What is the difference between screening and assessment for a substance use disorder (SUD)?

Screening for a substance use disorder is a quick way to either "rule-in" or "rule-out" the need for an assessment. An assessment is a more thorough evaluation that usually leads to a diagnosis. A good reference for deciding which tool to use is SAMHSA's - Treatment Improvement Protocol TIP 31: Screening and Assessing Adolescents For Substance Use Disorders.

Generally, screening takes 10 to 20 minutes and can be done by any qualified human service worker using a standardized screening instrument. The instrument should be standardized in published reports and known to provide accurate information for the population and risk being screened.

Assessment, on the other hand, can take anywhere from 45 minutes to 3 hours and should be performed, or at least reviewed, by a licensed clinician, who is qualified to develop a diagnosis. The assessment should lead to a "working" diagnosis, which should then evolve as treatment progresses.

Whenever possible, screening and assessment instruments should be comprehensive and include co-occurring disorders. In our system of care communities, most youth using substances have more than one diagnosis at intake. Similarly, the Center for Substance Abuse Treatment (CSAT) research studies commonly find the majority of youth with a substance use disorder have some other emotional or behavioral co-occurring disorder. Several tools are specifically designed to screen for youth co-occurring disorders.

Many treatment programs are choosing to use the following two tools:

Massachusetts Youth Screening Instrument (visit www.umassmed.edu/nysap/maysi2/what.cfm ) and Global Appraisal of Individual Needs-Quick (GAIN-Q; visit www.chestnut.org).

Our system of care communities need to decide what information is essential to meeting the needs of youth and families presenting for services. The agency also must consider what level or type of information is needed to determine an outcome, what after services have been delivered, and what is needed to fulfill funding requirements.

The required national evaluation already includes a substance use survey. This survey is being updated to better reflect current drug trends and the questions that many substance treatment agencies use. This survey information can also be used as a starting point for screening for risk of SUD. Although the evaluation tool is called a "survey," it is comprised of known risk indicators and measures of use. Thus, the survey does provide enough information to decide whether an assessment is necessary. Again, a more thorough evaluation would need to be administered before a professional can devise a diagnosis and treatment plan.