Mast assessment tool substance abuse

Have you ever gotten into physical fights when drinking? YES or NO 8. YES or NO 9. YES or NO Have you ever lost friends because of your drinking?

Have you ever gotten into trouble at work because of drinking? Have you ever lost a job because of drinking? Do you drink before noon fairly often? Have you ever been told you have liver trouble such as cirrhosis? Have you ever gone to anyone for help about your drinking? Have you ever been hospitalized because of drinking? No Question 2. Yes Question 3. Yes Question 4. No Question 5. Does any near relative or close friend ever worry or complain about your drinking? Can you stop drinking without difficulty after one or two drinks?

Do you ever feel guilty about your drinking? Have you ever attended a meeting of Alcoholics Anonymous AA? Have you ever gotten into physical fights when drinking? Has drinking ever created problems between you and a near relative or close friend? Has any family member or close friend gone to anyone for help about your drinking?

Have you ever lost friends because of your drinking? Have you ever gotten into trouble at work because of drinking? Have you ever lost a job because of drinking?

Have you ever neglected your obligations, family, or work for two or more days in a row because you were drinking? Do you drink before noon fairly often? Have you ever been told you have liver trouble, such as cirrhosis? After heavy drinking, have you ever had delirium tremens DTs , severe shaking, visual or auditory hearing hallucinations?

Have you ever gone to anyone for help with your drinking? Have you ever been hospitalized because of drinking? Has your drinking ever resulted in your being hospitalized in a psychiatric ward? Have you ever gone to any doctor, social worker, clergyman, or mental health clinic for help with any emotional problem in which drinking was part of the problem? Have you been arrested more than once for driving under the influence of alcohol? Have you ever been arrested, or detained by an official for a few hours, because of other behavior while drinking?

Score one point if you answered "no" to the following questions: 1 or 4. Score one point if you answered "yes" to the following questions: 2, 3, 5 through A total score of six or more indicates hazardous drinking or alcohol dependence and further evaluation by a healthcare professional is recommended. Do you think you may have a drinking problem? Missed opportunities can be especially unfortunate during prenatal care. However, only 43 percent of those who screened positive had symptoms recorded in their chart, and only 23 percent of those screening positive were given treatment.

This low rate of treatment is of great concern, given the untoward consequences of substance use for maternal and infant health Kelly et al. To address the disconnection that often happens beginning with the lack of identification of substance-related problems of the patient and extending to the failure of appropriate referrals and brief interventions , SAMHSA has invested in the Screening, Brief Intervention, and Referral to Treatment Initiative SBIRT —research, resources development, training, and program implementation across healthcare settings.

Although studies have not focused on gender comparisons, SBIRT programs have yielded short-term improvements in individual health for review, see Babor et al. The assessment examines a client's life in far more detail so that accurate diagnosis, appropriate treatment placement, problem lists, and treatment goals can be made.

Usually, a clinical assessment delves into a client's current experiences and her physical, psychological, and sociocultural history to determine specific treatment needs. Using qualified and trained clinicians, a comprehensive assessment enables the treatment provider to determine with the client the most appropriate treatment placement and treatment plan CSAT c.

Notably, assessments need to use multiple avenues to obtain the necessary clinical information, including self-assessment instruments, clinical records, structured clinical interviews, assessment measures, and collateral information. Rather than using one method for evaluation, assessments should include multiple sources of information to obtain a broad perspective of the client's history, level of functioning and impairment, and degree of distress.

Assessment should be a fluid process throughout treatment. It is not a once-and-done event. Considering the complexity of withdrawal and the potential influence of alcohol and drugs on physical and psychological functioning, it is very important to reevaluate as the client engages into recovery.

Periodic reassessment is critical to determine the client's progress and her changing treatment needs. In addition, reassessment is an opportunity to solicit input from the client on what is and is not working for her in treatment and to alter treatment accordingly.

The following section reviews core assessment processes tailored for women, including gender-specific content for biopsychosocial histories and assessment tools that are either appropriate or possess normative data for women in evaluating substance use disorders and consequences. It is beyond the scope of this chapter to provide specific assessment guidelines or tools for other disorders outside of substance-related disorders.

To provide an accurate picture of the client's needs, a clinical assessment interview requires sensitivity on the part of the counselor and considerable time to complete thoroughly. While treatment program staff may have limited time or feel pressure to conduct initial psychosocial histories quickly, it is important to portray to clients that you have sufficient time to devote to the process. The assessment interview is the beginning of the therapeutic relationship and helps set the tone for treatment.

Initially, the interviewer should explain the reason for and role of a psychosocial history. The notion that the women's substance use is not an isolated behavior but occurs in response to, and affects, other behaviors and areas of her life is an important concept to introduce during the intake phase. This information can easily disarm a client's defensiveness regarding use and consequences of use.

The focus of the assessment may vary depending on the program and the specific issues of an individual client. Investigators have sought to retain the fundamental structure of ASI while expanding it to include family history and relationships, relationships with partners, responsibilities for children, pregnancy history, history of violence and victimization, legal issues, and housing arrangements Comfort and Kaltenbach PSH has been found to have satisfactory test-retest reliability i.

While many States require screening and assessment for women, specific guidelines and specificity in incorporating women-specific areas vary in degree CSAT Note : When using information across State standards, the following psychosocial and cultural subheadings should be included in the initial assessment for women, and these areas need to be addressed in more depth as treatment continues.

Keep in mind that the content within each subheading does not represent an entire psychosocial and cultural history.

Only biopsychosocial and cultural issues that are pertinent to women were included in the list below. Substance Abuse History : Identify people who initially introduced alcohol and drugs; explore reasons for initiation of use and continued use; discuss family of origin history of substance abuse, history of use in previous and present significant relationships, and history of use with family members or significant others.

Mental Health and Treatment History : Explore prior treatment history and relationships with prior treatment providers and consequences, if any, for engaging in prior treatment; review history of prior traumatic events, mood or anxiety disorders including PTSD , as well as eating disorders; evaluate safety issues including parasuicidal behaviors, previous or current threats, history of interpersonal violence or sexual abuse, and overall feeling of safety; review family history of mental illness; and discuss evidence and history of personal strengths and coping strategies and styles.

Family, Parenting, and Caregiver History : Discuss the various caregiver roles she may play, review parenting history and current living circumstances. Children's Developmental and Educational History applicable to women and children programs : Assess child safety issues; explore developmental, emotional, and medical needs of children. Sociocultural History : Evaluate client's social support system, including the level of acceptance of her recovery; discuss level of social isolation prior to treatment; discuss the role of her cultural beliefs pertaining to her substance use and recovery process; explore the specific cultural attitudes toward women and substance abuse; review current spiritual practices if any ; discuss current acculturation conflicts and stressors; and explore need or preference for bilingual or monolingual non-English services.

Vocational, Educational, and Military History : If employed, discuss the level of support that the client is receiving from her employer; review military history, then expand questions to include history of traumatic events and violence during employment and history of substance abuse in the military; assess financial self-reliance.

Legal History : Discuss history of custody and current involvement with child protective services, if any; obtain a history of restraining orders, arrests, or periods of incarceration, if any; determine history of child placement with women who acknowledge past or current incarceration. TIPs that provide assessment information relevant to women in specific settings:. Barriers to Treatment and Related Services : Explore financial, housing, health insurance, child care, case management, and transportation needs; discuss other potential obstacles the client foresees.

Strengths and Coping Strategies : Discuss the challenges that the client has faced throughout her life and how she has managed them, review prior attempts to quit substance use and identify strategies that did work at the time, identify other successes in making changes in other areas of her life.

It is administered as a semi-structured interview and gathers information in seven domains i. Additional items refer to homelessness; sexual harassment; emotional, physical, and sexual abuse; and eating disorders.

The supplemental questions are asked after the administration of ASI. Psychometric data for ASI-F are limited. Texas Christian University Brief Intake, the Comprehensive Intake, and Intake for Women and Children : These instruments are available electronically and are administered by a counselor. Scoring is immediate, and the program generates a one-page summary of the client's functioning in 14 domains Joe et al. The Comprehensive Intake has an online version for women Simpson and Knight Since women are more likely to experience greater consequences earlier than men, using an instrument that highlights specific consequences of use is crucial.

Drinker Inventory of Consequences DrinC : This measurement is a self-administered item, true-false questionnaire that elicits information about negative consequences of drinking in five domains: physical, interpersonal, intrapersonal, impulse control, and social responsibility Miller et al. This instrument has normative data for women, men, inpatient and outpatient, and has good psychometric properties. A version that assesses drug use consequences is also available Tonigan and Miller For a copy of the assessment tool, scoring, and gender profile in interpreting severity of lifetime consequences, see Appendix C.

Figure p. This is not an exhaustive list, and counselors and administrators should not assume language availability is a sign that the instrument is appropriate for a particular culture, ethnic, or racial group.

Focusing on a woman's strengths instead of her deficits improves self-esteem and self-efficacy. Familiarity with a woman's strengths enables the counselor to know what assets the woman can use to help her during recovery. In the Woman's Addiction Workbook Najavits a , the author provides a self-assessment worksheet that focuses on individual strengths.

In addition to assessing strengths, coping styles and strategies should be evaluated see Rotgers Spirituality and religion play an important role in culture, identity, and health practices Musgrave et al. In addition, women are more likely to embrace different coping strategies including emotional outlets and religion to assist in managing life stressors Dennerstein Practices such as consulting religious leaders or spiritual healers curanderas , medicine men and attending to spiritual activities including sweats and prayer ceremonies, praying to specific saints or ancestors are common.

The consensus panel believes it is important that programs assess the spiritual and religious beliefs and practices of women and incorporate this component into their treatment with sensitivity and respect.

A challenge in determining the effect of spirituality on treatment outcomes is how to assess the extent and nature of a person's spirituality or religiousness. Several assessment tools are available; however, they are more often used for research. Because women develop serious medical problems earlier in the course of alcohol use disorders than men, they should be encouraged to seek medical treatment early to enhance their chances of recovery and to prevent serious medical complications.

Health screenings and medical examinations are essential in women's treatment. In particular, women entering substance abuse treatment programs should be referred for mental health, medical, and dental examinations. In many cases, they may not have had adequate health care because of lack of insurance coverage or transportation, absence of child care, lack of time for self-care, chaotic lifestyle related to a substance abuse, or fear of legal repercussions or losing custody of children.

The acute and chronic effects of alcohol and drug abuse, the potential for violence, and other physical hardships e. Women may practice behaviors that put them at high risk for contracting sexually transmitted diseases STDs and other infectious diseases Greenfield Anticipation of the test results is stressful and may place the client at risk for relapse.

Residential centers may offer medical exams onsite, but outpatient service providers may need to refer patients to their primary care provider or other affordable health care to ensure that each client has a thorough medical exam. This is an open-access report distributed under the terms of the Creative Commons Public Domain License.

You can copy, modify, distribute and perform the work, even for commercial purposes, all without asking permission. Turn recording back on. National Center for Biotechnology Information , U. Search term. Box In This Chapter. Overview Understanding the extent and nature of a woman's substance use disorder and its interaction with other life areas is essential for careful diagnosis, appropriate case management, and successful treatment. The Difference Between Screening and Assessment The purpose of screening is to determine whether a woman needs assessment.

Screening and Assessment: Factors of Influence Ethnicity and Culture The treatment field depends on tools or questionnaires that, for the most part, have been found valid and reliable with two populations of women—Caucasians and African Americans.

Acculturation and Language Issues Acculturation level may affect screening and assessment results. Socioeconomic Status Counselors may have conscious or subconscious expectations based on socioeconomic status.

Specific Populations: Other Noteworthy Considerations Cognitive and learning disabilities Prior to screening and assessment, the counselor should inquire about current or past difficulties in learning, past participation in special education, a diagnosis of a learning disability, prior involvement in testing for cognitive functioning or learning disability, and problems related to self-care and basic life management skills.

Sexual orientation The Institute of Medicine's IOM report on lesbian health identifies substance abuse as one of the primary heath concerns among lesbians Solarz Screening Screening often is the initial contact between a woman and the treatment system, and the client forms her first impression of treatment during screening and intake.

Screening for Tobacco Use Similar to other substances, women pay an exceptional price for using tobacco. Screening Instruments for Pregnant Women Considering the devastating impact of substances on the developing fetus, routine screening for drug, alcohol, and tobacco use among pregnant women is imperative. Prenatal substance abuse screen 5Ps This screening approach has been used to identify women who are at risk for substance abuse in prenatal health settings.

Figure 5Ps Screening. Acute Safety Risk Related to Serious Intoxication or Withdrawal Screening for safety related to intoxication and withdrawal at intake involves questioning the woman and her family or friends with client's permission about current substance use or recent discontinuation of use, along with past and present experiences of withdrawal.

Mental Illness Symptoms and Mental Disorders Considering that women are twice as likely as men to experience mood disorders, excluding bipolar and anxiety disorders Burt and Stein , all women entering substance abuse treatment should be screened for co-occurring mental disorders.

General mental disorder screening instruments Symptom screening involves questions about past or present mental disorder symptoms that may indicate the need for a full mental health assessment. Preventive Services Task Force recommends two simple questions that are effective in screening adults for depression: 1. Over the past 2 weeks have you felt down, depressed, or hopeless?

Assessing Risk of Harm to Self or Others Suicidal attempts and parasuicidal behavior nonfatal self-injurious behavior with clear intent to cause bodily harm or death; Welch are more prevalent among women.

Trauma and Posttraumatic Stress Disorder PTSD can follow a traumatic episode that involves witnessing, being threatened, or experiencing an actual event involving death or serious physical harm, such as auto accidents, natural disasters, sexual or physical assault, war, and childhood sexual and physical abuse APA a.

Figure Questions to Screen for Trauma History. Sexual Victimization, Childhood Abuse, and Interpersonal Violence Sexual victimization and childhood abuse Women entering treatment for substance use disorders have consistently reported high rates of sexual abuse.

Figure Questions Regarding Sexual Abuse. Box Note to Clinicians. Interpersonal violence Studies estimate that between 50 to 99 percent of women with substance use disorders have a history of interpersonal violence Miller et al.

Interpersonal violence and disabilities Women with disabilities are at a significantly greater risk for severe interpersonal violence and neglect Brownridge Eating Disorders Eating disorders have one of the highest mortality rates of all psychological disorders Neumarker ; Steinhausen Screening by Healthcare Providers in Other Settings Healthcare providers such as nurse practitioners, physicians, physicians' assistants, and social service professionals have opportunities to screen women to determine whether they use or abuse alcohol, drugs, or tobacco.

Assessment The assessment examines a client's life in far more detail so that accurate diagnosis, appropriate treatment placement, problem lists, and treatment goals can be made. The Assessment Interview To provide an accurate picture of the client's needs, a clinical assessment interview requires sensitivity on the part of the counselor and considerable time to complete thoroughly.

Box TIPs that provide assessment information relevant to women in specific settings:. Available screening and assessment tools: Language availability Figure p. Other Considerations in Assessment: Strengths, Coping Styles, and Spirituality Looking at women's strengths Focusing on a woman's strengths instead of her deficits improves self-esteem and self-efficacy.

Measurements of spirituality and religiousness Spirituality and religion play an important role in culture, identity, and health practices Musgrave et al. Health Assessment and Medical Examination Because women develop serious medical problems earlier in the course of alcohol use disorders than men, they should be encouraged to seek medical treatment early to enhance their chances of recovery and to prevent serious medical complications.

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