Assessing Substance Use Patterns, Consequences, and Contexts

Some of these measures are part of larger, semistructured interviews administered by the therapist. The most commonly used assessments in this category are a family of instruments developed mainly in the Veterans Administration (VA) hospital system. The first instrument in this family is known as the Addiction Severity Index (ASI McLellan et al., 1985). The ASI assesses for a wide variety of biographical data, so it has the advantage of potentially being used as part of an intake interview. The ASI asks about consequences in a wide variety of life domains, and determines recent and lifetime patterns of drug and alcohol use. The ASI also detects recent and lifetime occurrence of problems in these different life domains (e.g., work). Each domain can be scored for the severity of the problems based upon the responses of the client and the clinical judgment of the interviewer. The ASI can be administered by computer to provide for rapid interpretation of answers. 

However, since instruments like the ASI do cover a breadth of material, they are not likely to give you as many details about a specific problem area as you may want when working with a client. The questions on these interviews are somewhat limited for each domain and sometimes the details are not fully assessed by the limited questions. For example, consumption-pattern questions on the ASI ask how many days a person may use or whether the person has problems with a particular substance, but do not assess how much is used each day and when, or what a particular pattern of use may be during a typical week. 

Beyond using measures that assess patterns and consequences of drug use, therapists and counselors may want to consider assessing other psychosocial factors that have been shown to be important in predicting successful (or unsuccessful) therapy and treatment outcomes (as discussed in Chapter 1). There are well-established measures for measuring psychosocial factors such as expectancies, mood and emotions, self-efficacy, the ability to problem solve and use 

Therapists and counselors also may wish to use one of several brief instruments that assess moods and emotions. These measures identify extreme emotional states that place the client at risk for drug use. A couple of the more well-known assessments include the Profile of Mood States (McNair, Lorr, Droppleman, 1992) and the Multiple Affect Adjective Check List (Herron, Bernstein, Rosen, 1968), which ask clients about various moods and emotions that they are experiencing at the moment. Furthermore, examining how the client socially interacts in therapy and treatment can identify strengths and weaknesses in the way a client is able to express emotions. If there are problems with identifying or expressing emotions, then the therapist or counselor can assess whether those problems are related to skill deficits. 

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