What To Expect At A Substance Abuse Evaluation
Medically reviewed byJennifer Cousineau MSCP, LPCI, NCC
A substance abuse evaluation is used to assess the degree of substance use or addiction in an individual and to build an effective treatment plan that is tailored to the needs of each person to give everyone the best possible chance at recovery.
Substance abuse or addiction has a heavy hand on a person’s life; it can deeply affect them on many levels, causing damage to their body, mind, and relationships. Sometimes—in certain circumstances—when a person’s substance use has gotten out of control, they may find themselves engaging in activities that endanger themselves, their health, or that of others.
When a person has reached this point and they need help, either as mandated through the court, by choice, or through an intervention, they will commonly be faced with a substance abuse evaluation. This evaluation is a tool used to help determine the extent of a person’s misuse and abuse of drugs or alcohol and to determine how to go about treating a person to achieve the greatest success.
The Purpose Of A Substance Abuse Evaluation
An evaluation does these things:
- Determines if the individual has a drug or alcohol addiction
- Assesses the extent of the substance use or addiction
- Discerns if there are any co-occurring conditions, including any physical or mental health concerns, or any other drug use
- Assesses the extent by which the substance use affects the person’s life
- Provides an understanding of the person and their circumstances so that the team may establish a baseline and build a treatment plan that is best suited for their needs and recovery
What To Expect In An Evaluation
An evaluation is broken down into two steps: a screening and an assessment. The Substance Abuse and Mental Health Services Administration (SAMHSA) defines them as:
- Screening is a process for evaluating the possible presence of a particular problem. The outcome is normally a simple yes or no.
- 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.
These components may be administered by a wide array of people who are trained to assess a person for an addiction, though the former may be administered with little to no training. The person responsible for this task may be a social worker, counselor, therapist, psychologist, psychiatrist, doctor, or nurse. They will, through written assessments and interviews, inquire about your health history, past and present drug and/or alcohol use, the manner and behaviors by which it affected your life, and any history of treatment for these concerns. If the evaluation is administered by a physician, a physical may also occur.
The screening is a preliminary evaluation that helps the professional to determine if there is a situation present that warrants a more in-depth look. It is an important element of the process because it can allow for preemptive care and support if it does indeed highlight a risk factor, thus helping a person before their substance abuse progresses even further. This is the first step in helping them to see if drug or alcohol abuse may in fact be present.
Here are examples of some of the most commonly used screening tools. They may be either administered online or in person.
- CAGE Questionnaire: This is a widely used method that has four questions which are asked in a brief, yet sensitive manner. One concern is its measure of usefulness in circumstances where a person may be trying to shield the extent of their alcohol abuse.
- Alcohol Use Inventory (AUI): This is a self-administered screening tool used for people who are thought to have an issue with alcohol abuse. It is suitable only for people who are able and willing to be honest about their misuse of alcohol. This inventory is useful because it recognizes that each person has a set of unique perspectives associated with the risks, results, and lifestyle choices associated with their drinking.
- Substance Abuse Subtle Screening Inventory (SASSI): The NIAAA defines SASSI as “a brief self-report, easily administered psychological screening measure that… helps identify individuals who have a high probability of having a substance dependence disorder with an overall empirically tested accuracy of 93 percent.” According to The SASSI Institute, it “identifies high or low probability of substance use disorders and provides clinical insight into level of defensiveness, willingness to acknowledge problems, and the desire for change.” This inventory is useful as it is easy to both administer and score. It also helps the assessor determine if the person’s use extends past social drinking or recreational drug use and what level of seriousness their use implies.
- State Specific Inventories: Your state may have a screening tool that it utilizes in place or in addition to any of the former.
Though some methods of screening can be done by the person themselves or by a family or friend, it is important to remember that in many cases this the first step towards recovery; for that reason it is most advantageous if the screening is either administered or reviewed by a professional who has the appropriate skills and knowledge to correctly ascertain results and provide the person with support and direction.
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The assessment of an individual who may have substance abuse problems is more thorough. Its purpose is to find direct evidence that supports either the presence or absence of a condition that can be diagnosable, such as a drug or alcohol addiction. At this point a diagnostic interview is performed whereupon the interviewer will go over the results of the screening and ask more questions to get a better picture of the individual’s drug or alcohol use and abuse. This may be done by one of two ways: either a structured interview or semi-structured interview.
Though the first, by way of set and structured questions, is easier for someone without an intense background in the field to administer, they do not result in as much detail, thus there is not as much information off of which to base a treatment plan. A semi-structured interview allows the professional, who is more skilled within this area, to supplement the structured questions by ones derived from their specific expertise within the field, allowing them to better cross-examine a person’s substance abuse.
Here follows two widely used tools within the assessment process.
- Diagnostic Interview Schedule-IV (DIS-IV): This is a fully structured questionnaire that determines the presence of a diagnosis as listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Some feel that as a tool this is limited as it only considers the qualifications as set forth in the DSM-IV and may not take into account any new research or theories within the realm of addictions that can lend a greater understanding to a person’s diagnosis or the circumstance that brought them there.
- Addiction Severity Index (ASI): This is a semi-structured interview which assesses seven areas, cited by NIAAA as “medical status, employment and support, drug use, alcohol use, legal status, family/social status, and psychiatric status.” This allows the administer to address questions not only to a person’s use over the past thirty days, but also the implications of the use over the course of their lifetime. It allows an assesor to see conditions that are both persistent and reoccurring which need to be addressed.
Today, in many cases, a person may begin this process by taking the screening online. In order to begin this you will have to create an account through the agency or platform to which you were directed. If you do not do this online, you will do one on paper in preparation for your evaluation. At your face-to-face interview, the person you are working with will have access to this and should have looked it over prior to your arrival.
Oftentimes, especially if the evaluation is being done for a treatment facility, you may find that several people evaluate you. This ensures that you received the most accurate assessment and diagnosis for your circumstances, thus allowing for a treatment plan to be built specific to your needs. Remember these people are here to help and support you. Your honesty helps build a foundation and a framework by which they can create the most successful plan to help you succeed!
Involvement Of Family Or Friends: In some instances, you may be asked to sign a release that allows for people close to you, who may have first-hand knowledge of your substance abuse, to report on their observations to those who are assessing you. In turn, this information will be evaluated as they determine the extent of your substance abuse and subsequently, your treatment needs.
There are two ways in which a person finds him or herself in the position of needing an evaluation. The first is when a person is taking steps toward entering a treatment or recovery program, and the second is when a court mandates it. Oftentimes the latter may also result in a person entering a program.
An Evaluation For Entering An Addiction Treatment Facility
Any time a person is entering into an addiction treatment facility, the staff must first have a way to understand the person and their individual situation. The first step—before treatment can even begin—is for the person to have their substance abuse evaluated by the facility’s team. This assessment gives the team of professionals a unique perspective into the individual’s situation and reveals any special concerns that he or she may need to be addressed within treatment.
Some people who struggle with a co-occurring condition, such as a mental health concern, may falsely think that they must deal with the substance abuse before they can address these circumstances. This is in fact false—the opposite is true—in order for your treatment to achieve maximum success it is imperative that a person treat these co-occurring issues as well. Mental health problems, such as depression or anxiety can magnify a person’s substance abuse struggles, making it harder to achieve sobriety. Additionally, if left untreated, mental health concerns can also create an environment that may make a person more apt to relapse. During the course of an evaluation you will be also screened for these things.
It is important to remember that any information obtained during these procedures is confidential and is used for the sole purpose of creating and following through with the best method of care for your situation.
A Court-Ordered Evaluation
If a case involves substance abuse, the judge may order a drug and alcohol evaluation. This evaluation is administered from an agency that is certified through the state. In some situations or certain convictions some states may require this as part of the mandatory sentencing procedures.
These are examples of circumstances or convictions where a judge might require an evaluation:
• Driving under the influence (DUI) or driving under the influence of drugs (DUID)
• Minor in possession (MIP)
• Arrest for drug or alcohol possession
• Disorderly conduct
• Public intoxication
• Using a false ID
There are certain documents that you will need to bring, which may be furnished by yourself or your attorney should you have one. These may include: a copy of the results of your NEEDS Assessment if you went to a DUI Alcohol or Drug Use Risk Reduction Program (RRP), a report from the Department of Driver Services or Department of Motor Vehicles detailing your driving history (generally going back 7 years), a copy of any criminal history or arrests, and a copy of the arrest report.
During the course of the evaluation, which typically takes between 60-90 minutes, you will have an interview with a person who is trained in substance abuse treatment. They will do an in-depth review of your substance abuse history and look over the documents you provided.
This evaluation is relevant because it determines if an ongoing condition is present such as a substance use disorder or addiction, or if there may not be enough evidence to support that you struggle with either, such as if the circumstances that resulted in the arrest were a one-time event of substance misuse. Even in the latter circumstance, in many states a person may still have to undergo various programs or treatment obligations as deemed acceptable by the court.
Depending on the state, the incident/sentencing, and the recommendations of the agency that evaluated you, you may be required to go to one or more of the following. Keep in mind, the courts may determine that you require some of these prior to even having the evaluation:
- DUI Alcohol or Drug Use Risk Reduction Program (RRP)
- Random drug and/or alcohol urinalysis
- AA or NA meetings
- Substance abuse education class(es)
- Substance abuse counseling sessions
- Treatment program; either individualized or group and either inpatient or outpatient
It is important to remember that even though you did not choose these circumstances, it is most advantageous for you to begin this process immediately. Not only does this exhibit to the judge and prosecution that you are taking your responsibilities seriously, but it allows you an opportunity to receive help that you may very well need.
Remember: An Evaluation Is A Tool To Help You Succeed
Though you might feel embarrassed or ashamed, or inclined to not be entirely forthcoming about your substance use behaviors, you must remember that ultimately this evaluation is for your own benefit. The substance abuse professional(s) cannot fully develop a plan or program without knowing exactly where you stand within your substance abuse or addiction.
In addition to your substance abuse, this is a time for you to be honest about any other factors that may influence your substance abuse or recovery options. The more honest you are, the greater the benefits you will reap. If you hide any habits or information, you are only harming yourself and hindering your chances for a healthier life and a full recovery. At any point within your recovery or treatment your success depends on your ability to be honest with both yourself and those who are striving to help you.
Begin The Treatment Process Today
If you find that your substance abuse is beginning or continuing to exert a negative impact on your life, or if you see this behavior in someone you love, don’t hesitate any longer—contact us today. Our team at RehabCenter.net is understanding and highly trained in helping you get the care you deserve.