Alcohol Abuse Assessment
Medically reviewed byDr. Anna Pickering
April 3, 2019
If you’re concerned that either yourself or someone close to you is drinking in a way that could be damaging to their health and life, it is important to understand the proper steps towards treatment. An assessment can help both loved ones and professionals to intercede on a person’s behalf. This can create an opportunity to get a person help so they can overcome these damaging behaviors.
An alcohol abuse assessment evaluates the extent of an individual’s alcohol use disorder (AUD). Prevention is key in avoiding further alcohol abuse, abuse which, if left unchecked could accelerate into the compulsive drinking which is hallmark to addiction. The assessment’s information helps treatment providers to intervene and design and implement an individualized treatment plan.
Is There A Difference Between A Screening And An Assessment?
While some may use these words interchangeably, there is, in fact, a difference. In a Substance Abuse and Mental Health Services Administration (SAMHSA) document on evaluating and planning treatment for co-occurring disorders, including alcohol, this distinction is made clear. It offers a succinct description of these components: “Screening, assessment, and treatment planning (see Table 1, Key Definitions) constitute three interrelated components of a process that, when properly executed, informs and guides the provision of appropriate, client-centered services.”
Why Do People Get Screened Or Assessed For Alcohol Abuse?
A person may be evaluated for an AUD for numerous reasons. Sometimes it is at a friend or family member’s urging. Other times the individual may themselves seek help. If a person has encountered any alcohol-related offenses such as a DUI (driving under the influence) or DWI (driving while intoxicated) they may be required by the courts to undergo these evaluations.
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Lastly, the evaluation may happen at a provider’s discretion; either because they believe there is a need or because they require it of all their patients at some point in time. Regardless of the reason, alcohol screening and assessment, when used properly, can be valuable tools for getting an individual help.
Who Administers A Screening And/Or Assessment?
If you’re anticipating this process either for yourself or loved one, it’s helpful to know what to expect. Screenings may be administered by clinicians, doctors, nurses, psychiatrists, psychologists, counselors, addictions specialists, pastors and even family, friends, coworkers or the individual themselves. However, an assessment should only be administered by a professional.
How Are These Evaluations Administered?
These tools are taken one of two ways—either self-administered, which means the individual will work through the screening tool themselves, either by pen and paper or on a computer, or administered by a professional.
What Is An Alcohol Abuse Screening?
Screening for alcohol abuse is the first step towards treatment. The purpose of screening is to recognize the presence of a problem as early as possible. This aids the provider in knowing if an intervention by further examination is necessary (the assessment). This process is typically brief, fairly direct, and most typically yields a simple yes or no answer.
To assist you, we will briefly explain the most common types of screening tools, as again, these are sometimes broadly referred to as part of the assessment. Some of these and other substance abuse evaluations can be found in a National Institute on Alcohol Abuse and Alcoholism (NIAAA) published chart here.
Should You Talk to Someone About a Drug, Alcohol or Mental Health Problem?: This is an electronic version a SAMHSA brochure. Within it you will find a simple 12-question tool which not only screens for alcohol abuse, but mental health issues as well.
Rethinking Drinking: Alcohol and Your Health: This research-based information is offered by NIAAA. Here you’ll find two brief screening tools and other resources to support you or your family member should a need exist.
Self- Or Professionally-Administered
The CRAFT Screening Tool: These questions are specially designed for individuals under the age of 21 and help to identity any at-risk behaviors or problematic substance abuse, including both alcohol and other drugs.
Alcohol Use Disorders Identification Test (AUDIT): Developed by the World Health Organization (WHO), this tool has ten questions. According to SAMHSA, “The purpose of the AUDIT is to identify persons whose alcohol consumption has become hazardous or harmful to their health.” They continue, noting that the results of this screening may result in either a brief intervention and/or a referral to treatment.
Brief Michigan Alcoholism Screening Test (BMAST): This ten-item tool helps to identify if alcohol addiction is present.
CAGE Questionnaire: As this is one of the shortest, we will use it for an example. As referenced from NIAAA, it consists of four questions which can point to an AUD, including:
- Have you ever felt you should Cut down on your drinking?
- Have people Annoyed you by criticizing your drinking?
- Have you ever felt bad or Guilty about your drinking?
- Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (Eye opener)?
Michigan Alcoholism Screening Test (MAST): This consists of 25 questions and looks into an individual’s lifetime experiences with alcohol along with the possibility of an alcohol addiction.
T-ACE Screening Tool: This is similar to the CAGE, in that the “ACE” represent the same questions; however, the “T” addresses tolerance. This is used to identify problems in pregnant women.
TWEAK: This five item tool seeks to evaluate patterns of harmful and problematic drinking. It is often used for pregnant women who warrant concern.
The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): Created by WHO, this is also offered in a NIDA-Modified Version (NM ASSIST). This is for use in a general medical setting. Practitioners ask their clients questions to identify potential areas of risk, including alcohol, smoking, and other forms of substance abuse.
What Is An Alcohol Abuse Assessment?
If a problem is identified through screening, an assessment should follow. According to SAMHSA, an assessment “is a process for defining the nature of that problem, determining a diagnosis, and developing specific treatment recommendations for addressing the problem or diagnosis.” While these questions may still consist of simple yes or no answers, some may be open-ended and take the form of an interview.
Assessments are delivered in one of two forms:
Semi-Structured: A tool for an individual with little to no training in substance abuse. The questions are structured in a progressive way which produces clearly defined results, including a diagnosis.
Structured: These are developed for an individual with substance abuse and/or mental health training. This form includes a series of questions which are supplemented by the assessor’s specialized training and insight in these fields. It is this extra training which enhances the final assessment. Of the two, this form offers a more definitive picture of the scope of abuse, thus allowing for a more detailed treatment plan to be created.
While assessments may follow a formal tool, many providers instead prefer to use simply an interview. The following tool may stand alone; however, results are often far more beneficial if it is paired with an interview.
- Addiction Severity Index (ASI): This assessment can be administered either way and gives providers a clear picture of the intensity of a person’s drinking. From this, an appropriate treatment method can be created. While this is sometimes referred to as a screening tool, it is often used as an assessment to illustrate the clear need for treatment. The most recent edition is the ASI-6, which an article explains as “a multidimensional tool assessing… medical, employment/ support, alcohol, drugs, family/ social, legal and psychiatric… lifetime and past 30-day time frames remain the primary assessment intervals.”
Other Tools: In situations of alcohol abuse or alcohol addiction other tools are necessary to provide client-centered care and treatment, including:
- Clinical Institute Withdrawal Assessment (CIWA-Ar): Alcohol withdrawal is very severe, and in some cases it may be deadly. For this reason proper treatment and detoxification services are often necessary. This assessment measures how severe this situation is, so providers may intercede and provide detox, medical, emotional, and mental support as needed.
- Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES): This assesses how a person views their drinking behaviors and motivation for change by looking at five scales: precontemplation, contemplation, determination, action, and maintenance. The results help to create and implement a treatment plan.
Counseling or treatment should be the end goal in situations of an alcohol use disorder. If a person has only just begun to abuse alcohol, counseling may be sufficient. As the severity of the alcohol use disorder increases, outpatient or inpatient treatment may even become necessary.
Concerned About Abuse?
If you’re worried that your or a loved one’s alcohol use has moved beyond moderate or safe levels and become problematic, let us help. RehabCenter.net has great resources on alcohol abuse, addiction, intervention, treatment and many areas in between. Contact us now.Article Sources
National Institute on Drug Abuse - AUDIT
Substance Abuse and Mental Health Services Administration - Detoxification and Substance Abuse Treatment: Appendix C: Screening and Assessment Instruments
Substance Abuse and Mental Health Services Administration - Substance Abuse Treatment: Addressing the Specific Needs of Women: Chapter 4: Screening and Assessment