Transcript What We Measure (continued)

Screening and Assessment in
Alcohol and Drug Counseling
R. Lyle Cooper, Ph.D., LCSW, ICADAC II
Assistant Professor
University of Tennessee
College of Social Work
Screening Issues


Importance to practice
Various approaches:
 structured
interview
 self-report
instruments/questionnaires,
 clinical laboratory tests

Screening versus diagnosis
Screening Accuracy
Specificity
Sensitivity
 Ability
of a screening tool
to avoid false negatives;
accuracy in including all
who have the problem.
 False Negative—Subject
has problem; incorrectly
identified as not having
the problem.


Ability of a screening tool
to avoid false positives;
accuracy in not including
non-affected persons.
False Positive— Subject
does not have problem;
incorrectly identified as
having the problem.
Discussion Questions
1.
2.
3.
4.
Why might you choose a sensitive measure?
Why might you choose a specific measure?
Think about who you work with, should you
use a sensitive or specific measure? Why?
What are the ethical implications regarding a
screening choice?
Screening for Alcohol Problems
First Rule…
ASK
Ask
“Do you drink alcohol?”
Ask
“On average, how many
days a week do you
drink?”
Ask
“On a day when you drink
alcohol, how many drinks do
you have?”
“What is the maximum number of
drinks you consumed on any given
occasion during the past month?”
Relationship Between Alcohol Use and
Alcohol Problems...
Alcohol Use
None
Light
Moderate
Heavy
At Risk
Low Risk
Problem
Dependent
Severe
Small
None
Moderate
Alcohol Problems
Why Ask?
 We
ask questions about the quantity and
frequency of alcohol consumption because
it is:
 Common
 Sensitive
 Based
on epidemiological research
 Related to a continuum of risk
Standard Drink Measure
Assessment Outline
A.
B.
C.
D.
E.
F.
G.
H.
Background
What We Measure
Sequential and Functional Approaches
How We Diagnose, Classifications
Assessment Tools
Multidimensional Assessment
Readiness Stages of Change
Conclusions
Background
 Remember…
Client motivation
and commitment to treatment
begins with the diagnosis and
assessment phase.
©2002 Microsoft Corporation.
What We Measure

Assessment needs to be
sufficiently broad to
capture the extent and
complexity of the many
factors that accompany,
potentially maintain, and
are affected by drug use.
©2002 Microsoft Corporation.
What We Measure (continued)
What to Assess
Physiology
 Behavior
 Pychology
 Social elements
 Motivation/Readiness to
change

Sources of
Information:
Who to Ask
 Client
 Clinician
 Social Network
What We Measure (continued)
–Etiology
–Course
–Severity
–Client readiness
–Relationship of drugs
and other life problems
–Strengths, resources
–Relapse risk
©2002 Microsoft
Corporation.
Sequential Approach
 Screening
 Assessment
 Diagnosis
 Treatment
Planning
 Motivating
 Treatment
 Evaluation and Follow-up
©2002 Microsoft
Corporation.
Functional Analysis
 Identify
determinants
(root causes) of drug use –
both interpersonal and
intrapersonal
 Decision tree and treatment
matching
 Selection and prioritization
of treatment goals
©2002 Microsoft
Corporation.
Exercise 1



In small groups review the criteria for
drug abuse and dependence
Develop some concrete examples of
behaviors and symptoms that would
clearly fit each criteria
Discuss examples that might be
ambiguous as well
DSM-IV Limitations
 Over-reliance
on clinician
judgment
 Diagnostic criteria are less
valid with certain
populations
 Does not capture levels of
drug involvement
 Provides little help with
motivation or treatment
planning
Reliability, Validity and Therapeutic
Relationship
Reliability and validity are affected by practice:
“The interviewer is responsible for the integrity
of the information collected and must be willing
to repeat, paraphrase, and probe until he/she is
satisfied that the patient understands the
questions and that the answer reflects the best
judgment of the patient, consistent with the intent
of the question.” (ASI Manual)
Multidimensional Assessment
Assessment Domain
Example Instrument
Drug Use Problems
Addiction Severity Index (ASI)
Relapse Risk Situation
Assessment of Warning Signs of
Relapse (AWARE)
Coping Resources
Drug Taking Confidence
Questionnaire (DTCQ)
Motivational Resources
Stages of Change Readiness and
Treatment Eagerness Scale
(SOCRATES)
Exercise 2




In small groups think of a population group
you may need to assess
Chose an element needed to be assessed
Identify any cultural or other considerations
that should be addressed by the tool
You have 15 minutes!
Exercise 2 Continued


Share your population and element of the
multidimensional assessment with the trainer
We will use the ADAI assessment website to
find an appropriate tool
Transtheoretical Model
Contemplation
Pre contemplation
Planning
Action
Relapse
Maintenance
Choosing an Assessment
Instrument
Factors to consider…

Clinical utility

 Target population

 Reliability and validity
 Ease of administration

Time
Cost
Scoring and
interpretation