Substance Use Disorder Testing & Assessment

Substance Use Disorder Testing and Assessment

Accurate diagnosis and assessment of substance use disorder (SUD) requires comprehensive evaluation using evidence-based screening tools, laboratory testing, and clinical interview. These assessments guide treatment planning, measure severity, track progress, and support recovery.

At KwikPsych, Dr. Monika Thangada uses standardized clinical assessment tools combined with thorough history-taking to provide accurate diagnosis and personalized treatment recommendations.

Purpose of SUD Assessment

A comprehensive substance use assessment serves multiple purposes:

Diagnostic: Determines whether a person meets DSM-5 criteria for substance use disorder and identifies the specific substance(s) involved

Severity assessment: Mild, moderate, or severe classification guides intensity of treatment

Safety evaluation: Identifies withdrawal risk, medical complications, and suicide risk to determine appropriate level of care

Co-occurring condition identification: Screens for depression, anxiety, PTSD, bipolar disorder, and other psychiatric conditions that require concurrent treatment

Personalization: Gathers information to develop an individualized treatment plan

Baseline measurement: Provides objective measures for tracking treatment progress

Medical safety: Identifies health conditions that affect medication selection and medical safety during detoxification

Clinical Interview Components

The clinical assessment begins with a structured interview gathering detailed information about:

Substance Use History

Pattern of current use:

• What substance(s)?
• How much (quantity per use)?
• How often (daily, several times weekly, binges)?
• Route of administration (oral, inhaled, injected, snorted)?
• When did current pattern begin?

Progression over time:

• Age when first used
• Age when pattern became regular
• When did it become problematic?
• Escalation over time (more quantity, higher frequency)?
• Periods of abstinence?

Consequences of use:

• Legal problems (arrests, DUIs, incarceration)?
• Medical complications (overdose, infections, organ damage)?
• Employment consequences (job loss, disciplinary action)?
• Relationship damage?
• Financial loss?
• Academic impact?

Previous treatment attempts:

• When treated before?
• What type of treatment (inpatient, outpatient, MAT)?
• How long did treatment last?
• Was it voluntary or mandated?
• How long did recovery last after treatment?
• Why did they relapse?
• What worked and what didn't?

Withdrawal Assessment

Understanding withdrawal risk determines whether inpatient vs. outpatient detoxification is appropriate.

Substance-specific withdrawal danger:

• High-risk (potentially life-threatening): Alcohol, benzodiazepines
• Moderate (very uncomfortable, not medically dangerous): Opioids, cannabis, stimulants

Questions about withdrawal history:

• When you've stopped before, what symptoms did you experience?
• Tremors, sweating, confusion, seizures?
• How long did withdrawal last?
• Were you hospitalized or medically supervised?

Current risk factors:

• Heavy daily use over years (higher risk)
• Multiple prior withdrawals (kindling effect—each withdrawal becomes worse)
• Medical conditions that increase seizure risk
• Medications that interact with withdrawal or detoxification

Psychiatric and Medical Evaluation

Mental health screening: Current and past depression, anxiety, bipolar symptoms, PTSD, psychosis, ADHD

Medical history: Chronic conditions, medications, allergies, previous surgeries

Family history: Addiction, mental health conditions, medical illness

Psychosocial Assessment

Living situation:

• Safe housing?
• Living with substance users?
• Family support vs. conflict?
• Homelessness or instability?

Employment and finances:

• Currently employed?
• Stable work history?
• Financial support?
• Ability to pay for treatment?

Legal system involvement:

• Court-mandated treatment?
• Probation, parole, or ongoing charges?
• Impact on treatment planning and monitoring?

Motivation and readiness:

• What brings them in now?
• Are they ready to change?
• What are their goals?
• What are barriers?

Standardized Screening and Assessment Tools

AUDIT (Alcohol Use Disorders Identification Test)

Purpose: Screen for hazardous and harmful alcohol use and probable alcohol dependence

When used: Initial assessment for anyone reporting any alcohol use

The 10 questions:

1. How often do you have a drink containing alcohol?
2. How many drinks do you have on a typical day when you're drinking?
3. How often do you have 6 or more drinks on one occasion?
4. How often during the last year have you found that you were unable to stop drinking once you had started?
5. How often during the last year have you failed to do what was normally expected of you because of drinking?
6. How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?
7. How often during the last year have you had a feeling of guilt or remorse after drinking?
8. How often during the last year have you been unable to remember what happened the night before because you had been drinking?
9. Have you or someone else been injured as a result of your drinking?
10. Has a relative or friend or a doctor or other health worker been concerned about your drinking or suggested you cut down?

Scoring:

• Each question scored 0-4
• Total score: 0-40
• 0-7: Abstinence or low-risk use
• 8-15: Hazardous use (at-risk drinking without dependence)
• 16-19: Harmful use (some dependence symptoms)
• 20+: Probable alcohol dependence (meets DSM-5 SUD criteria)

Interpretation: Used to identify severity and guide treatment recommendations

Advantages: Well-validated, quick to administer, widely used in primary care and addiction settings

DAST-10 (Drug Abuse Screening Test)

Purpose: Screen for problems related to use of non-alcohol drugs

When used: Initial assessment for anyone reporting use of illicit drugs or prescription drug misuse

The 10 questions:

1. Have you used drugs other than those required for medical reasons?
2. Do you abuse more than one drug at a time?
3. Are you unable to control your drug use?
4. Have you ever had blackouts or flashbacks as a result of drug use?
5. Do you ever feel bad or guilty about your drug use?
6. Does your spouse (or parents) ever complain about your involvement with drugs?
7. Have you neglected your family because of your use of drugs?
8. Have you engaged in illegal activities in order to obtain drugs?
9. Have you ever experienced withdrawal symptoms (felt sick) when you stopped taking drugs?
10. Have you had medical problems as a result of your drug use (e.g., memory loss, hepatitis, convulsions, bleeding)?

Scoring:

• Each yes = 1 point, no = 0
• Total score: 0-10
• 0-2: No apparent problems
• 3-5: Low-level problems
• 6-8: Moderate problems suggesting significant impairment
• 9-10: Substantial or severe problems (likely meets SUD criteria)

Interpretation: Identifies problems related to drug use; can be adapted for specific substances

Advantages: Quick, reliable, widely used in addiction and mental health settings

CAGE Questionnaire

Purpose: Brief screening for alcohol use problems (quick version of AUDIT)

When used: Primary care, emergency departments, when time is limited

The 4 questions:

1. Have you ever felt you should Cut down on your drinking?
2. Have people Annoyed you by criticizing your drinking?
3. Have you ever felt Guilty about your drinking?
4. Have you ever had a drink first thing in the morning as an Eye-opener?

Scoring:

• 2+ affirmative responses: Suggests possible alcohol use disorder
• Each positive answer warrants further evaluation

Advantages: Very brief; can be administered in a minute; well-validated

Limitations: Less sensitive than AUDIT in certain populations; doesn't measure quantity/frequency; best used as initial screen followed by more comprehensive assessment

Clinical Institute Withdrawal Assessment for Alcohol Scale—Revised (CIWA-Ar)

Purpose: Quantify severity of alcohol withdrawal symptoms

When used: After patient stops alcohol use; used at initiation, 30 minutes after medication dose, and periodically to track withdrawal course

10 items assessed:

1. Nausea and vomiting (0-7): Visual observation and questioning
2. Tremor (0-7): Extended hands, tremor observed
3. Paroxysmal sweats (0-7): Observation and questioning
4. Anxiety (0-7): Patient's self-report and observation
5. Agitation (0-7): Observation
6. Tactile disturbances (0-7): Patient report of itching, pins/needles, burning, numbness
7. Auditory disturbances (0-7): Hallucinations reported or observed
8. Visual disturbances (0-7): Visual hallucinations reported or observed
9. Headache (0-7): Patient report
10. Orientation and clouding of sensorium (0-4): Assess confusion and awareness

Total score:

• 0-9: Mild withdrawal
• 10-18: Moderate withdrawal
• 19-24: Moderate to severe withdrawal (typically requires medication)
• 25+: Severe withdrawal, medical emergency (risk of seizures, delirium tremens)

Use: Guides medication dosing and hospitalization decisions; scores monitored every few hours during acute withdrawal to adjust treatment

Advantages: Objective measurement; used to guide treatment decisions; monitors progression

Clinical Opioid Withdrawal Scale (COWS)

Purpose: Quantify severity of opioid withdrawal symptoms

When used: After last opioid use; used to assess withdrawal severity and guide medication initiation and dosing

11 items assessed:

1. Resting pulse rate: Compared to patient's baseline; elevated = withdrawal symptom
2. Sweating: Observation based on ambient temperature and patient's report
3. Restlessness: Observation of ability to sit still
4. Pupil size: Observation of pupil dilation
5. Bone or joint aches: Self-reported aching in joints
6. Runny nose or tearing: Observation and patient report
7. GI upset: Stomach cramps, loose stools
8. Tremor: Hand tremor observed when hands extended
9. Yawning: Observed yawning (not counted if related to fatigue)
10. Anxiety or irritability: Patient report and observation
11. Gooseflesh skin: Observation of piloerection

Scoring:

• Each item scored 0-5
• Total score: 5-48
• 5-12: Mild withdrawal (can typically be managed outpatient)
• 13-24: Moderate withdrawal (may benefit from medication)
• 25-36: Moderately severe withdrawal (medication recommended)
• >36: Severe withdrawal (inpatient treatment often recommended)

Use: Determines appropriateness of outpatient vs. inpatient detoxification; guides buprenorphine or methadone dosing; monitored to track withdrawal course and medication response

Advantages: Objective, quantifiable; guides treatment decisions

Addiction Severity Index (ASI)

Purpose: Comprehensive multidimensional assessment of factors relevant to treatment planning and case management

When used: Initial assessment, and periodically throughout treatment to assess progress

7 domains assessed:

1. Medical status: General health, medical problems, medications, hospitalizations
2. Employment/support status: Occupational functioning, financial situation, income sources
3. Drug use: Frequency, route, type of substances, age of first use
4. Alcohol use: Quantity, frequency, age of first use, abstinence periods
5. Legal status: Criminal history, current legal problems, arrests
6. Family/social relationships: Quality of relationships, living situation, family substance use history
7. Psychiatric status: Mental health symptoms, hospitalizations, medications, current concerns

Output: Severity ratings for each domain on 0-1 scale (0 = no problem; 1 = significant problem)

Use: Comprehensive picture of areas of impairment; identifies co-occurring problems; tracks improvement across multiple life domains

Advantages: Multidimensional; captures complexity of SUD and its impact; useful for treatment planning and case management

Time required: 45-60 minutes

Laboratory Testing

Urine Drug Screen (UDS)

Purpose: Objective confirmation of substance use and monitoring during treatment

Standard immunoassay panel typically includes:

• Amphetamines (includes methamphetamine, MDMA/"ecstasy")
• Benzodiazepines (all benzodiazepines)
• Cannabinoids (marijuana/THC)
• Cocaine (cocaine and metabolites)
• Opioids (morphine, codeine, heroin metabolites)
• Phencyclidine (PCP)

Extended panels may add:

• Barbiturates
• Methadone
• Propoxyphene
• Tramadol
• Buprenorphine
• Tricyclic antidepressants
• Other substances

How it works:

• Urine specimen collected (supervised or unsupervised)
• Immunoassay testing identifies presence of substances
• Positive results can be confirmed by gas chromatography-mass spectrometry (GC-MS) for legal proceedings

Cutoff values:

• Standardized thresholds (e.g., 300 ng/mL for cocaine, 50 ng/mL for opioids)
• Distinguish incidental exposure from active use

Interpretation:

• Positive result: Substance detected above cutoff
• Expected (patient on buprenorphine or methadone): Confirms medication adherence
• Unexpected (substance of abuse): Indicates possible relapse
• Negative result: No substance detected
• If medication expected: May indicate non-adherence or metabolism issue

Monitoring during treatment:

• May be scheduled (e.g., monthly) or random
• Used to monitor abstinence
• Positive results don't equal treatment failure; rather, signal need for treatment adjustment

Important notes:

• UDS typically doesn't detect alcohol
• Results can be affected by medication use, foods, and other factors
• Confirmatory testing important if legal consequences involved

Breath Alcohol Testing

Purpose: Detect recent alcohol consumption

Timeline: Can detect alcohol consumed within last 2-3 hours

How it works:

• Breathalyzer device measures breath alcohol concentration (BrAC)
• Converted to blood alcohol concentration (BAC) equivalent
• Results immediate

Use during treatment:

• Verify abstinence in people with alcohol use disorder
• May be done randomly or on schedule
• Less invasive than urine testing

Limitations:

• Only detects recent consumption (not useful for detecting abstinence over days/weeks)
• Requires patient cooperation

Blood Testing

Baseline laboratory panel:

• Liver function tests (LFTs):
• AST, ALT, bilirubin, alkaline phosphatase
• Assess for alcohol-related liver disease (cirrhosis, hepatitis)
• Baseline for monitoring medication effects
• Complete blood count (CBC):
• Red and white blood cells, platelets
• Detect anemia, infection, bone marrow effects
• Comprehensive metabolic panel (CMP):
• Kidney function (creatinine, BUN)
• Electrolytes (sodium, potassium, chloride, CO2)
• Glucose, calcium
• Baseline for monitoring medication effects
• HIV and hepatitis B and C serology:
• Screen for infectious diseases (risk higher in IV drug users)
• Important for health monitoring and medication selection

Pregnancy testing:

• For women of childbearing age prior to medication initiation
• All MAT medications are Category C (animal studies show safety; limited human data)
• Important for medication decisions

Repeat labs during treatment:

• Liver function: Periodically to monitor for hepatotoxicity
• Metabolic panel: To monitor electrolytes and kidney function
• Frequency depends on baseline abnormalities and medications used

Screening for Co-Occurring Mental Health Conditions

Comprehensive SUD assessment includes screening for psychiatric disorders:

Mood Disorders

Questions assessing depression:

• Persistent sadness or hopelessness?
• Loss of interest in activities?
• Sleep changes?
• Weight or appetite changes?
• Fatigue?
• Difficulty concentrating?
• Feelings of worthlessness or guilt?
• Thoughts of death or suicide?

Questions assessing bipolar disorder:

• Periods of unusually elevated mood or energy?
• Decreased need for sleep?
• Racing thoughts or rapid speech?
• Grandiose beliefs?
• Risky behaviors?
• Irritability during elevated periods?

Anxiety Disorders

Questions assessing anxiety:

• Excessive worry?
• Panic attacks (sudden severe anxiety)?
• Social anxiety (fear of social situations)?
• Specific fears (phobias)?
• Physical anxiety symptoms (palpitations, sweating, tremor)?

PTSD

Screening for trauma exposure and PTSD:

• History of trauma?
• Intrusive memories of trauma?
• Avoidance of trauma reminders?
• Changes in thoughts/mood related to trauma?
• Hyperarousal (jumpiness, hypervigilance)?

ADHD

Assessment of attention and impulse control:

• Difficulty sustaining attention?
• Difficulty with organization?
• Impulsivity (interrupt others, speak without thinking)?
• History of childhood ADHD symptoms?
• Current functional impact?

Psychotic Disorders

Screening for hallucinations and delusions:

• Do you hear voices or see things others don't?
• Do you have beliefs that others think are strange?
• Distinguish substance-induced psychosis from primary psychotic disorder

Withdrawal Symptom Monitoring Tools

For alcohol withdrawal:

• CIWA-Ar: Quantifies severity; guides medication dosing
• Administered every few hours during acute withdrawal
• Tracks progression and treatment response

For opioid withdrawal:

• COWS: Quantifies severity; guides medication initiation and dosing
• Administered at baseline, 30 minutes after buprenorphine dose (to assess response), periodically throughout stabilization

Assessment Summary and Treatment Planning

After comprehensive assessment:

Diagnostic formulation:

• Substance use disorder diagnosis (DSM-5)
• Severity (mild, moderate, severe)
• Substances involved
• Withdrawal risk

Co-occurring conditions identified:

• Depression, anxiety, PTSD, bipolar disorder, etc.
• Medical conditions affecting treatment

Treatment recommendations:

• Level of care: Outpatient, intensive outpatient, inpatient
• Medications: MAT medications, psychiatric medications for co-occurring conditions
• Behavioral therapy: Type recommended (CBT, MI, group, family)
• Support services: Peer support groups, case management
• Monitoring plan: Lab testing, urine drug screens, follow-up frequency

Privacy and Confidentiality in Assessment

Substance use treatment is protected by federal confidentiality law (42 CFR Part 2), which provides stronger privacy protections than standard HIPAA:

• Information cannot be disclosed without written consent
• Exceptions: Emergency situations, legal exceptions (court order, child abuse)
• Your privacy is protected; treatment information won't be shared without your permission

Getting Assessed at KwikPsych

Initial appointment (60-90 minutes):

1. Comprehensive interview about substance use, medical history, psychiatric history
2. Administration of standardized screening tools (AUDIT, DAST-10, ASI, or others as indicated)
3. Physical examination
4. Ordering of appropriate laboratory testing
5. Discussion of assessment findings and treatment recommendations

Follow-up appointment (to review results and treatment plan):

1. Lab results reviewed
2. Detailed treatment plan discussed
3. Medication recommendations explained
4. Referrals to therapists and support services

Contact KwikPsych:

Phone: 737-367-1230

Address: 12335 Hymeadow Dr, Ste 450, Austin, TX 78750

Telehealth: Available across Texas

Cost:

• Insurance: Covered by 10+ major carriers
• Self-pay: $299 initial evaluation

Crisis Resources:

• Suicide & Crisis Lifeline: 988
• SAMHSA National Helpline: 1-800-662-4357
• Emergency: 911

Disclaimer: This content is educational. Professional assessment and treatment should be provided by qualified healthcare professionals. If you're in crisis, please contact emergency services.