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Article Excerpt
Adolescent substance abuse is an increasing problem in U.S. society. This article provides an overview of adolescent substance abuse, screening, and assessment strategies; contact information related to specific assessment instruments; and information regarding ethics important to consider during the assessment process.
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In 1990, it was estimated that more than 5 million persons in the United States had a diagnosable substance abuse problem (National Institute on Drug Abuse, 1990). By the late 1990s, the United Nations Office for Drug Control and Crime Prevention (2000) estimated that 180 million people worldwide--4.2% of people ages 15 years and above--were consuming illicit drugs. According to the report issued in 2002 by the National Household Survey on Drug Abuse (NHSDA), a project of the Substance Abuse and Mental Health Services Administration (SAMHSA), an estimated 15.9 million Americans ages 12 and older used illicit drugs in the month immediately prior to the interview for the survey. This represents an estimated 7.1% of the population in 2001, compared with an estimated 6.3% of the population of American ages 12 and older who used illicit drugs during 2000 (SAMHSA, 2002).
The incidence of adolescent illicit drug use also continued to rise. The NHSDA report (SAMHSA, 2002) revealed that in the United States, approximately 10.1 million people between the ages of 12 to 20 years reported current use of alcohol in 2001. This is 28.5% of the population, a population for whom alcohol is an illicit substance. Of these 10.1 million people, 6.8 million (19% of the total population ages 12-20) were identified as binge drinkers and 2.1 million (6% of the total population ages 12-20) were considered heavy drinkers. A major factor associated with drinking among young adults ages 18 to 25 years was the fact that 22.8% drove under the influence of alcohol. In 2001, 10.8% of youths 12 to 17 years old were current drug users, compared with 9.7% in 2000 (SAMHSA, 2002). In addition, there was a significant increase in the estimated number of people ages 12 and older requiring treatment for an illicit drug problem between 2000 and 2001. This number increased significantly from 4.7 million to 6.1 million during that same period. Also, there was an increase from 0.8 million to 1.1 million in the number of persons receiving treatment at a specialty facility; however, the number of people needing but not getting appropriate treatment increased from 3.9 million to 5 million (SAMHSA, 2002). Of more concern is the finding that of the 5 million people who needed but did not receive treatment, an estimated 377,000 indicated that they believed that they needed treatment for their drug use. Included in this number is an estimated 101,000 who reported that they made an effort to get treatment but were unable to do so.
Many members of the helping professions lack clinical skills related to screening and assessing adolescent substance use. Inevitably, detailed knowledge and direct experience are necessary to gain expertise in screening and assessment for substance abuse in adolescents. For example, understanding and empathizing with youths during screening and assessment interviews may be enhanced if the counselor has knowledge of characteristic developmental tasks, transitional issues, and life roles of adolescents (Copans & Kinney, 1996). However, a basic understanding of risk factors for substance abuse in adolescence, specific interviewing processes and procedures, and information on assessment resources can provide mental health professionals with a structure from which future clinical skills will develop. This article is intended as a primer to help counselors learn which adolescents to screen for substance abuse, what information to gather, how to complete a comprehensive assessment, and which legal considerations to monitor during the assessment process.
Screening and Assessing for Substance Abuse
Screening refers to the gathering of information in varied and broad areas for the purpose of evaluating whether or not a comprehensive assessment is necessary. The screening process does not result in detailed, definitive information that is useful in diagnosing and treating substance abuse; thus, the main purpose of screening is to identify red flags that may indicate serious substance-related problems (Rahdert, 1991). In general, the screening process, using brief instruments, should last between 10 to 15 minutes and should rarely take longer than 30 minutes. However, more elaborate screening instruments take an average of 45 minutes. According to SAMHSA (1994), the hallmarks of an effective screening program are its ease and quickness of use and its broad applicability across diverse clientele.
The substance use/abuse screening process often occurs as part of a brief semistructured interview. During the interview, the counselor should focus primarily on the overall possibility of substance use or abuse and its level of severity. In addition, the counselor should generally inquire about psychological symptoms (e.g., depression), home life, and school status, particularly because problems in these areas often correlate with substance use or abuse. The primary source of information during screenings is the client; secondary information is often obtained from parents or guardians. Although relatively short interviews are certainly the most common means for screening for substance abuse, the use of brief questionnaires (e.g., 5-10 minutes) may also be useful and efficient (Center for Substance Abuse Treatment [CSAT], 1999). For information about various instruments, see the Screening and Assessment Inventories...
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