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

25. Adolescent Substance Abuse 571Abuse Subtle Screening Inventory—Adolescent Version (SASSI-A; Miller,1990). Comprehensive assessment instruments usually provide more detailedinformation about substance use behavior, as well as other domains offunctioning. The formats for comprehensive instruments vary, with some beingself-report questionnaires (e.g., Personal Experience Inventory [PEI]; Winters& Henly, 1988), others being structured interviews (e.g., Adolescent DrugAbuse Diagnosis [ADAD]; Friedman & Utada, 1989), and still others beingsemistructured interviews (e.g., Adolescent Problem Severity Index [APSI];Metzger, Kushner, & McLellan, 1991; Teen Addiction Severity Index [T-ASI];Kaminer, Bukstein, & Tarter, 1991; Kaminer, Wagner, Plummer, & Seifer,1993); and the Global Appraisal of Individual Needs [GAIN]; Dennis, Titus,White, Unsicker, & Hodgkins, 2003).Toxicology of bodily fluids, usually urine, but also blood and hair samples,can be used as a screen to detect the presence of specific substances for both initialassessment and as an ongoing check for substance use. The optimal use ofurine screens requires proper collection techniques, including visual proof ofsample authenticity, evaluation of positive results, and a specific plan of actionshould the specimen be positive for the presence of substance(s) (Casavant,2002; Cole, 1997). Clinicians should establish rules regarding the confidentialityof the results prior to testing.LEVEL OF CAREPlacement of adolescents with SUDs at a particular level of care is based onseveral factors. Dispositional options (triage) involve a variety of possibilities,which may also depend on service availability. Despite certain inherent advantagesof residential programs in terms of intensity and control, the generalizationof improvement made during these programs is uncertain. More emphasisshould be given to community-based programs that may guide the adolescentand his or her family through their real-life problems and experiences.Appropriate referrals to an inpatient unit or residential program mayinclude (1) adolescents with SUDs who have either failed or do not qualify foroutpatient treatment; (2) dually diagnosed adolescents with moderate or severepsychiatric disorders; (3) adolescents who display a potentially morbid or mortalbehavior toward themselves or others (e.g., suicidal and self-injurious behavior);(4) adolescents who are intravenous drug abusers, drug dependent, or needto be detoxified; (5) patients with accompanying moderate-to-severe medicalproblems; (6) adolescents who need to be isolated from their community toensure treatment without interruptions; and (7) pregnant adolescents whomanifest SUDs that endanger the fetus (Kaminer, 1994).Enrollment criteria in a drug-free outpatient or partial hospitalization settinginclude (1) SUDs and other psychiatric disorders that do not require inpa-