A substance abuse evaluation is a comprehensive assessment conducted by a professional specializing in substance use disorders. This evaluation takes a complete history of one’s life and specifically seeks to understand the patterns of substance-using behaviors. The hope is to gain enough information to develop a plan for treatment and recovery with you, not for you.
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What Is a Substance Abuse Evaluation?
Substance abuse evaluations (SAEs) are assessments that determine the function of substances in a person’s life. Most people use substances because they perceive they are “helpful” rather than “harmful.” The evaluation will seek to understand a person’s relationship with substances. Questions will center around when they started using substances, how often they use substances now, and to what extent it interferes with their day-to-day life.
These assessments are conducted by a licensed clinician or counselor specializing in substance use disorders. Clinicians could be licensed, social workers or mental health counselors. All states have specific credentialing for persons who focus their education mainly on substance use treatment, often called alcohol and drug counselors.
Substance use disorders are diagnosed depending on the substance(s) used and the extent of their severity, from mild to severe. Clinicians and counselors often will use validated screening and assessment instruments to support their findings and their treatment recommendations.
Additionally, a clinician and counselor will assess for co-occurring disorders, such as depression, and other addictive behaviors, such as gambling. These are important areas to assess for as co-occurring disorders generally feed into one another. A substance may even be the root cause of a mental health disorder or vice versa.1
How Are Substance Abuse Evaluations Performed?
Evaluations are performed with a therapist or a counselor one-on-one. They occur in the privacy of the counselor’s office. Depending on the setting, an evaluation can last anywhere from one hour to a few hours. This will depend on a few factors, such as the initial screening done and the information one provides throughout the assessment. It will depend on what other facets of one’s life are affected by or have affected substance-using behaviors. It will also depend on the program and type of services offered.
Again, a person’s comfort level is what is most important. It is helpful for the evaluator to know a few key areas: in-depth history of substance use, history of mental health diagnoses, history of hospitalizations, medical concerns for which substance use could impact, traumatic experiences, and family history of substance use or mental health disorders. However, individuals are only expected to share information they are comfortable disclosing.
Substance Abuse Evaluation Screening
Screening is the first step in evaluations. The screening component is essential to the SAE because it can help to inform further questions asked in the assessment phase. Depending on the state and setting, valid screening tools will be utilized. Often, state governing agencies will put into place specific screeners. If clinicians are working within a hospital or community agency, there may be screeners those specific sites will require or include.
The tools used in a substance abuse evaluation screening include:
Substance Abuse Subtle Screening Inventory (SASSI)
The SASSI is a self-report questionnaire that has been shown to indicate the potential for substance use disorders. There are subtle questions that depict whether or not a person using substances would find certain aspects of their use problematic.2
CAGE Questionnaire
The CAGE Questionnaire is a validated tool for alcohol use disorder screening. CAGE is an acronym for the four key questions of this tool: “Have you ever: (1) felt the need to cut down your drinking; (2) felt annoyed by criticism of your drinking; (3) had guilty feelings about drinking; and (4) taken a morning eye-opener?” This tool is easy to use and can lead to other pertinent assessment questions.3
Alcohol Use Inventory (AUI)
The AUI is a 24-question inventory to assess a person’s perception of alcohol. It was developed based on the theory that a person’s perception of alcohol plays a large role in their use and/or misuse.4
CRAFFT
The CRAFFT is the most widely used screener for persons aged 12-21 for substance misuse detection in community health agencies.5 It comprises six questions to determine high-risk alcohol or drug-using behaviors in adolescents.
Screening to Brief Intervention (S2BI)
The S2BI is a screener for adolescent patients that focuses on the most used drugs (alcohol, marijuana, and tobacco products) by adolescents. It provides a risk level based on the adolescent patient’s self-report. This screen also asks about other substances, such as non-prescribed medications, illicit substances, inhalants, and synthetic substances.6
Drug Abuse Screening Test (DAST-10)
The DAST-10 is a 10-question self-report that screens for substance use and consequences of misusing substances in a person’s life (i.e., feeling guilty of one’s use and engaging in illegal acts related to drugs).7
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Substance Abuse Evaluation Assessment
In the assessment phase, the clinician or counselor will ask more in-depth questions about substance use and fellow symptoms one may be experiencing. The assessment is done by asking open-ended questions, which are questions that often elicit more than just a yes/no response. Each community health, hospital program, etc., will have specific assessments their therapists and counselors complete. These assessments are often uniform and done with each patient.
The tools used in a substance abuse evaluation assessment are:
- Diagnostic Interview Schedule (DIS): The DIS is a structured interview that assesses past and present symptoms of mental health and substance use disorders. The DIS has specific sections dedicated to substance use disorders and is considered an objective assessment.8
- Addiction Severity Index (ASI): The ASI is a semi-structured interview that assesses the impact of addiction on persons in various life areas. From specific questions around substance use to questions assessing impacts in employment, medical, family, legal history, and psychiatric.9
- Triage Assessment for Addictive Disorders – 5 (TAAD-5): The TAAD-5 is a brief assessment that detects current alcohol and substance use.10
- Comprehensive Addiction and Psychological Evaluation (CAAPE): The CAAPE is a tool that was designed specifically for the detection of co-occurring mental health and substance use disorders.11
- Substance Use Disorder Diagnostic Schedule – 5 (SUDDS-5): This SUDDS-5 interview assesses the current and lifetime prevalence of substance use disorders. It also assesses past and current symptoms of depression and anxiety disorders.12
Types of Substance Abuse Evaluations
Certain SAEs are conducted due to employment or legal concerns. These evaluations are often similar in nature to an assessment done in a community health clinic. However, they differ because the purpose and scope are for specific reasons with consequential factors. For example, a court-ordered assessment could assist in determining for a judge whether to recommend treatment during sentencing based on the findings.
Types of substance abuse evaluations include:
Court-Ordered Substance Use Assessments
A person may be required to complete a court-ordered assessment due to legal charges where the individual was under the influence of substances or substances were involved to some extent. For example, in family court, a judge may request an evaluation of the parents at a drug treatment center due to a reported history of substance misuse. Additionally, charges such as Driving While Intoxicated (DWI) or Driving Under the Influence (DUI) often require assessments, especially concerning retaining one’s license to operate a motor vehicle. During a court-ordered assessment, one can expect that the evaluator’s determination and findings will play a role, to some extent, in their case.
Drug-Free Workplace Evaluation
A Drug-Free Workplace Evaluation (DWP for short) is often completed with employees at federal and federally overseen workplaces. However, non-federal workplaces can adopt similar practices, the main difference being the government does not require them to do so. This commenced following Executive Order 12564. All federal employers are required to complete these evaluations accordingly.13 Any non-federal workplaces may require all employees or will require an evaluation should there be a report or suspicion of drug and alcohol misuse.
DOT SAP Assessment
The U.S. Department of Transportation requires employees who violate their drug and alcohol policies to undergo a Substance Abuse Professional (SAP) Assessment. The SAP is a vital role in the decision-making of the DOT on where to move forward with an employee in violation. In their professional capacity, the SAP will recommend follow-up treatment, education, and aftercare.14
Addiction Treatment Facility Evaluations
An addiction treatment facility is often an inpatient rehabilitation program or residential service facility. Inpatient rehabilitation is a program where a person will stay at the location, receiving support for withdrawal, medicated assisted treatment, and individual and group therapy. A residential program is similar in scope in practice.
The main difference between inpatient rehab and residential is the length of stay. Inpatient rehabilitation programs can be anywhere from 7 to 30 days, sometimes up to 90 days. A residential program is a longer-term program where a person may be housed and receive treatment daily for 6 months up to one calendar year.
The length of stay in these programs depends on the severity of one’s substance use disorder and co-occurring disorders, amongst many other factors.
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What Happens After a Substance Abuse Evaluation?
Following an SAE, the clinician or counselor will discuss their findings with the individual. The practitioner will provide recommendations based on the assessment. The individual and their well-being are always considered first and foremost. Once the individual agrees with recommendations, the clinician or counselor will commence discussions with the individual about the next steps in the plan of care.
Along this same vein, the practitioner may have determined that a higher level of care is more appropriate. As long as the individual agrees, the practitioner will move forward with referrals. Once an appropriate program and setting are identified, the clinician or counselor will provide their information to the program. This is done to ensure the patient is reconnected back to them once discharged.
If the patient is deemed appropriate for the clinician or counselor’s level of care, they will begin discussing treatment plan goals and objectives. Treatment is commenced immediately, and the patient determines an appropriate schedule between individual and group therapy. Ideally, both therapies are done together simultaneously.
If an individual does not meet the diagnostic criteria for a substance use disorder, the practitioner will provide brief therapeutic interventions and assist the patient in finding a more appropriate fit for their needs.
Substance Use Treatment Plan
When a person is determined to be experiencing a substance use and/or alcohol use disorder, treatment will commence. A treatment plan will also be done with the client collaboratively to ensure treatment will be tailored to the individual. A treatment plan is a mutually agreed upon plan with goals and objectives to meet those goals. A treatment plan may be completed within the first 30 days of treatment and periodically reviewed to account for the individual’s progress and/or any new goals/objectives that arise.
A typical substance use treatment plan has seven parts:
1. Diagnostic Summary
A diagnostic summary is often a brief statement of the person’s presenting problems and diagnosis(es). It will often include the following: past diagnoses, present symptoms, any significant risk factors, identifying protective factors, and the patient’s motivation for treatment and attitude toward change. This summary is essentially a snapshot of the reason a person experiencing a substance use disorder will benefit from treatment.
2. List of Addressable Life Areas
The negative impacts substance use disorders have on one’s life are often the main reason for entering treatment. During the SAE, the patient and practitioner will have discussed areas where the patient feels they are most struggling. In addition to substance use, addressable life areas will include medical/physical health, past/present mental health concerns, traumatic exposure, family history/concerns, social supports/concerns, religious/spiritual, finances, employment/education, housing, legal history/concerns, and resources. These areas being homeostatic, are vital for a complete and enriching life. The reason a practitioner will look more in-depth at these is because of the damaging influence substance use disorder can have. For example, money is often a trigger for a person to use substances. Therefore, financial health/concerns will be assessed.
3. Goals
Goals are mutually defined between the individual receiving services and their practitioner. The goals will address what the client feels are most pressing as they commence treatment, such as substance use. Goals are often broad, and the subsequent objectives break them down further into manageable parts. A treatment goal should include a client’s personal statement of the presenting problem to be addressed. For example, “I don’t want drugs to have a hold over me anymore”. These statements highlight the person’s motivations and can be revisited to reinforce to clients why they entered treatment in the first place. Following the statement, an objective goal would be for: Client will abstain from mind-altering substances.
4. Objectives
As mentioned above, objectives break down the overall goals into more manageable parts. Objectives are often best written as measurable and time-limited. This gives clients and practitioners clarity on what they hope to achieve to meet the overall goals. For example, a practitioner may write: Client will build at least three coping skills to mitigate urges and triggers to use substances over the next 6 months.
5. Interventions
The intervention piece of the treatment plan is where the clinician or counselor details the specific therapeutic skill(s) that will be implemented. These skills may vary depending on the clinician/counselor and their preferred treatment modality. For example, an intervention may detail: Clinician/Counselor will utilize cost-benefit analysis to assist the client in building insight into the long-term cost of continued substance use. Cost-benefit analysis is a cognitive behavior therapy skill where a practitioner will have the client detail the present benefits and costs of their use, similar to a pro-cons list of sorts yet more directive.
6. Treatment Plan Updates or Progress Reports
Over time, a practitioner and client will review the treatment plan and mutually discuss the client’s progress. The client and clinician/counselor may agree to update the goals and/or objectives, potentially focusing on new ones. Ideally, as time has gone on, the treatment plan updates will show achievements toward objectives and, eventually, overall goals.
7. Relapse Prevention
Once a person has fully committed to treatment and has abstained from substances, a relapse prevention plan is established. This is a mutually developed plan where the practitioner and client review the following areas: triggers to use substances, developed coping skills to mitigate use, reasons to remain sober, the client’s strengths, and the client’s long-term goal for themselves that remaining sober would support. This is a plan a client can refer back to when needed to reinforce to themselves their progress, capability, and, most of all, a reason to continue their recovery process.
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Treatment Options for Substance Use Disorders (SUD)
Treatment for a substance use disorder (SUD) usually falls between harm reduction and abstinence-based. Harm reduction is a humanistic and person-centered approach that works to meet clients where they are in their process and have resources available to them when they feel recovery is right for them. For example, needle exchange programs in the community ensure substance users exchange dirty needles for clean needs to avoid spreading sexually transmitted infections.15 Harm reduction is also a philosophy adopted in therapeutic services for substance use disorders, in that, at times, a person may not be fully ready to abstain from substances, yet, they are ready to reduce their use and set limits on their use so that it does not impact them as significantly.
Conversely, abstinence-based treatment is where the expectation of the program or clinic is abstinence over time while a person is receiving services. These programs will be flexible as relapse is a part of the recovery process. However, persistent relapse will often result in referral to a higher level of care, such as an inpatient or outpatient rehabilitation program.16
As previously discussed, the recommendations of one’s SAE will determine their initial recommended level of care, from detox to outpatient treatment to inpatient or residential. Many states have a dedicated overseeing office for substance use treatment services where a person can find approved treatment programs and individual practitioners. The Substance Abuse and Mental Health Services Administration has an extensive directory for finding care as well.
Treatment options for substance use disorder include:
Detoxification
A detox program is a short-term, crisis-oriented program to stabilize a person who is acutely intoxicated while they go through withdrawal symptoms. Withdrawal from all substances is possible. However, withdrawal from certain substances is best done with medical supervision. For example, alcohol withdrawal can cause seizures, which can prove fatal. Alternatively, opioid withdrawal, while rarely fatal, is highly uncomfortable and painful.17
Individual, Group, and Family Therapy for Substance Abuse
Combining individual and group therapy is often the gold standard of treatment. Individual therapy supports the person entering services to identify the “why” of their substance use. From there, insight is built around patterns of use and triggers to use. This helps to identify themes in and around substance-using behaviors. Once these patterns and insights are established, clients can build coping skills to mitigate excessive use or relapse.
Group therapy supports a person in feeling less alone as they go through their process. Not only can group therapy build camaraderie, but it can also offer additional support to using coping skills for which fellow group members have found success. Often, a person who has struggled with substances may have lost much of their support due to their use. Therefore, engagement in a group can rebuild their sense of belonging and confidence in reconnecting with those they love.
Lastly, family therapy has shown increased evidence, especially for young persons, as a vital component of the healing journey from substance misuse.18 While family conflict and history may have contributed to a person’s eventual substance use, the family unit’s healing is equally important as the individuals, if willing. Family members are open to learning and growing with their loved ones through this process, and accepting responsibility for their actions as well, could be an essential resource in one’s recovery.
Finding a therapist or counselor specialized in substance use treatment is available through the online therapy directory, and there are many other online therapy options to find the best fit for you.
Outpatient Treatment Programs for Substance Abuse
City and state governing agencies generally oversee outpatient treatment programs. These programs often provide individual and group therapies, with a heavy emphasis on group treatment. Given the governing agencies involved, many of these programs are licensed to provide court-ordered SAEs. A person may expect to attend the program 2-3 days per week, depending on their needs.
Intensive Outpatient or Partial Hospitalization Programs
When a person is experiencing mild withdrawal or very persistent triggers and relapses, an intensive outpatient or partial hospitalization program may be most beneficial. These programs will last throughout your day between individual sessions, multiple group sessions, expressive therapies (such as art), and meetings with a psychiatrist or medical doctor. Another critical factor and service in these programs are Medicated-Assisted Treatment (MAT), where certain, regulated medications are utilized to support a person in remaining abstinent from opioids or alcohol. The main difference between these and inpatient programs is you do not have to stay the evening. Some of these programs may even offer detoxification.
Inpatient Rehabilitation Programs
Inpatient rehabilitation is most appropriate for persons with severe substance use disorders; they are best managed in a 24/7 setting. Most of these settings will also have detoxification services and MAT. This treatment could be court-ordered depending on the SAE and judges’ ruling of the defendant’s needs in conjunction with their charge(s).
Residential Programs
Engagement in a residential program usually occurs after a person has been medically stabilized. Following their stabilization, it is determined they would benefit from ongoing clinical oversight of their recovery for an extended period of time, in a facility, 24/7.19 This may occur due to a lack of resources and limited protective factors.
In My Experience
Substance Abuse Evaluations (SAEs) are vital to service delivery in substance use disorder treatment. In my experience conducting these evaluations, following through on this initial process shows one’s readiness to change or consider changing. These evaluations also give you, the client, a chance to determine whether the therapist or counselor is a good fit for your needs. If you can feel comfortable in the evaluation process, there is a better likelihood of you continuing treatment.
Additionally, an SAE for legal or work purposes can often be intimidating. However, a practitioner is still a trained clinician or counselor. Despite the circumstances, transparency is always best to receive the support one needs. When I have met clients in court or work-mandated services, I treat them with the same respect as any client. Preconceived notions of a person should not have a place in a newly formed therapeutic alliance.
Seeking support, especially for substance use disorders, is a vulnerable step. With the proper help and one’s own resiliency, recovery is possible. Ensure you are receiving the care you deserve, and if you find a program unsuitable for you, other options are available. As hard as being open can be, the more you reveal, the better suited you will be to receive the best support. Please remember recovery is possible, and you are capable.
Additional Resources
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Substance Abuse Evaluation Infographics
