Substance Use Assessment and Screening

In this section we will learn about accessing the needs of your patients, referred throughout the article as clients, and how to screen a client for potential substance use or mental health problems. We will also learn how to perform a brief intervention if a client is identified as a person at risk following assessment and screening.

Assessing Substance Use

Assessing the needs of your clients is always the first step before recommending any intervention or treatment. An assessment can simply mean engaging a person in a meaningful conversation about what’s going on in their lives. People in addiction treatment with the comorbidity of mental health and substance use problems, known as dual diagnosis, may have challenges around legal issues, homelessness, housing, family, and medical and mental health challenges (13).

The process of assessment should be conducted within an atmosphere where practitioners and individuals share the power to plan and deliver care and support together. Therefore, an assessment will not be exactly the same for everyone and should be -specific to the individual’s circumstances. The focus of assessment should involve providing information, advice and assistance which guides the person to engage with services that provide support so the client can achieve their desired outcome (14).

For people with anxiety problems resulting from a pending legal case or the threat of homelessness, for example, it may mean listening to the cause of anxiety and providing the information they need to access legal or homeless services.

However, if the client has experienced a significant life event such as the death of a close family member and has begun to self-medicate, an assessment may lead to the need for a mental health or substance misuse screening assessment.

Screening Tools

A number of screening tools are used for detecting mental health issues or harmful substance use. For example, the CORE 10 is a mental health screening tool for detecting possible psychological issues. The Alcohol Use Disorder Identification Test (AUDIT C) and the Fast Alcohol Screening Test (FAST) are commonly used assessment tools for alcohol use. The Drug Use Disorders Identification Test (DUDIT) and Drug Abuse Screening Test (DAST) are used to assess drug use. The Screening, Brief Intervention, and Referral to Treatment (SBIRT), widely used in the US also incorporates a referral to treatment path for clients identified with problematic substance use (15).

Although the assessment tools can be different for alcohol or drugs, the assessment process is very similar. The AUDIT C is a gender-specific tool and scored by asking a person three questions based on how much and how often they consume alcohol. When the individuals’ score suggests risky or a harmful range of alcohol use (4 to 5 for males; 3 to 5 for females), the health practitioner would usually conduct a more in-depth assessment for alcohol use using the AUDIT assessment tool followed by a brief intervention. We will discuss brief interventions in more detail in the next activity of the course.

Evidence suggests that people are not offended by health professionals asking about their substance use habits, with commentators also showing that patients find it appropriate when GPs take a non-judgmental interest in the wider aspects of their health. These assessments and screening tools can therefore provide vital information in creating the best plan for your client’s treatment (16).

References

<sup>13. O’Shea J, Goff P, Armstrong R. SAOR Screening and Brief Intervention for Problem Alcohol and Substance Use. In: Executive HS, editor. 2 ed. Dublin: Health Service Executive; 2017.
14. Organization WH. Motivational Interviewing for Substance Use: A Manual for Use in Primary Care. Geneva: WHO; 2003.
15. Babor TF, McRee BG, Kassebaum PA, Grimaldi PL, Ahmed K, Bray J. Screening, Brief Intervention, and Referral to Treatment (SBIRT) toward a public health approach to the management of substance abuse. Substance abuse. 2007;28(3):7-30.
16. EMCDDA. The role of psychosocial interventions in drug treatment (Perspectives on drugs). Lisbon: European Monitoring for Drugs and Drug Addiction; 2016 8 April 2021.</sup>