Evidence-Based Assessment of Substance Use Disorder

The current review describes updated information on the evidence-based assessment of substance use disorder. We offer an overview of the state of the science for substance-related assessment targets, instruments (screening, diagnosis, outcome and treatment monitoring, and psychosocial functioning and wellbeing) and processes (relational and technical) as well as recommendations for each of these three components. We encourage assessors to reflect on their own biases, beliefs, and values, including how those relate to people that use substances, and to view the individual as a whole person. It is important to consider a person's profile of symptoms and functioning inclusive of strengths, comorbidities, and social and cultural determinants. Collaborating with the patient to select the assessment target that best fits their goals and integration of assessment information in a holistic manner is critical. We conclude by providing recommendations for assessment targets, instruments, and processes as well as recommendations for comprehensive substance use disorder assessment, and describe future directions for research.

[1]  Kevin A. Hallgren,et al.  Psychometric Performance of a Substance Use Symptom Checklist to Help Clinicians Assess Substance Use Disorder in Primary Care , 2023, JAMA network open.

[2]  Emily M. Becker-Haimes,et al.  A systematic review of brief, freely accessible, and valid self-report measures for substance use disorders and treatment. , 2022, Drug and alcohol dependence.

[3]  D. Gastfriend,et al.  Thirty Years of TheASAMCriteria: A Report Card. , 2022, The Psychiatric clinics of North America.

[4]  M. Magill,et al.  Mechanisms of behavior change in adolescent substance use treatment: A systematic review of treatment mediators and recommendations for advancing future research. , 2022, Clinical Psychology.

[5]  N. Gogtay,et al.  DSM‐5‐TR: overview of what’s new and what’s changed , 2022, World Psychiatry.

[6]  American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders , 2022 .

[7]  Kevin A. Hallgren,et al.  Practical assessment of DSM-5 alcohol use disorder criteria in routine care: High test-retest reliability of an Alcohol Symptom Checklist. , 2022, Alcoholism, clinical and experimental research.

[8]  K. Witkiewitz,et al.  Mechanisms of Behavior Change in Substance Use Disorder With and Without Formal Treatment. , 2022, Annual review of clinical psychology.

[9]  Kevin A. Hallgren,et al.  Practical Assessment of Alcohol Use Disorder in Routine Primary Care: Performance of an Alcohol Symptom Checklist , 2021, Journal of General Internal Medicine.

[10]  T. Mark,et al.  Assessing Assessments: Substance Use Disorder Treatment Providers’ Perceptions of Intake Assessments , 2021, Substance abuse.

[11]  Ruth S. Shim Dismantling Structural Racism in Psychiatry: A Path to Mental Health Equity. , 2021, The American journal of psychiatry.

[12]  Ashley L. Watts,et al.  Does crude measurement contribute to observed unidimensionality of psychological constructs? A demonstration with DSM-5 alcohol use disorder. , 2021, Journal of abnormal psychology.

[13]  Kevin A. Hallgren,et al.  What do clinicians want? Understanding frontline addiction treatment clinicians’ preferences and priorities to improve the design of measurement-based care technology , 2021, Addiction Science & Clinical Practice.

[14]  J. Bjork,et al.  Development and Feasibility Study of an Addiction-Focused Phenotyping Assessment Battery. , 2021, The American journal on addictions.

[15]  T. Mark,et al.  “The assessment really helps you with the first step in recovery.” What do clients think substance use disorder treatment intake assessments should look like? , 2021, Substance abuse.

[16]  Dylan K. Richards,et al.  Reconsidering Alcohol Treatment Non-Responders: Psychosocial Functioning among Heavy Drinkers Three Years Following Treatment. , 2020, Addiction.

[17]  Kevin S. Montes,et al.  What Is Recovery? , 2020, Alcohol research : current reviews.

[18]  D. Hasin,et al.  Test-retest reliability of DSM-5 substance disorder measures as assessed with the PRISM-5, a clinician-administered diagnostic interview. , 2020, Drug and alcohol dependence.

[19]  Ayana Jordan,et al.  Achieving Mental Health Equity: Addictions. , 2020, The Psychiatric clinics of North America.

[20]  A. Shabani,et al.  Psychometric properties of Structured Clinical Interview for DSM‐5 Disorders‐Clinician Version (SCID‐5‐CV) , 2020, Brain and behavior.

[21]  Ashley L. Watts,et al.  Psychiatric Comorbidity as a Function of Severity: DSM-5 Alcohol Use Disorder and HiTOP Classification of Mental Disorders. , 2020, Alcoholism, clinical and experimental research.

[22]  Emily M. Becker-Haimes,et al.  Evidence Base Update for Brief, Free, and Accessible Youth Mental Health Measures , 2019, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[23]  K. Witkiewitz,et al.  Abstinence Not Required: Expanding the Definition of Recovery from Alcohol Use Disorder. , 2019, Alcoholism, clinical and experimental research.

[24]  R. Martín-Santos,et al.  Clinical validity and intrarater and test–retest reliability of the Structured Clinical Interview for DSM‐5 – Clinician Version (SCID‐5‐CV) , 2019, Psychiatry and clinical neurosciences.

[25]  J. Rehm,et al.  Facilitating Screening and Brief Interventions in Primary Care: A Systematic Review and Meta‐Analysis of the AUDIT as an Indicator of Alcohol Use Disorders , 2019, Alcoholism, clinical and experimental research.

[26]  Drew T. Bassett,et al.  Evaluation of the psychometric properties of the cannabis use disorders identification test - revised among college students. , 2019, Addictive behaviors.

[27]  K. Sher,et al.  Not All Alcohol Use Disorder Criteria Are Equally Severe: Toward Severity Grading of Individual Criteria in College Drinkers , 2019, Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors.

[28]  Melissa L. Walls,et al.  Onset, Comorbidity, and Predictors of Nicotine, Alcohol, and Marijuana Use Disorders Among North American Indigenous Adolescents , 2018, Journal of Abnormal Child Psychology.

[29]  Ashley C. Helle,et al.  Borderline personality disorder and substance use disorders: an updated review , 2018, Borderline Personality Disorder and Emotion Dysregulation.

[30]  Kevin A. Hallgren,et al.  Profiles of recovery from alcohol use disorder at three years following treatment: can the definition of recovery be extended to include high functioning heavy drinkers? , 2018, Addiction.

[31]  Tamika C. B. Zapolski,et al.  The Crossover Effect: a Review of Racial/Ethnic Variations in Risk for Substance Use and Substance Use Disorder Across Development , 2018, Current Addiction Reports.

[32]  T. Babor,et al.  Reliability and Validity of a Two-Question Version of the World Health Organization's Alcohol, Smoking and Substance Involvement Screening Test: The ASSIST-FC. , 2018, Journal of Studies on Alcohol and Drugs.

[33]  A. Stacy,et al.  The Rutgers Alcohol Problem Index for Adolescent Alcohol and Drug Problems: A Comprehensive Modern Psychometric Study. , 2018, Journal of studies on alcohol and drugs.

[34]  L. Squeglia,et al.  Research Review: What have we learned about adolescent substance use? , 2018, Journal of child psychology and psychiatry, and allied disciplines.

[35]  K. Witkiewitz,et al.  Revisiting the Drinker Inventory of Consequences: An Extensive Evaluation of Psychometric Properties in Two Alcohol Clinical Trials , 2018, Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors.

[36]  Starlyn M Hawes,et al.  Community-Based Participatory Research (CBPR): Towards Equitable Involvement of Community in Psychology Research , 2018, The American psychologist.

[37]  G. Koob,et al.  Addictions Neuroclinical Assessment: A reverse translational approach , 2017, Neuropharmacology.

[38]  David Watson,et al.  The Hierarchical Taxonomy of Psychopathology (HiTOP): A Dimensional Alternative to Traditional Nosologies , 2017, Journal of abnormal psychology.

[39]  S. Nagel,et al.  Addiction and Moralization: the Role of the Underlying Model of Addiction , 2017, Neuroethics.

[40]  Zhuang Fengqing,et al.  Patients’ Responsibilities in Medical Ethics , 2016 .

[41]  R. Schwartz,et al.  Design of the NIDA clinical trials network validation study of tobacco, alcohol, prescription medications, and substance use/misuse (TAPS) tool. , 2016, Contemporary clinical trials.

[42]  G. Koob,et al.  Addictions Neuroclinical Assessment: A Neuroscience-Based Framework for Addictive Disorders , 2016, Biological Psychiatry.

[43]  Kenneth J Sher,et al.  Assessment of Withdrawal and Hangover is Confounded in the Alcohol Use Disorder and Associated Disabilities Interview Schedule: Withdrawal Prevalence is Likely Inflated. , 2016, Alcoholism, clinical and experimental research.

[44]  S. Levy,et al.  Substance Use Screening, Brief Intervention, and Referral to Treatment , 2016, Pediatrics.

[45]  Scott E. Hadland,et al.  Objective Testing: Urine and Other Drug Tests. , 2016, Child and adolescent psychiatric clinics of North America.

[46]  Nathan E. Dodds,et al.  Validation of the alcohol use item banks from the Patient-Reported Outcomes Measurement Information System (PROMIS). , 2016, Drug and alcohol dependence.

[47]  Noah N Emery,et al.  Quantifying alcohol consumption: Self-report, transdermal assessment, and prediction of dependence symptoms. , 2015, Addictive behaviors.

[48]  Nathan E. Dodds,et al.  Item banks for substance use from the Patient-Reported Outcomes Measurement Information System (PROMIS(®)): Severity of use and positive appeal of use. , 2015, Drug and alcohol dependence.

[49]  Jarrod M. Ellingson,et al.  Integrating Social-Contextual and Intrapersonal Mechanisms of "Maturing Out": Joint Influences of Familial-Role Transitions and Personality Maturation on Problem-Drinking Reductions. , 2015, Alcoholism, clinical and experimental research.

[50]  D. Mackinnon,et al.  Role transitions and young adult maturing out of heavy drinking: evidence for larger effects of marriage among more severe premarriage problem drinkers. , 2015, Alcoholism, clinical and experimental research.

[51]  G. Koob,et al.  Heterogeneity of alcohol use disorder: understanding mechanisms to advance personalized treatment. , 2015, Alcoholism, clinical and experimental research.

[52]  Fuschia Serre,et al.  Ecological momentary assessment in the investigation of craving and substance use in daily life: a systematic review. , 2015, Drug and alcohol dependence.

[53]  B. Grant,et al.  The Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 (AUDADIS-5): reliability of substance use and psychiatric disorder modules in a general population sample. , 2015, Drug and alcohol dependence.

[54]  K. O’grady,et al.  Validation and performance of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) among adolescent primary care patients. , 2015, Addiction.

[55]  Kenneth J Sher,et al.  Truth or consequences in the diagnosis of substance use disorders. , 2014, Addiction.

[56]  R. Krueger,et al.  Challenges and Strategies in Helping the DSM Become More Dimensional and Empirically Based , 2014, Current Psychiatry Reports.

[57]  R. Weiss,et al.  An electronic screen for triaging adolescent substance use by risk levels. , 2014, JAMA pediatrics.

[58]  K. Bucholz,et al.  Psychiatric comorbidity and perceived alcohol stigma in a nationally representative sample of individuals with DSM-5 alcohol use disorder. , 2014, Alcoholism, clinical and experimental research.

[59]  K. O’grady,et al.  Validity of Brief Screening Instrument for Adolescent Tobacco, Alcohol, and Drug Use , 2014, Pediatrics.

[60]  E. Brouwers,et al.  Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review. , 2013, Drug and alcohol dependence.

[61]  Jason B. Colditz,et al.  Item banks for alcohol use from the Patient-Reported Outcomes Measurement Information System (PROMIS): use, consequences, and expectancies. , 2013, Drug and alcohol dependence.

[62]  M. Larimer,et al.  Substance Use Related Stigma: What we Know and the Way Forward. , 2013, Journal of addictive behaviors, therapy & rehabilitation.

[63]  H. Skinner,et al.  The drug abuse screening test. , 2013, Addictive behaviors.

[64]  Richard F. Catalano,et al.  Review of risk and protective factors of substance use and problem use in emerging adulthood. , 2012, Addictive behaviors.

[65]  S. Tiffany,et al.  Beyond drug use: a systematic consideration of other outcomes in evaluations of treatments for substance use disorders. , 2012, Addiction.

[66]  Katherine Keyes,et al.  Psychiatric comorbidity and the persistence of drug use disorders in the United States. , 2012, Addiction.

[67]  M. Nordentoft,et al.  Validity of Timeline Follow-Back for self-reported use of cannabis and other illicit substances--systematic review and meta-analysis. , 2012, Addictive behaviors.

[68]  S. Tiffany,et al.  The clinical significance of drug craving , 2012, Annals of the New York Academy of Sciences.

[69]  E. Walker,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[70]  R. Caetano There is potential for cultural and social bias in DSM-V. , 2011, Addiction.

[71]  B. Meltzer,et al.  The Pharmacotherapy of Adolescent Opioid Dependence , 2010 .

[72]  F. Kay-Lambkin,et al.  An improved brief measure of cannabis misuse: the Cannabis Use Disorders Identification Test-Revised (CUDIT-R). , 2010, Drug and alcohol dependence.

[73]  R. Flett,et al.  The Cannabis Use Problems Identification Test (CUPIT): development, reliability, concurrent and predictive validity among adolescents and adults. , 2010, Addiction.

[74]  S. Hyman,et al.  The diagnosis of mental disorders: the problem of reification. , 2010, Annual review of clinical psychology.

[75]  M. Wall,et al.  Trajectories of Substance Use Disorders in Youth: Identifying and Predicting Group Memberships , 2010, Journal of child & adolescent substance abuse.

[76]  M. Kerr,et al.  A Reinterpretation of Parental Monitoring in Longitudinal Perspective , 2010 .

[77]  Jon Morgenstern,et al.  An Item Response Theory (IRT) analysis of the Short Inventory of Problems-Alcohol and Drugs (SIP-AD) among non-treatment seeking men-who-have-sex-with-men: evidence for a shortened 10-item SIP-AD. , 2009, Addictive behaviors.

[78]  G. Bigelow,et al.  Concurrent validation of the Clinical Opiate Withdrawal Scale (COWS) and single-item indices against the Clinical Institute Narcotic Assessment (CINA) opioid withdrawal instrument. , 2009, Drug and alcohol dependence.

[79]  E. BarnesGordon,et al.  Risk and Protective Factors for Adolescent Substance Use and Mental Health Symptoms , 2009 .

[80]  S. Heishman,et al.  Reliability and validity of a short form of the Marijuana Craving Questionnaire. , 2009, Drug and alcohol dependence.

[81]  N. Mulia,et al.  Disparities in alcohol-related problems among white, black, and Hispanic Americans. , 2009, Alcoholism, clinical and experimental research.

[82]  M. Anglin,et al.  Effect of Religiosity and Spirituality on Drug Treatment Outcomes , 2009, The Journal of Behavioral Health Services & Research.

[83]  M. Longo,et al.  Psychometric evaluation of the Amphetamine Cessation Symptom Assessment. , 2008, Journal of substance abuse treatment.

[84]  J. Hunsley,et al.  A Guide to Assessments That Work , 2008, Oxford Clinical Psychology.

[85]  Ed Day,et al.  Measuring the use and career histories of drug users in treatment: reliability of the Lifetime Drug Use History (LDUH) and its data yield relative to clinical case notes. , 2008, Drug and alcohol review.

[86]  M. Galanter,et al.  Assessment of spirituality and its relevance to addiction treatment. , 2007, Journal of substance abuse treatment.

[87]  M. Larimer,et al.  The factor structure of a dichotomously scored Rutgers Alcohol Problem Index. , 2007, Journal of studies on alcohol and drugs.

[88]  J. H. Hoffman,et al.  Adolescents’ time use: Effects on substance use, delinquency and sexual activity , 2007 .

[89]  B. Druss,et al.  Can psychiatry cross the quality chasm? Improving the quality of health care for mental and substance use conditions. , 2007, The American journal of psychiatry.

[90]  J. Hunsley,et al.  Evidence-based assessment. , 2007, Annual review of clinical psychology.

[91]  K. Lynch,et al.  Initial evidence for the reliability and validity of a "Lite" version of the Addiction Severity Index. , 2007, Drug and alcohol dependence.

[92]  D. Epstein,et al.  Heroin and cocaine craving and use during treatment: measurement validation and potential relationships. , 2006, Journal of substance abuse treatment.

[93]  T. Dishion,et al.  Variable- and Person-Centered Approaches to the Analysis of Early Adolescent Substance Use: Linking Peer, Family, and Intervention Effects With Developmental Trajectories , 2006 .

[94]  M. Schuckit Comorbidity between substance use disorders and psychiatric conditions. , 2006, Addiction.

[95]  D. Ziedonis,et al.  The validity and reliability of a brief measure of cocaine craving. , 2006, Drug and alcohol dependence.

[96]  N. Wallerstein,et al.  Using Community-Based Participatory Research to Address Health Disparities , 2006, Health promotion practice.

[97]  R. Gatchel,et al.  An Opioid Screening Instrument: Long‐Term Evaluation of the Utility of the Pain Medication Questionnaire , 2006, Pain practice : the official journal of World Institute of Pain.

[98]  L. Webster,et al.  Predicting aberrant behaviors in opioid-treated patients: preliminary validation of the Opioid Risk Tool. , 2005, Pain medicine.

[99]  Martin M Antony,et al.  Evidence-based assessment of anxiety disorders in adults. , 2005, Psychological assessment.

[100]  Olga V. Demler,et al.  Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. , 2005, Archives of general psychiatry.

[101]  B. McCrady,et al.  Is alcohol assessment therapeutic? Pretreatment change in drinking among alcohol-dependent women. , 2005, Journal of studies on alcohol.

[102]  A. H. Berman,et al.  Evaluation of the Drug Use Disorders Identification Test (DUDIT) in Criminal Justice and Detoxification Settings and in a Swedish Population Sample , 2004, European Addiction Research.

[103]  D. Svikis,et al.  Selection of a substance use disorder diagnostic instrument by the National Drug Abuse Treatment Clinical Trials Network. , 2004, Journal of substance abuse treatment.

[104]  J. Kimber,et al.  An overview of the use of urine, hair, sweat and saliva to detect drug use. , 2004, Drug and alcohol review.

[105]  T. B. Üstün,et al.  The World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) , 2004, International journal of methods in psychiatric research.

[106]  S. Adamson,et al.  A prototype screening instrument for cannabis use disorder: the Cannabis Use Disorders Identification Test (CUDIT) in an alcohol-dependent clinical sample. , 2003, Drug and alcohol review.

[107]  W. Ling,et al.  The Clinical Opiate Withdrawal Scale (COWS) , 2003, Journal of psychoactive drugs.

[108]  M. Rubio‐Stipec,et al.  The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): development, reliability and feasibility. , 2002, Addiction.

[109]  N. Rigotti,et al.  Measuring the loss of autonomy over nicotine use in adolescents: the DANDY (Development and Assessment of Nicotine Dependence in Youths) study. , 2002, Archives of pediatrics & adolescent medicine.

[110]  T. Trull,et al.  Substance use disorder and personality disorder , 2002, Current psychiatry reports.

[111]  L. Cox,et al.  Evaluation of the brief questionnaire of smoking urges (QSU-brief) in laboratory and clinical settings. , 2001, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[112]  L C Sobell,et al.  Natural recovery from alcohol and drug problems: methodological review of the research with suggestions for future directions. , 2000, Addiction.

[113]  K. Winters,et al.  Development of a Parent Questionnaire for Use in Assessing Adolescent Drug Abuse , 2000, Journal of psychoactive drugs.

[114]  J. Volpicelli,et al.  Psychometric properties of the Penn Alcohol Craving Scale. , 1999, Alcoholism, clinical and experimental research.

[115]  J. Vander Bilt,et al.  A new brief screen for adolescent substance abuse. , 1999, Archives of pediatrics & adolescent medicine.

[116]  W. Miller,et al.  Reliability of Form 90D: An Instrument for Quantifying Drug Use , 1998, Substance abuse.

[117]  D. Kivlahan,et al.  The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. , 1998, Archives of internal medicine.

[118]  J. Freudenheim,et al.  Test-retest reliability of the cognitive lifetime drinking history. , 1997, American journal of epidemiology.

[119]  G F Koob,et al.  Drug abuse: hedonic homeostatic dysregulation. , 1997, Science.

[120]  J. Ware,et al.  A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. , 1996, Medical care.

[121]  F. D. Del Boca,et al.  Measurement of drinking behavior using the Form 90 family of instruments. , 1994, Journal of studies on alcohol. Supplement.

[122]  O. Aasland,et al.  Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II. , 1993, Addiction.

[123]  J. E. Brazier,et al.  Validating the SF-36 health survey questionnaire: new outcome measure for primary care. , 1992, BMJ.

[124]  S. Tiffany,et al.  The development and initial validation of a questionnaire on smoking urges. , 1991, British journal of addiction.

[125]  L. Kozlowski,et al.  The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerance Questionnaire. , 1991, British journal of addiction.

[126]  C. Naranjo,et al.  Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). , 1989, British journal of addiction.

[127]  A. Farmer,et al.  The Composite International Diagnostic Interview. An epidemiologic Instrument suitable for use in conjunction with different diagnostic systems and in different cultures. , 1988, Archives of general psychiatry.

[128]  J. Stevenson,et al.  The Psychosocial Functioning Inventory , 1983, Evaluation & the health professions.

[129]  H A Skinner,et al.  Reliability of alcohol use indices. The Lifetime Drinking History and the MAST. , 1982, Journal of studies on alcohol.

[130]  W. Miller Alcoholism scales and objective assessment methods: a review. , 1976, Psychological bulletin.

[131]  Gregory T. Smith,et al.  Less drinking, yet more problems: understanding African American drinking and related problems. , 2014, Psychological bulletin.

[132]  K. Kendler,et al.  Levels of explanation in psychiatric and substance use disorders: implications for the development of an etiologically based nosology , 2012, Molecular Psychiatry.

[133]  B. Grant,et al.  Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States: results from the national epidemiologic survey on alcohol and related conditions. , 2007, Archives of general psychiatry.

[134]  John R Knight,et al.  Validity of brief alcohol screening tests among adolescents: a comparison of the AUDIT, POSIT, CAGE, and CRAFFT. , 2003, Alcoholism, clinical and experimental research.

[135]  D. Shaffer,et al.  NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): description, differences from previous versions, and reliability of some common diagnoses. , 2000, Journal of the American Academy of Child and Adolescent Psychiatry.

[136]  R. Niaura,et al.  Measuring nicotine dependence among high-risk adolescent smokers. , 1996, Addictive behaviors.

[137]  C. Diclemente,et al.  Project MATCH: Rationale and methods for a multisite clinical trial matching patients to alcoholism treatment , 1993 .

[138]  H. White,et al.  Towards the assessment of adolescent problem drinking. , 1989, Journal of studies on alcohol.