Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

570 V. TREATMENTS FOR ADDICTIONSprocess. An initial screening phase involves identification of health disorders,psychiatric problems, and psychosocial maladjustment. Based on the screeningphase, a minority of adolescents are required to go through the second extensiveassessment phase. This assessment provides a diagnostic summary that identifiesthe adolescent’s treatment needs within specific life domains, such as substanceuse, psychiatric status, physical health status, school adjustment, vocational status,family function, peer relationship, leisure and recreation activity, and legalsituation. The third phase involves the preparation and implementation of anintegrated, problem-focused, and comprehensive treatment plan.Substance use and SUDs are multidimensional behaviors that demand athorough assessment of several dimensions of substance use behavior in additionto quantity and frequency of use. Within the domain of substance usebehavior, important dimensions include the pattern of use (quantity, frequency,onset, and types of agents used), negative consequences (school–vocational,social–peer–family, emotional–behavioral, legal and physical), context of use(time–place, peer use–attitudes, mood antecedents, consequences, expectancies,and overall social milieu), and control of use (view of use as a problem,attempts to stop or limit use, other DSM-IV-TR dependence criteria).Clinicians frequently question whether any self-report by an adolescentabout substance use is accurate. Self-reports may, however, provide reliable andvalid information, particularly when no legal contingencies for drug use arepending (Barnea, Rahav, & Teichman, 1987; Winters, 1992). The clinicianmay attempt to substantiate suspected use by reports from third parties orthrough the use of urine or blood toxicology. Parents, however, tend tounderreport their child’s level of drug involvement and resulting problems(Burleson & Kaminer, in press; Winters, Stinchfield, & Opland, 2000).A variety of instruments are available and others are being developed toassist in the screening and detailed assessment of substance use, and relatedbehaviors and problems. Although readers are referred elsewhere for a moredetailed discussion of individual instruments (Leccese & Waldron, 1994; Winters,Latimer, & Stinchfield, 2001), we provide several examples of types ofinstruments.Screening instruments are used to identify the potential presence of SUDas a preliminary step toward a more detailed, comprehensive assessment,although many substance use/abuse screening instruments are designed to measurethe substance use domain only, such as the CAGE (cut down, annoyed,guilty, eye opener) developed by Ewing (1984). The CRAFFT (car, relax,alone, forget, friends, trouble), a longer, modified version of the CAGE,has shown superior psychometric properties (Knight, Sherritt, Shrier, Harris,& Chang, 2002). Other instruments screen other domains for psychosocialfunctioning; Problem-Oriented Screening Instrument for Teenagers (POSIT;Rahdert, 1991); Drug Use Screening Inventory (DUSI; Tarter, 1990); PersonalExperience Screening Questionnaire (PESQ; Winters, 1992); and Substance