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Screening and Assessment of Substance Use Disorders
Tom Wilson, MA, LCPCLicensed Clinical Professional Counselor
Certified Substance Abuse Prevention Specialist
514 So. Orchard St., Suite 101Boise, ID 83705
Ph:1-877-368-9909
On the Web: www.TomWilsonCounseling.com
Substance Use Disorder - Definition
A cluster of symptoms which are..
cognitive, behavioral and physiological
in nature and..
indicate the individual continues to use..
despite significant related problems.
(Specific criteria are listed in DSM-5)
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DSM-5 Criteria
Alcohol is often taken in larger amounts or
over a longer period than was intended.
There is a persistent desire or unsuccessful
efforts to cut down or control alcohol use.
A great deal of time is spent in activities
necessary to obtain alcohol, use alcohol, or
recover from its effects.
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DSM-5 Criteria (Continued)
Craving, or a strong desire or urge to use alcohol.
(continued
Recurrent alcohol use resulting in a failure to
fulfill major role obligations at work, school, or
home.
Continued alcohol use despite having persistent
or recurrent social or interpersonal problems
caused or exacerbated by the effects of alcohol.
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DSM-5 Criteria (Continued)
Important social, occupational, or recreational
activities are given up or reduced because of
alcohol use.
Recurrent alcohol use in situations in which it is
physically hazardous.
Alcohol use is continued despite knowledge of
having a persistent or recurrent physical or
psychological problem that is likely to have been
caused or exacerbated by alcohol
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DSM-5 Criteria (Continued)
Tolerance - defined by either of the
following:
a) A need for markedly increased amounts
of alcohol to achieve intoxication or desired
effect
b) A markedly diminished effect with
continued use of the same amount of
alcohol 6
DSM-5 Criteria (Continued)
Withdrawal, as manifested by either of
the following:
a) The characteristic withdrawal syndrome
for alcohol.
b) Alcohol or related substance is taken to
relieve or avoid withdrawal symptoms.
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DSM-5 Criteria (Continued)
The presence of at least 2 of these symptoms
indicates an Alcohol Use Disorder (AUD).
The severity of the AUD is defined as:
– Mild: The presence of 2 to 3 symptoms
– Moderate: The presence of 4 to 5 symptoms
– Severe: The presence of 6 or more symptoms
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A primary chronic disease of brain reward, motivation, memory and related circuitry.
Dysfunction in these circuits leads to biological, psychological, social and spiritual manifestations.
Reflected in pathologically pursuing reward and/or relief by substance use and other behaviors.
(http:///www.asam.org/for-the-public)
Addiction- ASAM Short Definition
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Photo courtesy of the NIDA Web site. From A
Slide Teaching Packet: The Brain and the
Actions of Cocaine, Opiates, and Marijuana.
pain
Drugs act
primarily on the
reward or
pleasure center
of the brain
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AOD Dependence is Related to :
Increased rates of property crimes and violence
Costs of emergency services and justice system
Decreased productivity/increased employer costs
Healthcare costs of treatment / recovery
Healthcare costs of victims of AOD- related crimes
Personal costs to AOD user and family
The Costs of AOD Addiction
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There is large gap between the need for treatment and receipt of treatment.
Early screening to identify substance use can increase the chance that a person enters treatment and recovers.
Outcomes are better for persons who enter treatment earlier than later.
The Need for Screening
7.4%
20.1%
7.0%
0.4% 1.1% 0.6%0%
5%
10%
15%
20%
25%
12 to 17 18 to 25 26 or older
Abuse or Dependence in past year Treatment in past year
While Substance Use Disorders are Common, Treatment Participation Rates Are Low
Source: SAMHSA 2010. National Survey On Drug Use And Health, 2010 [Computer file]
Over 88% of adolescent and
young adult treatment and
over 50% of adult treatment is
publicly funded
Few Get Treatment:
1 in 20 adolescents,
1 in 18 young adults,
1 in 11 adults
Much of the private
funding is limited to 30
days or less and
authorized day by day or
week by week
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Potential AOD Screening & Intervention Sites:Adults (age 18+)
Source: SAMHSA 2010. National Survey On Drug Use And Health, 2010 [Computer file] 14
Predictive Power of Simple Screener
Crime/
Violence
Screener
Substance
Disorder
Screener
12 Month
Recidivism
Rate
Odds
Ratio
\a
Low (0) Low (0) 17% 1.0
Low (0) Mod (1-2) 29% 2.0*
Low (0) High (3-5) 30% 2.1*
Mod (1-2) Low (0) 30% 2.1*
Mod (1-2) Mod (1-2) 35% 2.6*
Mod (1-2) High (3-5) 42% 3.5*
High (3-5) Low (0) 41% 3.4*
High (3-5) Mod (1-2) 55% 6.0*
High (3-5) High (3-5) 61% 7.6*
* p<.05
\a Odds of row (%/(1-%) over low/low odds across all groups
Source: CSAT 2010 Summary Analytic Dataset (n=20,932) 15
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Summary of Key Points
There is a large gap between those getting treatment and those in need, ranging from 1-20 adolescents to 1 in 11 adults
The people in need are coming into contact with a range of systems that could serve as screening sites where problems could be identified and addressed before people end up in the courts
Simple Screening tools are feasible, valid and useful to identify substance use disorders, co-occurring behavioral health, monitor placement and predict the risk of recidivism
The GAIN Short ScreenerThe 3- 5minute GAIN-Short Screener is designed:
1) To serve as a screener in general populations to
quickly and accurately identify clients whom the full
1.5- to 2-hour GAIN-Initial would identify as having
1 or more behavioral health disorders.
2) To serve a quality assurance tool across diverse
fields for staff with minimal training or direct
supervision.
3) To serve as a periodic measure of change in
behavioral health over time.
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Contact Information
Tom Wilson
Licensed Clinical
Professional Counselor
514 So. Orchard St. Suite
101, Boise, ID 83705
(208) 368-9909
www.TomWilsonCounseling.com
GAIN Family of Instruments
Chestnut Health Systems
448 Wylie Drive Normal IL 61761
Phone: (309) 451-7700
Fax: (309) 451-7762
Administration and Scoring manual:
http://gaincc.org/_data/files/Posting_Pub
lications/GAIN-SS_Manual_2.0.3.pdf
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