Diagnosis. Diagnosing drug addiction (substance use disorder) requires a thorough evaluation and often includes an assessment by a. Addiction is a chronic condition that is difficult to diagnose and treat. While the signs can be clear, diagnosis first relies on the person with an. The 11 Official Criteria for Addiction/Substance Use Disorder. In the last edition of the DSM, DSM-IV, there were two categories: substance abuse and substance dependence. Substance use disorders are classified as mild, moderate, or severe, depending on how many of the diagnostic.
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The National Institute on Drug Abuse defines addiction as a chronic, relapsing brain disease. The symptoms of addiction can be different for everyone, but typically addiction includes the inability to stop taking drugs despite harmful effects, and withdrawal symptoms when the drugs are not ingested. Research shows that those with an addiction are twice as likely to have co-existing psychological disorders as the general population. In addition, those who have mental illness are twice as likely to struggle with addiction issues.
However, there is no clear evidence that one causes the other. Many drugs have side effects that mimic psychological and mental health disorders. For instance, long-term marijuana use has a connection with an increase in psychosis. Long-term cocaine addiction can cause paranoia. These side effects may be permanent even after an individual stops drug use. As a result, they must be treated as co-existing conditions. If the conditions have not been properly identified, those suffering from co-occurring disorders may not recognize that anything is wrong.
They may also believe that everyone feels as they do. If they are in a high-risk environment or see other people use drugs, drug use is seen as a way alleviate their sadness or anxiety.
Drug use also feels like a normal and appropriate solution. An individual who has been properly diagnosed may receive prescription medications for anxiety, stress or depression. When this occurs, there is a chance that he or she will misuse their prescriptions and develop a serious dependence on the drug. This can easily lead to addiction. Proper evaluation is an important first step.
At a quality treatment center, the recovering addict undergoes a series of psychological tests. This helps find the root of the addiction issue. These tests will help the treatment center staff develop a treatment program that might include:. When caring medical professionals surround a recovering addict, the individual will feel safe, secure and loved.
During treatment an individual is drug- and alcohol-free. The peaceful environment at The Canyon promotes healing. He will likely begin to feel the same panic that he experienced previously. Because of this, the cycle of drug abuse can restart with a dual diagnosis situation. However, if this individual is properly diagnosed with his anxiety disorder while in treatment, he can leave rehab with the proper prescription medication and education.
In addition, psychological counseling teaches healthy ways to deal with addiction issues as well as mental health issues. Mental health disorders can range from mild to severe. A recent review of trials to determine whether tricyclic antidepressants can help substance abusers with comorbid depression provides an illustrative example Nunes and Levin, Early trials demonstrated little or no benefit from the medications.
These trials admitted patients based on their current depressive symptoms as itemized in instruments such as the Hamilton Depression Scale Hamilton, or the Beck Depression Inventory Beck et al. Participants would have included some individuals who had comorbid major depression and others who were experiencing transient low moods related to intoxication, withdrawal, or stress reactions.
More recent studies, in contrast, admitted only individuals who met formal diagnostic criteria for major depressive disorder, which include persistent symptoms over a period of time.
Some recent studies also delayed assessment until candidates had been abstinent for a week to ensure that they were past withdrawal. The assessment instruments we will discuss, with the exception of the ASI, all elicit the information required to diagnose substance use disorders and other psychiatric disorders according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision DSM-IV; American Psychiatric Association, Where the instruments differ is in.
A fully structured assessment instrument is a script. It specifies the questions the interviewer is to ask, exactly as written, as well as a choice of responses for the interviewee. When asking the questions, the interviewer skips some, based on patient characteristics or previous responses, and avoids adding probes of his or her own.
Both formats have advantages and disadvantages. Fully structured interviews are economical. They require no clinical judgment, so trained lay interviewers can administer them. They generally take less time to administer.
Many large research studies and large treatment facilities use fully structured instruments, because staff members with little experience can perform the initial and followup assessments. Many assessment instruments are modular, permitting flexibility in the choice of sections used and diagnoses assessed. Thus, for example, researchers or clinicians who do not encounter psychotic individuals because of program regulations or a research protocol may omit a psychosis module.
Several structured and semi-structured diagnostic interviews are available in computer-assisted formats. Interviewers read questions to interviewees and enter responses into a computer rather than a paper form. Further, computerized administration saves many hours of data entry and avoids the errors that can occur in transferring data from paper into a computer database for analysis. Computerizing the logic of the interview also reduces the need for post-interview data cleaning.
The data go directly into a database that can immediately generate reports and statistics. Prior to adopting these measures, a CTN workgroup evaluated many measures for reliability, validity, efficiency, and suitability for widespread use in nonresearch settings.
All the instruments discussed in this article are highly reliable and valid, but the extent of their reliability or validity may differ in particular situations. The question of reliability is: Will users of the instrument consistently reach the same diagnostic conclusions? A straightforward and rigorous way to answer this question is the test-retest method. Two or more clinicians use the instrument to conduct independent assessments of the same patient, and the degree of correlation among their findings is calculated.
Generally, a test-retest kappa score of 0. The question of validity is: Does the instrument truly and unambiguously assess the condition it is designed to evaluate? This question has more dimensions than the estimation of reliability; accordingly, validity is estimated with a number of methods.
Brief descriptions of these instruments follow. For a summary comparison of their properties, see Table 1. The ASI provides information that clinicians can use to address these problems with appropriate interventions or referrals. Finally, the administrator calculates a composite score from a subset of the distress and treatment need responses.
This score becomes the basis for treatment planning. Altogether, the ASI takes approximately 45 to 60 minutes to administer, plus 10 to 20 minutes for post-interview scoring. The year saw the publication of an epochal document in psychiatry: The DSM-III provided clinicians and researchers with standardized definitions and diagnostic criteria for more than psychiatric disorders, including substance abuse and dependence disorders.
Prior to this publication, clinicians and researchers commonly used the same diagnostic terms to mean different things, and clinicians often disagreed on whether patients had specific disorders Spitzer, Endicott, and Robins, ; Spitzer and Fleiss, Substance abuse professionals engaged in semantic debates over the definition of addiction—even over the very existence of such a condition. Some patients seeking treatment report too few symptoms to meet the criteria for either diagnosis.
In these cases, the specific symptoms, symptom clusters, and the severity of associated problems can inform effective strategies for intervention and management. Drug or alcohol dependence is diagnosed by documenting that a patient has experienced at least three of seven criteria for a particular substance within a month period.
Withdrawal, in particular, predicts medical problems and poor outcome Hasin et al. Alternatively, a symptom or criteria count can function as a measure of dependence severity Hasin et al. The DSM-IV lists substance-specific intoxication and withdrawal symptoms for most of the common classes of drugs. Planners for the DSM-V are considering the addition of a withdrawal syndrome for cannabis. Test-retest studies have repeatedly shown good to excellent reliability for the diagnosis of substance dependence with the DSM-IV Bucholz et al.
The DSM-IV substance dependence diagnosis also shows good validity in two forms of multi-method comparisons. The other compares diagnoses from a single system such as DSM-IV produced by different diagnostic interviews Cottler et al. Studies of families with alcohol problems have validated the criteria for the substance dependence diagnosis.
In addition, animal models support the validity of many elements of dependence Robinson, ; Tapper et al. Patients who do not meet the criteria for substance dependence may be diagnosed with substance abuse if they report experiencing one or more of four abuse symptoms repeatedly over a month period.
Many clinicians have questioned the separation of substance dependence and substance abuse. Studies have shown that the DSM criteria for abuse are less valid than those for dependence. However, these studies diagnosed substance abuse hierarchically, meaning that an abuse diagnosis was considered to be redundant if dependence was present.
Women and minorities appear especially likely to experience dependence without abuse Hasin et al. Studies that assessed abuse regardless of whether dependence was present showed better reliability for the criteria for abuse Bucholz et al. In summary, the DSM-IV hierarchical status of abuse is problematic, but the criteria yield reliable diagnoses.
Extensive comorbidity between substance use disorders and other psychiatric disorders has been reported consistently in patients Nunes, Hasin, and Blanco, as well as in the general population Grant et al.
Such comorbidity can be serious. For example, studies with acceptable response rates 70 percent or more and reliable diagnostic assessments have consistently found an adverse effect of major depression on the outcome of substance use disorders Hasin, Nunes, and Meydan, Further, among patients with histories of substance dependence and major depression, the occurrence of a major depressive episode during periods of sustained abstinence predicts a higher number of suicide attempts Aharonovich et al.
To be accurate, assessments must address the fact that substance intoxication and withdrawal can mimic symptoms of depression, psychosis, or other independent psychiatric disorders. Psychiatric disorders that co-occur with substance intoxication or withdrawal can be considered primary if 1 symptoms substantially exceed the expected effects of the substance in the amount that was used; 2 there is a personal history of psychiatric symptoms during periods of extended abstinence; 3 the onset of psychiatric symptoms clearly preceded the onset of substance use; and 4 symptoms persisted for at least a month after the cessation of intoxication or withdrawal.
Symptoms that are not considered primary fall into the category either of expected effects of a substance or of a substance-induced disorder that exceeds intoxication or withdrawal effects and deserves independent clinical attention. Several studies have demonstrated good to excellent reliability and validity for the instrument Butler et al.
Three of the seven ASI domains medical conditions, use of alcohol, and psychiatric disorders have high internal consistency across studies, while the other four are more variable. Correlations between domains are usually low, except those between the drug and legal measures and those between the psychiatric and social impairment measures.
The ASI, by itself, may not be a highly reliable screen for special populations, such as the homeless or dually diagnosed. Standardized training is available and consists of a 2-day classroom component and materials for independent study see www. Many community programs include the ASI in their initial assessment battery, but informal reports suggest that some look upon it as merely required paperwork and use its information minimally, if at all, in treatment. For each substance use disorder, the CIDI elicits other information useful for treatment planning, such as the patterns and course of alcohol and drug use.
Various versions and adaptations of the original CIDI have been developed. The University of Michigan version, the UM-CIDI, has been used in a large international epidemiological survey Wittchen and Kessler, , but appears to produce lower prevalence estimates than other diagnostic instruments Wittchen et al. Programs or projects may use the CIDI substance use sections alone or combine them with other sections to achieve the desired range of assessment. To meet the particular needs of the substance abuse field, researchers have developed the CIDI Substance Abuse Module CIDI-SAM , an expanded version of the original CIDI substance use section that elicits detailed information on such areas as the onset and history of substance abuse, withdrawal symptoms, common comorbidities, social consequences, and treatment history Cottler, Robins, and Helzer, ; Horton, Compton, and Cottler, ; epi.
The reliability of the CIDI, version 3. Concordance for alcohol dependence with or without abuse was excellent; concordance for drug dependence with or without abuse was fair; and concordance for alcohol abuse and drug abuse was good. The SCID is available in different versions for researchers and clinicians. Additionally, the research version is available in formats for patients, nonpatients, and patients with psychotic disorders. The semi-structured SCID is designed for administration by interviewers with clinical expertise, but research assistants having extensive experience with a population under study have sometimes learned to administer it successfully.
After an open-ended overview and brief general screening, the interviewer takes the patient through the questions on the form, following up as needed based on clinical judgment to clarify responses. The instrument is modular, so clinicians can make use of only those sections that pertain to assessment aims.
It contains a minimal number of nondiagnostic items to keep administration time as brief as possible. A small test-retest study of 52 patients with DSM-IV diagnoses showed excellent reliability for substance use disorders Zanarini et al. In addition, an hour videotape training program is available with examples of interviews with actual patients. In addition to alcohol, tobacco, and other drug use, modules address treatment and family history.
Numerous queries address the frequency and quantity of use of each type of alcohol e. Its test-retest reliabilities for alcohol and drug consumption, abuse, and dependence, as well as those for other modules, were good to excellent Grant et al.
Along with abuse and dependence diagnoses for specific substance categories, clinicians and researchers can use the PRISM to make current and lifetime DSM-IV diagnoses of Axis I and Axis II disorders that commonly occur with substance abuse, such as mood, anxiety, and psychotic disorders. The PRISM sections on substance use disorders are placed at the beginning of the interview and provide a background for the overall clinical picture. The timeline is the only part of the PRISM that is conducted in an unstructured format, and timeline information is not coded for data entry.
The purpose of the timeline is to assist in differentiating primary versus substance-induced symptoms in later diagnostic sections. PRISM developers incorporated two features into the instrument to avoid the lengthy administration time associated with many standardized interviews.
First, diagnostic sections are modular, so the instrument can be tailored to fit specific treatment or research needs. A recent test-retest study of heavy substance users showed good to excellent reliability for most dependence diagnoses, including alcohol, cocaine, heroin, cannabis, and sedative dependence Hasin et al.
A computer-assisted version, which will include questions on marijuana withdrawal and modules for nicotine-related disorders, pathological gambling, and attention deficit hyperactivity disorder, will be available in Derived from the Semi-Structured Assessment for the Genetics of Alcoholism, the SSADDA provides extensive coverage of the physical, psychological, social, and psychiatric manifestations of cocaine and opioid abuse and dependence in addition to a number of related Axis I and Axis II disorders.
A standout feature of the SSADDA is its inclusion of questions about the onset and recency of individual alcohol and drug symptoms, permitting a temporal assessment of symptom clusters.
Information about the timing of symptoms is particularly helpful in distinguishing comorbid disorders from intoxication or withdrawal effects. The reliability of individual dependence criteria in the SSADDA has been tested to determine the extent to which independent interviewers arrive at the same diagnostic conclusions. Overall, the inter-rater reliability estimates were excellent for individual DSM-IV criteria for nicotine and opioid dependence; good for alcohol and cocaine dependence; and fair for dependence on cannabis, sedatives, and stimulants Pierucci-Lagha et al, Further information can be obtained by contacting Dr.
The publication of the DSM-III ushered in a period of standardized assessment and diagnosis in mental health research. Several widely used structured and semi-structured instruments for assessing dependence, co-occurring psychiatric disorders, and associated problems have shown good reliability, validity, and acceptance in clinical research settings. These instruments are now being used in community settings to inform treatment planning and case management.
Regardless of their original purposes, all of the measures described in this paper can be used for both research and treatment. The decision to use one instrument rather than another will depend on a number of practical considerations. Reliability and validity often vary considerably between specific drug categories. Thus, a review of the strength of the specific drug diagnoses of interest is important. Users will need to consider whether disorders other than substance use or other characteristics of interest are covered and, when necessary, if the instrument is available in a language other than English.
Staff level of experience and training costs are also key factors in evaluating the appropriateness of an instrument for a particular research or treatment setting. Most of the measures are in modular format. Substance disorder and other modules, along with a measure of problem severity like the ASI, can serve as the basis of a thorough intake interview and, as the patient progresses through treatment, can be used to assess changes in status systematically.
Modules from different instruments can be combined, but this can be complicated if computer-assisted versions are used. In addition, even the most user-friendly computer-assisted instruments require staff with technical know-how, and computer and software costs and licensing fees can be high in relation to budget allowances. Conversely, paper-and-pencil versions consume additional staff time for data cleaning and data entry, require repeated printing, and can take up a great deal of storage space, depending on the sample or patient population size.
Thus, a thorough cost estimate is needed before deciding whether to use a paper-and-pencil or computerized format. The authors wish to thank Ms. Valerie Richmond for editorial assistance and manuscript preparation.
National Center for Biotechnology Information , U. Addict Sci Clin Pract. Sharon Samet , M. Author information Copyright and License information Disclaimer. See commentary " Response: This article has been cited by other articles in PMC. Abstract Efficient, organized assessment of substance use disorders is essential for clinical research, treatment planning, and referral to adjunctive services. Open in a separate window. Where the instruments differ is in Format—that is, whether they are fully structured or semi-structured;.
Convenience Features Many assessment instruments are modular, permitting flexibility in the choice of sections used and diagnoses assessed. Home-study CDs, classroom training 2. Continued use despite knowledge of having a persistent or recurrent physical or psychological problem likely to have been caused or exacerbated by the substance.
Numbers are codes for recording the four responses. How much do you drink? Has there ever been a time in your life when you had five or more drinks on one occasion?
Diagnosing a drug addiction requires assessment by a medical or mental health professional. A thorough diagnosis often includes assessment by multiple. Addiction to drugs or alcohol affects millions of people nationwide. Learn more about how a substance abuse problem develops, warning. Learn what drug addiction is, the signs, risk factors and more in this article. If you or a loved one is struggling with a drug addiction, call us today.