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

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 Relationship Between Alcohol Use and Alcohol Problems...Use and Alcohol Problems...

None

LightModerate

Heavy

None

SmallModerate

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:CommonSensitiveBased on epidemiological researchRelated to a continuum of risk

Standard Drink Measure

Assessment Outline

A. BackgroundB. What We MeasureC. Sequential and Functional ApproachesD. How We Diagnose, ClassificationsE. Assessment ToolsF. Multidimensional AssessmentG. Readiness Stages of ChangeH. 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 AskClientClinicianSocial Network

What We Measure What We Measure (continued)(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 Multidimensional Assessment

Assessment Domain Example Instrument

Drug Use Problems Addiction Severity Index (ASI)

Relapse Risk Situation Assessment of Warning Signs of Relapse (AWARE)

Coping Resources Drug Taking Confidence Questionnaire (DTCQ)

Motivational Resources Stages 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…