Screening clients is a crucial step in the implementation of treatment in the field of addiction.
STUDENT 1 ROSEANNE :
Screening clients is a crucial step in the implementation of treatment in the field of addiction. Assessing clients quickly allows for a professional to identify the treatment appropriate for the client based on substance use severity (Sprong & Davis, 2018). The Alcohol, Smoking, and Substance Involvement Screening assessment is an instrument that was developed by the World Health Organization that consist of 8 items that are relatively easy to administer and score the test results. After the assessment is given the clients are given a card with the result of the assessment. The ASSIST can be given in a primary care or medical office setting and there is no training required to administer the test as well as no cost and comes with a manual provided for staff (Sprong & Davis, 2018). The purpose of the ASSIST is to screen clients for psychoactive substances, tobacco, and alcohol and if the substance use is harmful or hazardous. The ASSIST assessment can also help clients understand if they are at risk for development of a substance abuse disorder as well as determine if substance use could be contributing to a current illness (World Health Organization, 2005). The information that is collected on the ASSIST consist of asking clients if they have ever used marijuana, tobacco, pain medication, morphine, heroin, stimulants or amphetamine, crack/cocaine, hallucinogenic substances, inhalants, or other substances. It also asks if the client has used any of these substances within the last three months. If the client answers yes to the substance next to that substance is a scoring board in which ask the client how many times, they have used with 0 being never, 2 is if the client has used at least one or twice, 3 is monthly use, 4 is weekly use, and 6 is almost daily or daily use of the substance. If all the answers on the assessment are negative, then the practitioner will ask the client If they have ever used in school, if the client answers no to all the items listed on the assessment, then the practitioner is to stop the assessment or the interview. If the client answers yes to any of the items on the ASSIST assessment the practitioner is to ask Question 2 on the assessment. If the client never used any of the items of question 2 the practitioner is to move to question 6 on the easement. If there were substances used in the last three months the practitioner is to proceed with questions 3, 4, as well as 5 on the assessment. The other part of the assessment consists of asking the client how often they have used or had the desire to use as well as how often the client has used in the last three months. The ASSIST assessment then proceeds to ask the clients during the past three months if they have failed to do their normal activities due to substance use and how often have, they failed based on the substances listed previously. The scoring guide is like the first part of the assessment, however continued with a different scoring system of 0 being never, 5 is listed with being once or twice, 6 is monthly use, 7 list weekly use, and 8 list that the client uses almost everyday or daily. The ASSIST test also asks if a client has ever tried and failed to stop of cut down on substance use as well as if an any family member or friend has expressed concern as a result of the client’s substance use either never, yes within the past three months, or yes but not within the past three months (Sprong & Davis, 2018). The client is then provided a report card so that can evaluate if they are at low, moderate, or high risk of developing problems related to substance use. The ASSIST assessment is scored based on the sum regarding all questions 2-7 based on the separate substance categories in which other drug scores have a maximum score of 39 and tobacco has a maximum score of 31 on the assessment (Sprong & Davis, 2018). In an article written by (WHO ASSIST Working Group, 2002), the ASSIST assessment was shown to be valid and reliable based on a study conducted in the article which consisted of 236 participants who volunteered to complete the testing and retesting interviews. The test-retest reliability of the ASSIST assessment was concluded to have a low score of 0.58 regarding if clients have regretting behaviors while under the influence of substances. The high score range was 0.90 with clients showing consistency in the reporting of ever using substances (WHO ASSIST Working Group, 2002). Based on the results of the assessment I would recommend the client to based on the severity of substance use would be to be referred over for substance abuse treatment either inpatient or outpatient treatment as well as participate in counseling sessions to work with the client to develop better coping mechanisms and life skills. Cognitive Behavioral Therapy can help clients better understand the impact of their behavioral, thoughts and feelings on their life choices. This therapeutic approach also recognizes factors that influence the clients’ behaviors that are addictive or abusive based on the understanding of the clients’ physiological processes (Sprong & Davis, 2018). I don’t have any personal or professional experience in the use of the ASSIST assessment; however, I do have understanding that the assessment has been shown to be reliable and valid and can help professionals analyze if a client is at risk of developing a substance abuse disorder or if a client has a substance abuse disorder. I also like the fact that the test provides a client with a report card which can better help the clients gain insight on the risk related to substance use in which the client can gain access to effective treatment.
STUDENT 2 CHARLIE :
Screening instruments (or tools) for substance use disorder (SUD) differ from assessment instruments in that screening is a first step of a larger assessment (Sprong-Davis, 2018). A screening instrument is a starting place for determining “the probability of the presence of a problem, substantiate that there is a reason for concern, or identify the need for further evaluation” (Substance Abuse, 2012, p.4). Screening instruments are brief procedures that can often be administered after a short training by individuals without professional credentials and given to a wide population (schools, jails, in routine health care settings) (Sprong-Davis, 2018). While assessment is a longer, more comprehensive process done by trained professionals to determine the diagnosis and treatment for an at risk individual (Sprong-Davis, 2018). The results of the screening will indicate whether a comprehensive assessment is warranted. Screening instruments need to be sensitive (ability to provide a true positive result), specific (ability to yield a true negative result), reliable (consistent results over time) and valid (ability to measure what it is designed to measure) (Sprong-Davis, 2018). Selection of a screening instrument should take into consideration the evidence for its reliability and validity, the population for which the instrument was developed and normed, the type of setting the instrument was developed in, and the intended purpose of the instrument (Substance Abuse, 2012). The ease of administering the screening instrument should also be considered, as well how long it takes to complete, its cost, and ease of scoring (Substance Abuse, 2012).
The Substance Abuse Subtle Screening Instrument (SASSI) screens for 52 subtle items that concern nondrug and alcohol behaviors like health, emotional states, social interactions, interests, and values, and 26 risk prediction items of which 12 are alcohol-related and 14 drug-related (Sprong-Davis, 2018). The most recent version for adults, the Adult SASSI-4, is only for those ages 18 and older (Bauman & Cellucci, 2021, n.p.). Features of the SASSI-4 are: it takes 15 minutes; is administered individually via either paper, online or via audio; has a Spanish language version; has a cost; and scores responses in 11 scales (Face Valid Alcohol, Face Valid Other Drugs, Symptoms, Obvious Attributes, Subtle Attributes, Defensiveness, Supplemental Addiction Measure, Family vs. Controls, Correctional, Prescription Drug Scale, Random Answering Pattern, plus Probability of Having a Substance Use Disorder (High or Low)) (Bauman & Cellucci, 2021). The results of the SASSI-4 would indicate the individual being screened either needs a comprehensive assessment for SUD or that no further assessment is warranted. It is important to communicate to the client that the results of this or any screen do not diagnosis a mental disorder nor do they rule one out. The results are a first step in a process of gathering information to assess a client’s problem and, if necessary, build a tailored treatment plan.
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