hopping,” where a patient replaces one addiction
object with another. Treating the disease of
addiction involves addressing not only the
specific object of the addiction, but the
antecedents, manifestations and consequences of
addiction more generally.^7
Assessment*
Once a patient has been screened for risky use
and identified as requiring professional services
beyond a brief intervention, a physician--
working with other health professionals--should
perform a comprehensive assessment of the
patient’s medical, psychological and substance
use history and current health status, present
symptoms of addiction, potential withdrawal
syndrome and related addictive behaviors. This
thorough assessment is a necessary precursor to
treatment initiation and must involve a trained
physician.^9 The assessment should utilize
reliable and valid interview-based instruments
and biological tests as needed. The goals of the
assessment are to help the provider determine
the nature, stage and extent of the disease and
whether the patient meets clinical criteria for an
- Despite the distinction between screening and
assessment tools, the term screening often is used to
subsume the concept of assessment or
interchangeably with the term in the clinical and
research literatures. Furthermore, while there is some
overlap between screening or assessment procedures
used to identify risky substance use and methods
used to diagnose a clinical addiction, a formal
diagnosis of addiction should be based on the
demonstration of specific symptoms included in the
most recent versions of the Diagnostic and Statistical
Manual of Mental Disorders (DSM) or the
International Statistical Classification of Diseases
(see Chapter II).
addiction diagnosis,† establish whether co-
occurring medical, including mental health,
problems exist and allow for the development of
an appropriate and specific treatment plan.^10Assessment tools, as distinguished from
screening tools, are meant to determine the
presence and severity of a clinical condition and
should parallel, at least in part, established
diagnostic criteria for the disease.‡ Assessments
tools also might examine social, family and
personal factors that might relate to or co-occur
with substance use.^11 This information can help
health care practitioners determine the most
appropriate intervention for their patients.A comprehensive assessment helps to create the
foundation for effective treatment that is
individualized and tailored to the patient.§ 12
The assessment should gather information about
many aspects of the individual including the
physiological, behavioral, psychological and
social factors that contribute to the patient’s
substance use and that might influence the
treatment process.^13 For example, in addition to
determining the patient’s health status, the stage
and severity of the disease^14 and the family
history of addiction, the assessment should
determine personality traits such as
temperament; family and social dynamics; the
extent and quality of the patient’s family and
social support networks; prior treatment
attendance and response to previous treatment
experiences;^15 and the patient’s motivation and
commitment to disease management.
Assessments also should cover the situations and
behaviors that may increase risk for relapse and
those that protect against relapse.^16 It is
important that assessment instruments also offer
some degree of cultural sensitivity and that they
are age and gender appropriate.^17† See Appendix H for some examples of assessment
instruments used by practitioners and researchers to
help make these diagnoses.
‡ This, however, is not always the case in commonly-
used assessment instruments (see Appendix H).
§ Much of the research on comprehensive
assessments relates to addiction involving alcohol.The bottom line is that addiction is an illness that
we are able to treat and manage, if not cure,
provided that we focus on the person with the
addiction, the family and the community--a
holistic approach to a sprawling problem.^8--Harold S. Koplewicz, MD
Child and Adolescent Psychiatrist
President
Child Mind Institute