Chapter 4 - Assessment

Treatment entry necessarily involves a relatively comprehensive assessment of the patient's condition and specific problems or needs, including medical, psychiatric, and psychosocial status. Often for research protocols, the assessment is completed formally by research staff prior to the start of counseling. However, in many other settings, the counselor will be responsible for completing the psychosocial assessment in conjunction with the gathering of history in the initial one or two sessions.

The main assessment instrument that is used routinely with addiction counseling is the Addiction Severity Index (ASI) (McLellan et al. 1992). This interview examines drug use and related problems over the past 30 days, so it is typically completed when the patient enters treatment to establish a baseline and identify areas of need and then at selected followup points thereafter to measure change. The ASI measures seven addiction-related domains: drug use, alcohol use, medical problems, psychiatric problems, legal problems, family/social problems, and employment/support problems. It requires approximately 45 minutes for the initial administration and about 25 to 30 minutes for each followup administration.

The only ongoing assessment procedures that are necessarily a part of addiction counseling are self-reports of drug use corroborated by some form of biological assay. The most commonly used drug screening test is urinalysis, which can test for drugs of abuse, as well as many medications. Typically, laboratories will screen for a panel of drugs that are commonly abused, including opiates, cocaine, benzodiazepines, amphetamines, barbiturates, and cannabis. Specific opiates and benzodiazepines can be identified when a patient is receiving an opiate or a benzodiazepine for a medical purpose, such as methadone maintenance, but also abuses heroin. The different drugs of abuse or their metabolites remain in the urine for differing lengths of time. Typically, alcohol is tested via Breathalyzer® because of the convenience, minimal expense, and immediacy of this method. There are other methods, such as saliva, hair, and blood tests, which have some advantages and disadvantages but generally are less widely used in drug treatment.

In the treatment of an addicted person in an outpatient setting, the patient's self-reports should be corroborated with urinalysis or some other form of biological assay. The counselor has much greater ability to monitor the patient's recovery and to be more certain of the patient's honesty in reporting drug use. Usually, patients feel that the counselor's careful monitoring supports their recovery because it discourages them from lying to themselves or others about any drug use. Also, patients struggling with recovery often appreciate the concrete feedback that urine screens provide. The counselor always should remember to give feedback on drug tests as promptly as possible and definitely should take every opportunity provided by a clean drug screen to compliment the patient on his or her progress.

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