What Happens in a Substance Abuse Evaluation?

People are tremendously diverse in regards to their substance abuse preferences, patterns, withdrawal and relapse histories, age, health status, families, education, culture, insurance coverage, and reasons for seeking treatment, etc. The Institute of Medicine (US) recommends that “All these perspectives must be considered, and they all point to the importance of evaluating each person and family and taking all these variations into account in the development of treatment plans.”

Reasons for Seeking Substance Abuse Treatment

Your psychiatric status is measured during a substance abuse evaluation.

There are many reasons for a person to seek substance abuse treatment. According to the SAMHSA, “One of the oldest, yet still surviving, misconceptions in the substance abuse treatment field is the notion that people have to “hit bottom” before they can be helped.” Although a crisis is apparent in many of the cases, a substance abuse evaluation can be used as a tool to help those who are less affected obtain resources and lower levels of services before they reach that critical stage.

The most common reasons for seeking substance abuse treatment are:

• Experiencing a negative consequence as a result of the substance abuse such as an arrest, overdose, or serious health problem
• Disruptions in the family, workplace, or community
• Social or financial disparities such as becoming homeless or lacking self sufficiency (for instance: no income, unemployable, stealing or manipulating others to support habits)

Sometimes, a person’s motives to seek treatment can be as general as being weary of the frequent intoxications and withdrawals, troubles that come from sustained abuse, or the loss of dignity and/or self respect. Whether the individual is a willful participant or has an external component of coercion, a preliminary determination of the severity of their dependence and discomfort is necessary to get them the right help they need.

The Purpose of the Substance Abuse Evaluation

Thanks to the improvements in health care and the careful considerations given to quality of care, everyone seeking treatment for substance abuse, regardless of their reasons, can anticipate a better outcome consistent with the current professional knowledge.

Safety in detox and determining appropriate levels of care required to obtain optimal treatment outcomes are at the forefront of the substance abuse evaluation. Questions begin with understanding the individual, who they are, where they come from, support networks at home, relevant concerns and consequential impacts of their substance abuse, and of course; the durations, amounts, behavioral patterns, and withdrawal potentials surrounding it.

Establishing the levels of physical or psychological dependency helps to clarify clinical decisions and estimate overall needs including whether or not a person should be placed in an inpatient care facility during the acute detox phase, types of medications that may be used to help alleviate withdrawal discomfort, and any medical or psychiatric needs that could pose a potential risk to their welfare or the welfare of others.

Suicides, overdoses, and early deaths from drug abuse and those who relapse after trying to quit are becoming epidemic occurrences and the substance abuse evaluation is the first step to addressing these issues that have largely been less preventable before.

Identifying Needs

Clinicians have a variety of tools at their disposal to assess the discomfort or anticipated withdrawal severities, complications, goals, treatment motivations, and specialty needs including those involving medical, psychological, or social services that can promote treatment engagement and retention. According to the Institute of Medicine (US), “Treatment is most successful when it matches an individual’s needs and includes an array of integrated services, including primary care, specialty mental health and substance abuse care, and community-based care, such as social support programs.”

• Counselors can identify specific hazards associated with different types of drugs and methods of use such as those who inject drugs raising their risk of existing communicable diseases or infections referring them to the proper resources for care.
• A urinalysis and medical exam may help to determine necessary medical interventions and anticipated levels of withdrawal distress and medical detox assistance possibilities.
• A psychiatric exam can help to determine any co-existing mental health problems that so commonly exacerbate symptoms of withdrawal and threaten the person’s likelihood of achieving optimal recovery.

Measuring Severities

Measuring the severities of associated problems and consequences is crucial to the substance abuse evaluation process. For instance, a person who is elderly, suicidal, or pregnant may require special services to help them deal with the physical, emotional, psychological, and social problems that a low dose or common substance abuser would not have to experience. During the withdrawal process, many problems that have been suppressed while using drugs, are exacerbated and the horrendous distress that some individuals must go through to get and stay clean can be dangerous if trying to do it alone.

One of the tools used in a substance abuse evaluation is theAddiction Severity Index, which according to the Institute of Medicine (US), is “a diagnostic screening interview and rating method designed to yield “a subjective estimate of the client’s level of discomfort in seven problem areas commonly found in alcohol and drug dependent individuals.”

The categories rated for severity include:

1. medical status
2. employment/support
3. drug use
4. alcohol use
5. legal status
6. family/social relationships
7. psychiatric status

A Final Thought

Not everything can be answered during the initial substance abuse evaluation and what counts as critical for most people, is the initial crisis involving the pain and discomfort of withdrawals. Some people may be a little less sincere about the other aspects of their substance abuse based on their ambivalence for treatment, attached stigmas, or defense mechanisms that nearly every substance abuser displays as some point in time. Looking at the big picture of how substance abuse relates to these issues in a person’s life can take a while to uncover, but, the evaluating clinician can promote positivity and trust to carry on with treatment progress.