Screening for Substance Abuse

1. Screening for Substance Abuse MAKING THE MOST OF LIMITED RESOURCES A web presentation for RSAT - T&TA by Phillip Barbour

2. About the Presentation • This presentation addresses the issues relevant to screening and makes recommendations for the appropriate use of screening and tools in specific settings. • Spotlight on Illinois Criminal Justice System and TASC

3. A Good Resource http://www.kap.samhsa.gov/

4. Learning Objectives • Understanding the resource challenges in the screening process: • Who should do it? • When it should be done? • Where is the best place?

5. Learning Objectives • Developing and maintaining integrity between the screening process and the actual treatment of the offender. • Consents, • Agreements • Incentives

6. Learning Objectives • Understanding how security classification, good time credit and length of a sentence affects treatment.

7. Learning Objectives • Selecting the right AOD tool for screening: e.g. • TCUDSII, • Simple Screening Instrument, • SASSI, etc.

8. Learning Objectives • The importance of sharing information from the screening.

9. Why are you screening clients? OK, you’re in! No way, you’re out!

10. Who should do it? Things to consider

11. What are your choices? • Cost wise, is it cheaper to have someone dedicated to that particular task? • Can they be part-time? • Could the person even be an intern? • Can the client just fill it out?

12. When & where should it be done? • The when question; Timing is very important, but so are logistics. Many, if not most screening instruments can be administered in a group setting. • Choosing where to do the screening is important too. Is the setting conductive to an interview process?

13. What Are The Screening Objectives? • Screen out offenders who do not need substance abuse treatment. • Assess the extent of offenders' treatment needs in order to make appropriate referrals. • Ensure that offenders receive the treatment that they need, rather than being released into the community with a high probability of re-offending. • Conserve assessment resources

14. We have to start somewhere Screening and in depth assessment are important first steps in the substance abuse treatment process; currently no comprehensive national guidelines for screening and assessment approaches exist in the criminal justice system.

15. Make this an opportunity that fits your need! In the absence of such guidelines, information in this presentation can help clinicians and counselors and administrators develop effective screening and referral protocols that will achieve objectives relative to your program design.

16. A Definition of Screening • Screening - A process for evaluating someone for the possible presence of a particular problem. The screening process does not necessarily identify what kind of problem the person might have or how serious it might be but determines whether or not further assessment is warranted.

17. Developing and Maintaining Integrity Wearing multiple hats!

18. How Screening Is Used • In most settings, “screening” and “assessment” are equated with “eligibility” and “suitability,” respectively.

19. Considerations • Problem or No Problem – that is the question • How long will the person be available for treatment • What is their motivation for treatment • Community ties / religious preferences • Ability to participate • Security risk • Reentry issues (criminogenic needs)

20. Considerations • Infectious disease • General health screening • Co-occurring disorders • Cognitive functioning • Housing • Language/Cultural barriers • Suicide/Lethality issues • Literacy/Education

21. Know what are you looking for?

25. Screening Tools Selecting the right tools for your program

26. Selection Criteria • limited in focus, • simple in format, • quick to administer, • and usually able to be administered by nonprofessional staff or in a group setting

27. Limitations of available Screening Tools • Screening does not typically include assignment of DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) diagnoses of alcohol or drug abuse or dependence and may only identify DSM-related problem areas. • Screening tools do not include program specific questions.

28. Getting The Most Bang For Your Buck • Ideally during the screening process staff members would use instruments that are • limited in focus, • simple in format, • quick to administer, • and usually able to be administered by nonprofessional staff or in a group setting • There are seldom any legal or professional restraints on who can be trained to conduct a screening.

29. Addiction Severity Index (ASI) • Purpose: The ASI is most useful as a general intake screening tool. It effectively assesses a client's status in several areas, and the composite score measures how a client's need for treatment changes over time. • Clinical utility: The ASI has been used extensively for treatment planning and outcome evaluation. Outcome evaluation packages for individual programs or for treatment systems are available. A. Thomas McLellan, Ph.D.

30. Addiction Severity Index (ASI) • Groups: designed for adults of both sexes who are not intoxicated (drugs or alcohol) when interviewed. Also available in Spanish. • Norms: The ASI has been used with males and females with drug and alcohol disorders in both inpatient and outpatient settings. • Format: Structured interview. • Administration time: 50 minutes to 1 hour. • Scoring time: 5 minutes for severity rating. • Computer scoring? Yes. • Fee for use: No cost; minimal charges for photocopying and mailing may apply. A. Thomas McLellan, Ph.D.

31. Circumstances, Motivation, and Readiness Scales (CMR Scales) • Purpose: The instrument is designed to predict retention in treatment and is applicable to both residential and outpatient treatment modalities. • Clinical utility: The instrument consists of four derived scales measuring external pressure to enter treatment, external pressure to leave treatment, motivation to change, and readiness for treatment. Items were developed from focus groups of recovering staff and clients and retain much of the original language. Clients entering substance abuse treatment perceive the items as relevant to their experience. George De Leon, Ph.D., or Gerald Melnick, Ph.D. National Development and Research Institutes, Inc.

32. Circumstances, Motivation, and Readiness Scales (CMR Scales) • Groups with whom this instrument has been used: Adults. • Norms: Norms are available from a large secondary analysis of more than 10,000 clients in referral agencies, methadone maintenance, drug-free outpatient and residential treatment. Norms are also available for specific populations, such as clients with COD, prison-based programs, and women's programs. George De Leon, Ph.D., or Gerald Melnick, Ph.D. National Development and Research Institutes, Inc.

33. Circumstances, Motivation, and Readiness Scales (CMR Scales) • Format: 18 items at approximately a third-grade reading level. Responses to the items consist of a 5-point Likert scale on which the individual rates each item on a scale from Strongly Disagree to Strongly Agree. Versions are also available in Spanish and Norwegian. • Administration time: 5 to 10 minutes. • Scoring time: Can be easily scored by reversing negatively worded items and summing the item values. • Computer scoring? No. • Administrator training and qualifications: Self-administered; no training required for administration. • Fee for use: N/A. George De Leon, Ph.D., or Gerald Melnick, Ph.D. National Development and Research Institutes, Inc.

34. The Drug Abuse Screening Test (DAST) • Purpose: The purpose of the DAST is (1) to provide a brief, simple, practical, but valid method for identifying individuals who are abusing psychoactive drugs; and (2) to yield a quantitative index score of the degree of problems related to drug use and misuse. • Clinical utility: Screening and case finding; level of treatment and treatment/goal planning. • Groups with whom this instrument has been used: Individuals with at least a sixth grade reading level. Centre for Addiction and Mental Health Canada

35. The Drug Abuse Screening Test (DAST) • Norms: Yes. A normative sample consisting of 501 patients, representative of those applying for treatment in Toronto, Canada. • Format: A 20-item instrument that may be given in either a self-report or in a structured interview format; a “yes” or “no” response is requested from each of 20 questions. • Administration time: 5 minutes. • Scoring time: N/A. Centre for Addiction and Mental Health Canada

36. The Drug Abuse Screening Test (DAST) • Computer scoring? No. The DAST is planned to yield only one total or summary score ranging from 0 to 20, which is computed by summing all items that are endorsed in the direction of increased drug problems. • Administrator training and qualifications: For a qualified drug counselor, only a careful reading and adherence to the instructions in the “DAST Guidelines for Administration and Scoring,” which is provided, is required. No other training is required. • Fee for use: The DAST form and scoring key are available either without cost or at nominal cost. Centre for Addiction and Mental Health Canada

37. Substance Abuse Subtle Screening Inventory (SASSI) • Purpose: SASSI is an objective screening tool designed to identify patients with a high probability of having a diagnosable SUD, which can be used in a variety of clinical settings. • Clinical utility: Because some substance abusers may not be able or willing to acknowledge relevant symptoms, SASSI was designed to include both face-valid items, which ask about lifetime frequency of specific behaviors related to substance use, as well as subtle true-or-false items that have no apparent relationship with substance abuse. SASSI Institute

38. Substance Abuse Subtle Screening Inventory (SASSI - 3) • Norms: Yes. 839 respondents were used to evaluate the accuracy of the SASSI-3. The overall accuracy of the SASSI-3 in distinguishing substance-abusing and substance-dependent respondents from those without a substance use disorder was 94%. • Format: A 93-item instrument. 67 True – False, 14 face valued for other drugs, 12 for alcohol • Administration time: 20-30 minutes • Scoring time: 5-10 min SASSI Institute

39. Substance Abuse Subtle Screening Inventory (SASSI - 3) • Computer scoring? Yes. Also on-line testing available • Administrator training and qualifications: Self-administered; Non technical, step-by-step information on administering and scoring the SASSI-3 • Basic information on interpreting profiles, including several samples • Fee for use: Prices start at $125 for 25 paper test and profiles. Computer software $215 for 25 test and profiles, online pricing-pay as you go SASSI Institute

40. TCU Drug Screen II • Purpose: The TCUDS-II is a self-administered tool and serves to quickly identify individuals with a history of heavy drug use or dependency (based on the DSM and the NIMH Diagnostic Interview Schedule) and who therefore should be eligible for treatment options. • Clinical utility: It is particularly useful (and widely used) in criminal justice settings, especially for offenders eligible for treatment as an alternative to regular incarceration. Institute of Behavioral Research, Texas Christian University

41. TCU Drug Screen II • Norms: Yes. Numerous studies are available at www.ibr.tcu.edu. Overall the TCUDS-II is 82% accurate in identifying persons with SUD. • Format: A 15-item instrument. Available in Spanish • Administration time: 5-10 minutes • Scoring time: 5-10 min • Fee for use: No cost Institute of Behavioral Research, Texas Christian University

42. Simple Screening Instrument for Substance Abuse (SSI-SA) • Purpose: The SSI-SA instrument, was designed to encompass a broad spectrum of signs and symptoms for substance use disorders. These conditions are characterized by substance use that leads to negative physical, social, and/or emotional consequences and loss of control over one's pattern and amount of consumption of the substance(s) of abuse. • Clinical utility: Since its publication in 1994 the SSI-SA has been widely used and its reliability and validity investigated in 13 state correctional facilities. Center for Substance Abuse Treatment (Tip 11 consensus panel)

43. Simple Screening Instrument for Substance Abuse (SSI-SA) • Norms: Yes. Peters et al. (2000) found the SSI-SA to be effective in identifying substance-dependent inmates, and the SSI-SA demonstrated high sensitivity (87.0-92.6 percent for alcohol or drug dependence disorder) and excellent test-retest reliability (.97). Knight et al. (2000) also found the SSI-SA a reliable substance abuse screening instrument among adolescent medical patients. Center for Substance Abuse Treatment (Tip 11 consensus panel)

44. Simple Screening Instrument for Substance Abuse (SSI-SA) • Format: A 15-item instrument, can be administered as part of an interview or self administered. • Administration time: 5-10 minutes • Scoring time: 5-10 min • Fee for use: No cost Center for Substance Abuse Treatment (Tip 11 consensus panel)

45. Sharing what you know The hand-off

46. Questions that need to be asked & answered • What are your barriers to sharing information? • Can you utilize technology? • What will you share? • How will it be used? • Who will use the information?

47. Benefits of sharing information • Eliminates redundancy • Confirm or refute self-report information • Encourages a team approach to the work • Promotes continuity of services across departments or agencies • Protects the rights of the client

48. Ideas on how to share information • Multilevel agreements • Understanding the rules on transmitting health information • Using proprietary information systems that are secure • Creating systems structure so not to violate CFR 42 or HIPPA regulations

49. This of course this makes it easy!

50. The End Q&A