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Appendix I: Description of screening tools 

From: Navigating Screening Options for Concurrent Disorders (© 2006 CAMH)

Screening for substance use problems

CAGE-AID

Description

The CAGE-AID is a four-item screening tool:

  • Have you ever thought you ought to Cut down on your drinking or drug use?
  • Have people Annoyed you by criticizing your drinking or drug use? 
  • Have you felt bad or Guilty about your drinking or drug use?
  • Have you ever had a drink or used other drugs first thing in the morning (Eye-opener) to steady your nerves, get rid of a hangover or get the day started?

The CAGE-AID was adapted from the original CAGE, which was designed to detect problem drinking. The CAGE-AID asks about lifetime use.

Population groups

The CAGE-AID is appropriate for use with adults and adolescents (over 16 years old).

Administration, scoring and interpretation

The CAGE-AID can be administered by an interviewer, self-administered in pencil-and-paper format or computer administered. It takes two minutes or less to administer. The instrument does not require any prior training. A score of two or more yes answers indicates that the client may be using substances at harmful or hazardous levels and needs a more comprehensive assessment.

Website

For more information about the CAGE-AID, see the Alcohol and Drug Abuse Institute (University of Washington) Substance Use Screening & Assessment Instruments Database. For Instrument name / Acronym, enter: CAGE Adapted to Include Drugs. Click Browse.

References

Mayfield, D, McLeod, G., & Hall, P. (1974). The CAGE questionnaire: Validation of a new alcoholism instrument. American Journal of Psychiatry, 131, 1121-1123

Fiellin, D.A., Reid, M.C. & O’Connor, P.G. (2000). Screening for alcohol problems in primary care: Systemic review. Journal of General Internal Medicine, 15 (Suppl. 1), 65-66.

GAIN Short Screener (GAIN-SS)

Description

The GAIN-SS is designed to identify people who are likely to have a mental health disorder and should have an full assessment. Because the GAIN-SS includes a subscale that screens for substance use disorders, we have included it in substance use screening tools list as well as the mental health screening tools list. The GAIN Substance Use Disorder Scale provides more detailed information about substance use problems.

The GAIN-SS has four subscales: 

  • internal disorders (somatic, depression, suicide, anxiety, trauma) 
  • behavioural disorders (attention deficit hyperactivity disorder, conduct disorder) 
  • substance abuse disorders (abuse, dependence)
  • behavioural crime/violence (interpersonal violence, property crime, drug-related crime).

Population groups

The GAIN-SS can be used with adolescents and adults.

Administration, scoring and interpretation

The GAIN-SS is designed for self-administration using paper and pencil or a computer.

Website

For more information, see the GAIN-SS website.

References

Dennis, M., Chan, Y.F., Funk, R. (In press). Development and validation of the GAIN Short Screener (GSS) for psychopathology and crime/violence among adolescents and adults. American Journal on Addictions.

 

GAIN Substance Use Disorder Scale (GAIN-SUDS)

Description

The GAIN-SUDS is a 16-item scale based on DSM-IV criteria for: 

  • substance abuse (consequences of use) 
  • substance dependence (tolerance, withdrawal, inability to control use)

The GAIN-SUDS is part of the Global Appraisal of Individual Needs. The substance abuse/dependence scale asks about both alcohol and other drug use.

Population groups

It can be used with adolescents and adults.

Administration, scoring and interpretation

Administration can be self-report, paper-and-pencil or computerized, and takes five to 10 minutes. A license agreement is required to use any of the GAIN family of instruments. Go to www.chestnut.org/LI/gain/index.html and click on Licensing Information for details.

Website

To view the GAIN-SUDS items, from the main Index click on the link Supporting Psychometrics, Crosswalks, Scales and Naming Conventions, and then on GAIN-I Scales and Variables, which will link you to the current version of the GAIN scales and variables file. Go over three tabs to Scales, scroll down to what you want and click on the link. It will take you to the exact location (the first is over 1,500 pages of documentation). If you select and print the column, you will get three pages on the measure, how it is calculated, relevant references, syntax and the actual items.

References

Dennis, M., Titus, J., White, M., Unsicker, J. & Hodkgins, D. (2002). Global Appraisal of Individual Needs (GAIN): Administration Guide for the GAIN and Related Measures (PDF). Bloomington, IL: Chestnut Health Systems. Accessed July24, 2006.

Note: The Global Appraisal of Individual Needs (GAIN) is an integrated series of measures that support: 

  • initial screening
  • biopsychosocial assessment (including diagnosis)
  • treatment planning
  • monitoring of changes in clinical status and service utilization

For more about the GAIN (including a downloadable GAIN manual and information about licenses), see the GAIN homepage.   

Psychiatric Diagnostic Screening Questionnaire (PDSQ)--alcohol/drug subscales

Description

The PDSQ includes two scales: 

  • alcohol abuse/dependence 
  • drug abuse/dependence.

These scales each include six items and measure current (in the past six months) abuse/dependence.

Population groups

The PDSQ has been widely used in outpatient mental health settings and is appropriate for adults 18 years and over.

Administration, scoring and interpretation

The PSDQ alcohol and drug subscales are designed to be self-administered. A score of more than one on either brief scale indicates probable abuse or dependence. A web-based version of the PDSQ is in development. See website (below) for information about fees for use of the PDSQ.

Website

The PDSQ is distributed by the commercial assessment test publisher Western Psychological Services (WPS). For more information, including how to purchase the PDSQ, see the WPS catalogue.

References

Zimmerman, M., & Mattia, J.I. (2001). A self-report scale to help make psychiatric diagnoses. The Psychiatric Diagnostic Screening Questionnaire. Archives of General Psychiatry, 58, 787-794.

Zimmerman, M., & Mattia, J.I. (2001). The Psychiatric Diagnostic Screening Questionnaire: Development, reliability and validity. Comprehensive Psychiatry, 42 (3), 175-189.

Zimmerman, M., & Sheeran, T. (2003). Screening for principal versus comorbid conditions in psychiatric outpatients with the Psychiatric Diagnostic Screening Questionnaire. Psychological Assessment. 15 (1), 110-114.

 

AUDIT

Description

The AUDIT is a 10-item questionnaire that screens for hazardous or harmful alcohol consumption.

Population groups

The AUDIT is particularly suitable for use in primary care settings and has been used with a variety of populations, including adult men and women, students, psychiatric clients, emergency room patients and people involved with the legal system. It has also been used been used in a variety of countries and would be suitable for use with a range of cultural groups.

Administration, scoring and interpretation

The AUDIT should be administered by a health professional or paraprofessional. Though a score of 8+ indicates an alcohol use disorder, it has been suggested that a lower cut-off score (4+) would be appropriate for women because women experience alcohol-related damage at lower levels than men. There has also been a suggestion that a lower cut-off score is appropriate for adolescents.

Website

The AUDIT manual, The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Care, can be downloaded from the World Health Organization website.:

References

Allen, J.P., Litter, R.Z., Fettig, J.B. & Babor, T. (1997). A review of research on the Alcohol Use Disorders Identification Test (AUDIT). Alcoholism: Clinical and Experimental Research,. 21, 613-619.

Maisto, S.A., Carey, M.P., Carey, K.B., Gordon, C.M. & Gleason, J.R. (2000). Use of the AUDIT and DAST-10 to identify alcohol and drug use disorders among adults with a severe and persistent mental illness. Psychological Assessment, 12 (2), 186-192.

Saunders, J.B., Aasland, O.G., Babor, T.F., De La Fuente, J.R., & Grant, M. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption II, Addiction, 88, 791-804.

In Navigating Screening Options for Concurrent Disorders:

Introduction

Screening for Substance Use and Mental Health Problems

The Roadmaps

Implementing Screening

References

Glossary

Appendix I: Description of Screening Tools

Appendix II: The Concurrent Disorders Screening and Assessment Tools Project

Acknowledgements

 

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