Approximately 15 million Americans meet diagnostic criteria for alcohol abuse or dependence every year (US Dept. of Health and Human Services, 1993). Assessment of substance abuse can be easy or very difficult. Some people give you all the signs, such as arrests for DUI's, positive drug screenings when they deny drugs, or inconsistent and suspicious stories that they trip themselves with. Others deny use altogether and make it hard for you to distinguish between use and abuse.

Assessing Substance Abuse

Here are several things to ask about, keep in mind, and consider:

  • Brief Screener: CAGE - Have you ever tried to
    • Cut back on your substance use? Do others
    • Annoy you by talking to you about your level of use? Have you ever felt
    • Guilty about what happened after you used? Have you ever needed to use in the morning, as sort of an
    • Eye Opener?
  • Substances To Ask About:
    • alcohol including beer, wine, and liquor (ask about each since some people won't add in the other substances unless asked),
    • marijuana (both alone and mixed with cocaine as a "primo"),
    • cocaine (both snorting and smoking),
    • heroin (both smoking and injecting), opium
    • amphetamines (speed, Ritalin),
    • barbiturates (uppers and downers, qualudes)
    • prescription drugs,
    • hallucinogens (LSD, mushrooms, peyote, general stuff than made you see things),
    • inhalants (paint cans and thinners for example),
    • Rave and X
  • History of Use
    • substance, age of first use, who introduced you to this substance, initial level of use, escalated, why, problematic when, level of use then, how did they support their habit
    • tolerance and mixing substances, using one after the other to alter state
    • did use impact job and family, result in DUI's or arrests, or cause health problems, what is the status on those issues now
    • History of sexual or physical abuse, victim or perpetrator
  • Family History
    • family history of ab/use, treatment, relatives you used with
  • Current Use
    • current use, how much and how often, how do you feel just before you use? any signs of withdrawal when you don't use? do you use after fights or disagreements? do you use with others or alone? what do you like about using, not like about using? do you have blackouts? do you find it takes more to get "buzzed" or "high" than it used to? do you find yourself using much more than you intended to?
  • Depression
    • be sure to ask about depressive symptoms, and when they began versus when the alcohol abuse began... clinical depression is associated with quicker and more serious relapse after treatment, as well as loner relapse periods, and increased suicide risk after treatment (Brown and Ramsey, 2000)
  • Treatment
    • efforts to cut back on their own, when and why
    • when and where did they go to treatment, what type (detox, brief inpatient, 30 day inpatient), followed by what kind of after care (brief outpatient, 3 month outpatient, halfway house)
    • what kinds of meetings (AA, NA, CA (Cocaine Anonymous), other CA (Cannabis Anonymous), Al-Anon, RR), how often did they go (did they do "90 in 90"), what did they get out of meetings, how far on the steps, which steps were troublesome, why, who was their sponsor
    • longest time sober, when did relapses occur and why, life stressors at the time and concomitant mental health issues like depression and bereavement
    • are they/were they romantically involved with a user, what happened with that relationship
    • how far did they get on the 12 Steps (Ask for a specific step and what working that step entails (look up the steps)
    • Also watch for recovery lingo, like discussing "triggers," "living life on life's terms" and being wary of "people, places, and things" as well as "admitting powerlessness" as signs that they have really worked the steps