ought to cut down on your drinking? (yes = 1 point)
NIDA Drug Screening Tool
- Alcohol
- Tobacco
- Prescription drugs for non-medical purposes
- Illegal substances
- Never
- Once or twice
- Monthly
- Weekly
- Daily/Almost daily
Other Ways to Screen for Substance Use Disorder
Are There Physically Observable Signs?
- Dilated pupils
- Red eyes
- Excessive sniffing/runny nose
- Pale appearance
- Lack of personal hygiene
- Loss of appetite/change in eating habits
- Weight loss
- Appearing undernourished
- Repetitive speech
- Unusual body odor
- Scabs or marks on the skin
- Dental/gun problems
Lab Evaluations to Detect Substance Use Disorder?
- Routine laboratory screening such as liver function tests, complete blood count, vitamin B12, and folate levels might raise red flags for substance use and require further evaluation.
- Blood alcohol levels, breathalyzer tests, urine drug tests, and hair and saliva analysis indicate the presence of alcohol or substances.
- Blood, urine, and saliva testing can also be used in the process of treatment to establish structure and limits, which help patients to follow guidelines, establish self-control, and monitor patient use.
Using a Patient’s History to Find Substance Use Disorder
Risk Factors for Addiction:
- Family History
- Abusive or Traumatic Childhood
- Pre-Existing Mental Illness
Adolescent Risk Factors for Substance Abuse:
- Low Self-Esteem
- Academic Problems
- Loneliness
- Depression
- Desire for Social Acceptance
Motivating a Patient to Recover from Substance Use Disorder
What is a Brief Intervention and When Is It Used?
Is a Patient Ready to Change?
Motivation Might Not Be Enough
SOCRATES
What is a Narcotic Contract?
How To Deal With Resistant Patient Behaviors?
Healthcare providers can’t change patients; only patients can make the changes they need to for themselves. That being said, there are some approaches and tips for dealing with resistant patient behaviors that might make it easier to motivate change in patients. Some tips include:12
Be Patient and Detached
- Try not to present yourself as an expert. A patient who is resistant to treatment is unlikely to want to be told what to do and made to feel unknowledgeable.
- Try to avoid dwelling on and accepting the patient's excuses for their use. While it is useful to understand why they started using substances, it is not beneficial to the patient to encourage their excuses.
- Take baby steps. If you encounter resistance in a patient, slow down and start small. If seeking treatment is too big of a goal, start with something smaller such as reducing the frequency of use.
- Do not argue with clients. Accept, listen to, and understand what they are telling you. Reflect back to them how they feel and suggest small changes.
- Try to focus on solutions. If your patient presents you with problems and excuses, try to come up with valid and realistic solutions.
Respect the Patient
- Try not to place blame on patients. While there might be many bad decisions a patient has made, there is no use in casting blame. They will only feel more defensive.
- Realize that patients have the agency to make decisions for themselves. Don’t try to force anything on them.
- Try to open a dialogue with a patient rather than have an interrogation where you bombard them with questions. You are more likely to succeed if your patient feels like you are just two people having a conversation.
- Respect patients! A patient wants to feel heard and respected. Using substances does not make them less of a person, and they deserve the same respect as anyone else.
- Try to bring out the patient’s motivation for change. Come up with good reasons together to highlight why change might be positive. If a patient can’t see any reasons for changing their behavior, why would they change? Work together to find the positive benefits of change.
How are Substance Use Disorders Treated?
Resources
- https://www.verywellmind.com/dsm-5-criteria-for-substance-use-disorders-21926
- https://www.ncbi.nlm.nih.gov/books/NBK83252/pdf/Bookshelf_NBK83252.pdf
- https://www.drugabuse.gov/sites/default/files/files/AUDIT.pdf
- https://www.mirecc.va.gov/cih-visn2/Documents/Provider_Education_Handouts/AUDIT-C_Version_3.pdf
- https://med.dartmouth-hitchcock.org/documents/CRAFFT-adolescent-substance-use-screen.pdf
- https://www.verywellmind.com/the-michigan-alcohol-screening-test-69497
- https://www.uspreventiveservicestaskforce.org
- https://ndri.curtin.edu.au/btitp/documents/Fagerstrom_test.pdf
- https://www.drugabuse.gov/sites/default/files/pdf/nmassist.pdf
- https://www.ncbi.nlm.nih.gov/books/NBK50628/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5844156/#:~:text=Brief%20intervention%20(BI)%20is%20a%20structured%2C%20client%2Dcentred,safe%20level%20or%20complete%20abstinence.
- https://ct.counseling.org/2010/02/managing-resistant-clients/