Hello again everyone and welcome back. In our last section we talked about screening instruments. In this section we will talk about assessment instruments and how they relate to substance use, abuse, and dependence. Let's begin by going to slide two.

First of all, as we see here, assessment is different from screening and is conducted from a variety of different perspectives depending upon the orientation of the person that is doing the assessment. It can be conducted from a medical side, or a legal side, or even a psychological or social side, or even from a substance abuse counselor side. However, all of these have major roles in the assessment process. Whatever the instrument used in the assessment process the instrument must be able to cover most of the components covered in this section. Further, when on does an assessment, an interview is mandatory as part of the process. A structured interview where you ask specific questions in a specific order is better than a non-structured interview.

Let's talk about some medical aspects of the assessment process. As we can see in slide three, physicians can do a wide variety of analyses to examine substance abuse and dependence. The first one of these is liver functioning tests. As talked about earlier, liver functioning tests are extremely important for both individuals undergoing alcoholism and for individuals engaging in intravenous drug use. Liver functioning can look at a lot of different aspects. In addition to that, on might look at endocrine functioning or neurological functioning. Neurological functioning can be from very simple, basically having the client squeeze the hand, tracking with the eyes, and a variety of other things, all the way up to a wide variety of brain scans. The changes in physical condition can also be very important. For example, has the client gained or lost weight, so they have a variety of different diseases or problems such as are their teeth falling out, do they have a deviated septum which is basically the skin that separates the left side from the right side of the nose? So all of these and other assessment tests that physicians do all have a role in the assessment process.

One addition to medical aspects of the assessment process is there are also legal aspects that need to be considered. For example, does the client have legal problems? If so, what are they? You will need to be able to tie them into the variety of DSM categories. Legal problems can be very helpful in the treatment process itself. For example, probation and parole can use clubs/organizations to help keep clients in treatment or to get treatment.

There are also a variety of psychological issues that need to be examined in the assessment process. As we can see in slide five, co-occurring disorders can occur with the addictions process. For example, bi-polar clients often self-medicate with a variety of different illicit drugs to help control their symptoms. Depression often accompanies many substance disorders, as well. Specifically, alcoholism and the use of downers. One aspect of the assessment process looks at what we call the clients mental status. That is, is the client currently in the here and now? For example, do they know the date? Do they know the time? Do they know where they are? Etc. Or, are they having hallucinations, delusions, etc? All of these things are extremely important in relation to client placement.

Another major aspect that one needs to examine relates to the social areas of assessment. That is, are the clients having problems? Are they having family problems? Employment problems? Housing problems? Are they renting, etc? All of these will play a major role in how the client is doing. Another major aspect is, are their family support mechanisms in place? Families can have a very important role in helping a client in the treatment process. Furthermore, are there community separate mechanisms in place? Some communities, like Boise, have lots and lots of community separate mechanisms. However, other places like Joel, Santee, Weippe, etc have minimal resources.

One component of the assessment process relates to the substance the client is using. For example, as we see in slide seven there are major differences in compounds the client uses. In addition to that, the duration of use is very important. Has the client been using two weeks or has the client been using for ten years? How much is the client using? Are they using it once a day or are they using it once a week, or, once a month, whatever? And finally, what is the client doing right now? For example, does the client walk in and they are high, or whatever? Here you can use breathalyzers, urinalysis testing, or even looking at their arms to see if there are tracks, etc.

There are also a wide variety of instruments that are available for one to use. As we see in slide eight, the instrument one uses will depend on the context which one is in. Regardless, the instrument must be reliable and it must be valid. However there are some considerations of the instruments that need to be considered as well. For example, how long does it take to administer and score the instrument? Some instruments are really quick and some take a long time. How much will it cost to administer the instrument? Is it free? Does it cost a lot of money? Etc. The cost of the instrument itself might be important. For example, there are freeware instruments out there. Other instruments cost about fifty to a hundred dollars per pop. The cost to the person making the assessment. If it is just a general person making the assessment you may only have to pay five to ten dollars versus a clinical psychologist making the assessment which may be two hundred dollars or more per hour. Will the instrument need to be discussed on the witness stand? This can be very, very expensive. For example, just walking into the room may cost you anywhere from two to five to ten thousand dollars. Just to sit there in the room may cost you up to two to five hundred dollars, just to sit there! Being on the stand can cost you more than that. It all depends on the person’s qualifications and certifications or their credentials, etc. Now, there are a couple more aspects that one needs to consider when choosing an instrument to use. For example, does it have a follow-up version? Furthermore has the person even been trained to administer the instrument? And, training does not mean giving the person a book, having them read it, and then have them go out there and give the assessment to the particular client.

There is a wide variety of instruments that can be used. And, as I show here in slide nine, there are lots and lots of different types. Many of these have minimal reliability or validity. However there are some very, very good instruments out there. Two that I really like and will talk about in a second are the ASI and the SUDDS.

So let's talk about the ASI first. As you can see in slide ten, the ASI is one of the most widely used assessment instruments and it is also free. It is basically, a semi-structured interview. It has two time frames that we look at. Lifetime use, and use in the last thirty days. It also has follow-up versions that one can use and this is very, very important for treatment planning.

The ASI has a variety of different domains that the investigator examines including, medical, employment, legal, psychiatric, etc.

And, it has lots of different measures one can use. For example, as we see in slide twelve, it looks at alcohol/drug use patterns that is the quantity/frequency, problems from the use, cognitive/psychological variables from the use that one has such as the relapse risk, etc. It even has motivational aspects that one can use.

Use patterns are also very, very important when using the ASI. For example, the calendar method gives a very good baseline measure of how much the client has been using. This can be easily repeated during and after treatment. Consequently, ASI with its follow-ups gives very good time aspects to examine whether there are changes in medical conditions, employment, etc. The ASI also provides clinically useful information such as, what are the things the person is doing before they are using, what are the consequence, etc?

The ASI also has lots of different versions. As we see in slide fourteen it has Native American versions, versions for Women, Hispanic Versions, etc.

The SUDDS on the other hand is a little bit shorter than the ASI. As we can see in slide fifteen it has about ninety-nine items and takes a little bit less than the ASI. It usually takes about thirty to forty-five minutes. It takes about ten to fifteen minutes to score by hand. So basically you can do the whole thing in about an hour. SUDDS also gives information about DSM diagnosis as with the ASI. It can also be used via computer or by book. However you need to be trained to administer both of these instruments. Regardless, both of them have very good diagnoses categories for chemical dependence and also for dual-diagnosis.

There are also adolescent versions of assessment instruments and adolescent instruments in general. For example, the APSI is shown in slide sixteen is the Adolescent Problem Severity Index. Again it is a structured interview like ASI and is designed to identify and respond to problems for adolescents. Again, it has a variety of different functioning areas and a variety of scores that you can get. This instrument also allows you to score it by hand.

So in general, as seen in slide seventeen, there are a wide variety of assessment instruments that one can use. Sometimes what you need to do is tie it together a lot of different assessment categories including medical, legal, etc and tie them all together to develop a strong diagnosis. Generally, it is best to use a variety of different assessments, conduct and interview and lots of other information to help tie it all together. Regardless of the instrument or categories that on examines the diagnosis that one develops must be able to hold up in court. This is the gold standard and if your diagnosis from the instruments and the materials that you are using to develop that diagnosis cannot hold up in court basically it is a total waste of time.

Well, that concludes this section on assessment instruments. In our next section we are going to talk about other issues that are related to the assessment process and the screening process and ultimately the DSM diagnosis. And then finally we will be moving into client placement. So until then we hope you are having yourself a great day and we look forward to talking with you soon.

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