Substance Use Disorder Screening and Assessment 1/18/22

Summary

This video script offers an in-depth look at substance use disorder screening and assessment tools, highlighting their importance in treatment planning. It covers various screening instruments like CAGE, AUDIT, DAST, and NM-ASSIST, emphasizing their flexibility and role in diagnosing substance-related issues. The script also discusses the significance of tracking withdrawal symptoms and assessing for comorbid conditions such as anxiety and PTSD. It underscores the value of comprehensive assessments, including collateral information and chart reviews, to ensure a holistic understanding of patients and guide effective treatment decisions.

Takeaways

• 😀 Screening tools are used to identify substance use disorders early, while assessments provide deeper insights for treatment decisions.
• 😀 The CAGE tool, though less common today, is a simple alcohol screening tool that helps identify alcohol use problems using four questions: Cut, Annoyed, Guilty, and Eye-opener.
• 😀 The AUDIT (Alcohol Use Disorders Identification Test) is a more comprehensive screening tool for alcohol, offering more detailed data than the CAGE tool, including frequency of use.
• 😀 The DAST (Drug Abuse Screening Test) is a general screening tool used for all substance use disorders, focusing on the functional impairment caused by substance use rather than frequency.
• 😀 The NM-ASSIST (Modified Alcohol, Smoking, and Substance Involvement Screening Test) is an advanced tool that screens for multiple substances and provides recommendations for care levels.
• 😀 Symptom tracking tools like COWS (Clinical Opiate Withdrawal Scale) and SIWA (Shortened Alcohol Withdrawal Scale) help monitor withdrawal symptoms to assess the need for medications.
• 😀 UDA (Urine Drug Analysis) is used for objective confirmation of substance use, though its reliability can vary depending on the drug and method used for testing.
• 😀 Using the Patient Stress Questionnaire, including tools like PHQ-9 (depression), GAD-7 (anxiety), and PC-PTSD (PTSD), can help assess comorbid conditions commonly seen in individuals with substance use disorders.
• 😀 Functional assessments, such as the HUDAS, evaluate daily functioning and quality of life, providing critical insight into how substance use affects an individual’s overall life.
• 😀 Collecting collateral information from family members and conducting a thorough chart review can be invaluable in understanding a patient's substance use and related issues, providing a fuller picture than self-reports alone.

Q & A

What is the purpose of screening tools in substance use disorder (SUD) treatment?

Screening tools are used to identify whether a person has a substance use disorder, determine the severity, and guide decisions regarding treatment plans. They are particularly helpful in assessing the risk and functional impairment caused by substance use, providing a starting point for more comprehensive assessments.

What is the CAGE tool, and how is it used in substance use assessments?

The CAGE tool is a brief screening tool used primarily for alcohol use. It consists of four questions that help assess whether an individual has an alcohol use problem. The questions focus on behaviors like cutting down, feeling annoyed by criticism, feeling guilty about drinking, and using alcohol as an eye-opener. It's a simple yes/no tool, although it's not commonly used today due to its focus on alcohol alone.

How does the AUDIT tool improve upon the CAGE tool?

The AUDIT (Alcohol Use Disorders Identification Test) is a more inclusive and detailed tool compared to CAGE. Developed by the World Health Organization (WHO), it collects data on alcohol consumption frequency, quantity, and related harms. The AUDIT is more flexible, with a short version (AUDIT-C) for initial screening and a full version for detailed assessment.

What makes the DAST tool unique in substance use assessments?

The DAST (Drug Abuse Screening Test) is unique because it is not limited to alcohol but applies to any substance use. It focuses on functional impairment rather than the frequency of use, helping to assess the consequences and impact of substance use on an individual's life. It also aligns with SAMHSA's diagnostic criteria, which aids in determining appropriate treatment levels.

How does the NM-Assist tool support clinicians in treatment decisions?

The NM-Assist (NIDA Modified Alcohol, Smoking, and Substance Involvement Screening Test) helps clinicians assess substance use by evaluating ten different substance classes. It provides a level-of-care recommendation based on responses and includes brief intervention options and community referrals, making it highly useful for both initial screenings and treatment planning.

Why is it important to track symptoms during substance use treatment?

Tracking symptoms helps clinicians monitor the progress of withdrawal, identify the severity of the patient's condition, and adjust treatment accordingly. Tools like the Clinical Opiate Withdrawal Scale (COWS) for opioid withdrawal and the SIWA for alcohol withdrawal are used to track symptom changes over time and guide medication decisions.

What role does urine drug monitoring (UDM) play in substance use assessments?

Urine drug monitoring (UDM) is used to detect the presence of substances in a patient's system. It serves as an objective measure to complement self-reporting and can help clinicians assess whether a patient's substance use is consistent with their reported behavior. The detection window varies depending on the substance being tested.

What is the significance of assessing for comorbid conditions in substance use disorder treatment?

Assessing for comorbid conditions like depression, anxiety, PTSD, and other mental health issues is crucial because they can complicate substance use disorder and affect treatment outcomes. Tools like the Patient Stress Questionnaire (which includes PHQ-9, GAD-7, and PCPTSD) help identify these co-occurring disorders, ensuring that the treatment plan is comprehensive.

How can the HODAS tool contribute to substance use assessments?

The HODAS (Health and Daily Living Assessment Scale) is used to evaluate how a patient's substance use affects their daily functioning and quality of life. This tool provides valuable insight into how the patient's ability to perform everyday tasks might be impacted, which can inform treatment strategies.

Why is collateral information and chart review emphasized during comprehensive assessments?

Collateral information from family or significant others, along with a thorough chart review, can provide a fuller picture of a patient's condition. Often, patients may underreport certain behaviors or symptoms, and external input can highlight additional concerns or verify self-reported data. This helps create a more accurate and tailored treatment plan.