October 2006

What are some screening tools that can be used to assess youth substance abuse?

Screening procedures are extremely important tools in identifying substance use, abuse, and dependence. However, not all screening tools are equally effective – some are more likely to lead to false negatives and false positives. Performing an effective screening also depends on factors specific to each individual case. For example, some factors to consider are whether the person has been drinking or using substances recently, the rapport between the youth and the interviewer, and the assurance of confidentiality.

If they can be obtained, biological screenings are the most effective tools to determine if the client is abusing alcohol or drugs. These include:

• Blood alcohol level/breathalyzers
• MCV (Mean Corpuscular Volume)
• GGT (Gamma-Glutamyl Transferase)
• CDT (Carbohydrate-Deficient Tranferrin)
• Urine Toxicology Screens

Because biological screenings can be difficult or costly to acquire, or may undermine the client/practitioner relationship, using a questionnaire may be a better way to perform the screening. This form of screening can help practitioners identify the possibility of abuse/dependence, which could lead to a more in-depth assessment and referral to treatment if necessary.

Before using any of these screening tools, it is very important to establish a level of comfort with the client by explaining that you will be asking personal questions that you ask all of your clients and that the information will help you to provide the best possible care for them. It is important to assure the client that all responses will be confidential and that they do not have to answer any questions if they are uncomfortable.

Some of the primary structured questionnaire tools are:

• CAGE
• TWEAK
• AUDIT
• Brief MAST
• CRAFFT
• GAIN SS

The CAGE screening questions are as follows:

• Have you ever felt that you should Cut down on your drinking?
• Have people Annoyed you by criticizing your drinking?
• Have you ever felt bad or Guilty about your drinking?
• Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover ( Eyeopener)?

TWEAK asks similar questions, and is validated for women:

• How many drinks can you hold? (Tolerance)
• Have close friends or relatives worried… ? (W)
• Do you drink when you first get up? (Eye opener)
• Has a friend told ‘x’ you could not remember? (Amnesia)
• Do you feel the need to cut down on your drinking? (Kut)

The CRAFFT questionnaire asks:

• Have you ever ridden in a Car driven by someone (including yourself) who was "high" or had been using alcohol or drugs?
• Do you ever use alcohol or drugs to Relax, feel better about yourself, or fit in?
• Do you ever use alcohol/drugs while you are by yourself, A?
• Do your family or Friends ever tell you that you should cut down on your drinking or drug use?
• Do you ever Forget things you did while using alcohol or drugs?
• Have you gotten into Trouble while you were using alcohol or drugs?

The AUDIT (Alcohol Use Disorder Identification Test) assessment asks 10 questions about the quantity of alcohol the client consumes in given amounts of time, as well as addressing questions of guilt and concern of families and friends. Brief MAST also has 10 questions, but the questions are more centered around effects of drinking too much alcohol, such as “Have you ever been in a hospital because of drinking?,” “Have you ever been arrested for drunk driving or driving after drinking?” and “Have you ever neglected your obligations, your family or your work for two or more days in a row because you were drinking?”

One of the most useful screening assessments is the GAIN SS (Global Assessment of Individual Needs Short Screener) because it is focused on predicting who will have a diagnosis, is based on a formal measurement model, and is highly correlated with both diagnosis and dimensional measures from the full 2 hour GAIN. The GAIN SS has minimal screening requirements and only takes 5 minutes to administer. The questionnaire asks a total of 20 questions covering common psychological, behavioral or personal problems as well as recent drug/alcohol that the person may have had in the last month, 2-12 months, or more than one year. There are 5 items for substance disorders, 5 for internalizing disorders (e.g. depression, suicide, anxiety), 5 for externalizing disorders (e.g. behavioral disorders), and 5 for crime/violence.