Hello and welcome back. In our past sections we have been discussing aspects of screening and assessment. In this section we begin to specifically talk about screening instruments. So let's begin by going to slide two.

First of all, as we can see here, there are lots of different types of screening instruments. However, regardless of the instrument, used screening should be done in a variety of settings, it should be very quick and easy to do, and it should be inexpensive and cost effective to do. Finally, whatever instrument one uses, the instrument should have very high reliability and high validity.

The results of screening are designed to do one thing, that is, establish if you need more information. Screening does not establish a diagnosis. Screening instruments are not designed to develop a diagnosis. This is a major mistake a lot of addiction counselors make. When they do use screening instruments to develop a diagnosis and they end up in court, the lawyer eats them for lunch.

So, as we see here in slide four, screening does not equal assessment. We will talk about assessment instruments a little bit later on in the next section.

The first thing the screener needs to do as we see in slide five is that the screener needs to first read the manual of the screening instrument that they are going to use. They have to look at the norms, for example, was the instrument developed for boys, or girls, etc. Other questions they need to ask is when should you use it, how should you use it, and under what circumstances, and also, who is it normed for?

Now, screening instruments as we can see in slide six can range from five questions to more than fifty. Some instruments claim to have lie scales, depression scales, etc. However, most instruments have a minimal amount of research to support whether they even work or not.

A list of a variety of screening instruments on slide seven. There are for example the CAGE and derivatives of it, AUDIT, TWEAK, and a variety of other ones. Each of these is used in a variety of different situations.

So, let's talk about the CAGE first. The CAGE, as we see in slide eight is very simple. It can be used on adults or adolescents and is primarily used in medical settings. You do not need a lot of training to do it. It is also very easy to learn and it has good internal consistency and productive validity.

The CAGE consists of four major questions and these questions are shown in slide nine. They include:

	Have you ever felt the need to Cut down on your drinking?
	Do you feel Annoyed by people complaining about your drinking?
	Do you ever feel Guilty about your drinking?
	Do you ever drink an Eye-opener in the morning to relieve the shakes?

So, CAGE.

Scoring is very simple and as we see in slide ten, if the person answers "yes" to any two questions it will identify seventy-five percent of the alcoholics who respond to it. It will also accurately eliminate ninety-six percent of the non-alcoholics. Since its inception, the CAGE has been modified for other drugs and all you have to do is change drinking to drugs use or drug abuse and one can get the same kind of answers.

However, as we talked about earlier in relation to norming, the CAGE is more sensitive for detecting alcohol dependence or abuse in African Americans than in Whites.

Now, there are a variety of derivations that have resulted from the CAGE. For example on slide twelve there is the CAGE-AID. It basically works the same as the CAGE and has a similar scoring system.

The next major screening instrument is what is called the AUDIT or the Alcohol Use Disorders Identification Test and this is shown in slide thirteen. This instrument has ten questions. It can be used in a variety of settings. And, it can be used as part of a structured interview such as in a general health interview, lifestyle questionnaire, or medical history. If you present it well then it gets very good results. Often times you will see these questions in medical screening stuff you see in the local doctor’s office.

The TWEAK seen on slide fourteen is similar to the CAGE except the wording is a little bit different. The TWEAK also looks at some other aspects. For example, it looks at tolerance and asks the question, how many drinks can you hold? It looks at whether the client is worried about using so it will ask a question such as, have class friends or relatives worried or complained about your drinking in the past year, and on and on and on.

The TWEAK, as seen in slide fifteen, has a very simple scoring system. Worry or tolerance, that is, five drinks or more, scores two, and the others score one. If the individual has a score of two or more they are considered to be a risky drinker. This test has shown to be good for detecting alcohol or drug use or abuse with pregnant women.

One of the most popular screening instruments out there is one that is called the MAST and is shown in slide sixteen. It is much more detailed than the CAGE and has approximately twenty-five questions. It takes about ten minutes to administer and about five minutes to score. It does not even require any training. One positive aspect of the MAST is that it is fairly sensitive to detecting alcoholism and can be used in longer interviews when one wants to do that. However it has minimal information on reliability and has very high face validity that is, the clients know exactly what they are being screened for when they are using it.

Each of the items in the MAST has a different scoring number and each item has a weight. Scores range from zero to fifty-three. Further, there are several questions in the MAST that are considered to be diagnostic of substance abuse or dependence.

Now, as we can see in slide eighteen, there are a wide variety of versions of the MAST. There is the Brief MAST, the SMAST, the MAST for fathers, and the MAST for mothers, and on and on and on.

The Short version of the MAST (SMAST) consists of thirteen questions and again, the questions are usually answered "yes" or "no". The score is very sensitive and if you have one or two of them you really do not have a problem. If you have three or more then you do have major problems.

Another major screening instrument is called the POSIT and this is shown in slide twenty. The POSIT is basically oriented toward teenagers. It has both an English and a Spanish version and uses "yes" and "no" responses. The one disadvantage about the POSIT is that it takes about twenty-five to thirty minutes to do however, it only takes about two minutes to score by hand and it also has a computerized scoring version. The POSIT has been normed on juvenile delinquents and pregnant or parenting teens. It is very useful for use in a case management approach. The POSIT basically has one hundred thirty-nine questions and examines a variety of different areas, most of which are listed below.

Another instrument called the T-ACE shown in slide twenty-one is another four item questionnaire. Again, this is used to assess pregnant women who may be at risk for drinking amounts which may be dangerous to their fetus. As you can see here, it is a very simple instrument to use.

On slide twenty-two is shown another screening instrument and is called the SASSI, Substance Abuse Subtle Screening Inventory and is in its second version. It is a short screening tool. It has both computer and paper versions and even has a lie scale. It is very effective with individuals who are in denial or deliberately trying to hide some kind of abusive pattern. It has seventy-eight questions and takes about fifteen minutes or so to administer and then another ten minutes to score by hand. In addition to that the SASSI also includes scales that look at defensiveness, depression, and that sort of thing. However, there is more debate about some of those instruments than in other aspects of it.

Now I have talked about some screening instruments and there are many, many more. What I would like to focus on for the next couple of minutes is on one specific group in which to screen and these are adolescents. As we can see in slide twenty-three, when one is examining adolescents you need to focus on the adolescent severity of use, that is, their consumption patterns. You should also focus on other factors such as legal status, client's awareness of the problem, etc., and their motivation for changing some kind of behavior.

With adolescents as we see in slide twenty-four, you may need to get information from other people such as family, friends, etc. This information may also be entered into a computerized module.

Now, there are a great number of adolescents out there. The question becomes who do you want to screen? As we can see in slide twenty-five there are a variety of groups we do want to screen. For example, adolescents that are arrested or who are receiving mental health assessment or treatment, teens in runaway shelters, teens entering the welfare system, and on and on and on. All these teens may be at high risk for substance abuse or dependence.

However, there are some red flags for groups of adolescents that one does want to assess. These are, as shown on slide twenty-six, substance use related groups and psychosocial disorder issue groups.

So let's talk about substance abuse related issues first on slide twenty-seven. Basically, if the adolescent is using a substance in childhood or their early teenage years you want to screen that client. If they are using substances before or during school, if they are involved with peers who are using, if they report daily use, or if the community norm is to drink, all of these are indicators that you will want to screen this client for some kind of substance use.

Another major group you will want to screen for substances is related to some kind of psychosocial issue and this is shown in slide twenty-eight. If, for example the client is shown to be or engaging in some kind of physical or sexual abuse or if physical or sexual abuse has been placed upon them. Another major one is if there is a sudden down-turning in school performance or attendance. Or, if their peers are involved in some sort of serious crime. Or, begin to have major changes in their physical health. Or, they are involved in some kind of crime or delinquency whether they have been caught or not. Or, if they have engaged in HIV/STD related high-risk behaviors. If that is the case then all of these clients should be evaluated.

High-risk sexual behavior is highly correlated with substance abuse. As we can see in slide twenty-nine, in 1995 fifty percent of teens in grades nine through twelve had some kind of sexual intercourse. Twenty percent had also had more than four partners. Fifty percent had used a condom and twenty-five percent of all these teenagers had used drugs during the last time before intercourse.

The implications for this, of course, as seen in slide thirty, is if an individual is presenting for an STD or coming in for STD counseling, or has been engaging in high-risk behavior or been caught doing so, they need to be screened for substance abuse and vice versa.

So, in conclusion, when one talks about screening instruments and as we can see in slide thirty-one, there are lots of instruments and techniques that one can use out there. Further, the instruments and techniques can be used in a lot of different settings. They can be used in school settings, medical settings, psychological settings, work settings, etc. For you, as a potential addictions counselor down the road, you need to know the strengths and weaknesses of each of these instruments. And the appropriate approach one takes when using them.

Well, that concludes that section related to screening instruments. In our next section we will begin talking about assessment instruments. Until then, we hope you have yourself a great day and we look forward to talking with you soon.

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