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

3. Psychological Evaluation 45substance use disorder between childhood and young adulthood (Tarter et al.,2003). These findings indicate that a core disorder of psychological selfregulationunderlies the risk for substance abuse (Tarter, Kirisci, Habeych,Reynolds, & Vanyukov, 2004). It should be emphasized, however, that there issubstantial population heterogeneity with respect to the expression of thesethree domains of psychological functioning. At the individual level, therefore,a disturbance may be confined to only one area of functioning, may pervade allpsychological domains, or (theoretically, at least) may not be present to a significantdegree in any of the three areas.METHODS OF PSYCHOLOGICAL ASSESSMENTThe overarching purpose of a psychological evaluation is to identify and quantifyseverity of problems integral to substance abuse that are amenable tomodification. Based on evaluation results, interventions can thus be directed atchanging the individual, the environment, or the quality of person–environmentinteraction to assist the client in terminating substance consumptionfrom the person’s behavioral repertoire.In addition to promoting an intervention strategy, psychological assessmentoffers the opportunity to monitor quantitatively changes occurring duringthe course of treatment. The use of brief standardized self-report checklists orrating scales, for example, facilitates objective and quantitative documentationof therapeutic progress. One multivariate instrument designed for this purposeis the revised Drug Use Screening Inventory (Tarter, 1990). The obtainedinformation not only provides ongoing feedback to the clinician but also servesthe purpose of goal setting for the client. Furthermore, demonstrating to the clientvia objective and quantitative indices that he or she is benefiting fromtreatment serves the important purpose of sustaining motivation for continuedinvestment in the rehabilitation. The following discussion reviews the mostcommonly used instruments for drug and alcohol assessment.Alcohol and Drug UseConsumption of alcohol and other drugs is closely linked to developmental processes.Not surprisingly, therefore, it unfolds in a more or less regular order.Typically, consumption begins with licit compounds (alcohol, tobacco) andprogresses, if at all, to the use of illicit drugs. Although much has been writtenabout the gateway hypothesis, in which drug use staging is presumably influencedby prior history of drug use (Kandel, 1975), the evidence to support thisspeculation is at best equivocal (Morral, McCaffrey, & Paddock, 2002). Rather,the progression across stages of substance use is most parsimoniously explained