CLINICAL HANDBOOK OF SCHIZOPHRENIA

126 II. ASSESSMENT AND DIAGNOSISAssessmentsClinician Rating ScalesThe 5-point Clinician Rating Scale (CRS) is used to rate the extent of alcohol, cannabis,and cocaine abuse over the preceding 6 months. Patients are placed in one of five categories:abstinence, use without impairment, abuse, dependence, or dependence withoutinstitutionalization. The clinician is instructed to rate patients based on self-report, behavioralobservation, and collateral reports. The CRS has been used frequently in a numberof studies and has been found to have good reliability and validity.Drug Abuse Screening TestThe Drug Abuse Screening Test (DAST) is used to identify drug-use-related problems inthe past year. The DAST has been found to be internally stable and to discriminate betweenpatients with and without current drug dependence. This scale asks patients to answer10 yes–no questions on drug use. Patients are categorized as having no problems ifthey answer all questions “no” versus “low,” “moderate,” or “substantial” levels basedon responses.Michigan Alcoholism Screening TestThe Michigan Alcoholism Screening Test (MAST) is a simple, self-scoring scale that askspatients about alcohol use and related problems. It is frequently used in both clinical andresearch settings.CAGEThis is a brief scale that mental health providers can use to assess alcohol use. The questionsare as follows:C—Has anyone ever felt you should Cut down on your drinking?A—Have people Annoyed you by criticizing your drinking?G—Have you ever felt Guilty about your drinking?E—Have you ever had a drink first thing in the morning (Eye-opener) to steady yournerves or to get rid of a hangover?One positive response suggests a drinking problem; two or more positive responses indicatea problem with approximately 90% reliability in most research studies.DALIThe Dartmouth Assessment of Lifestyle Instrument (DALI), an 18-item questionnaire, isa useful screen for both current alcohol and drug (i.e., marijuana and cocaine) use disordersin people with severe mental illness.Addiction Severity IndexThe Addiction Severity Index (ASI) is one of the most widely used standardized instrumentsfor assessing substance use. It can be used for multiple purposes, such as to assessseverity of substance use or to assess periodic changes in patients’ substance use prior to,during, and after treatment.