Clinical assessment of substance use disorders
- Karen L Dugosh, PhD
Karen L Dugosh, PhD
- Senior Scientist
- Treatment Research Institute
- John S Cacciola, PhD
John S Cacciola, PhD
- Senior Scientist
- Treatment Research Institute
- Adjunct Professor of Psychology in Psychiatry
- Perelman School of Medicine at University of Pennsylvania
- Section Editors
- Richard Saitz, MD, MPH, FACP, DFASAM
Richard Saitz, MD, MPH, FACP, DFASAM
- Section Editor — Substance Use Disorders
- Professor of Community Health Sciences and Medicine
- Boston University Schools of Public Health and Medicine, Boston Medical Center
- Andrew J Saxon, MD
Andrew J Saxon, MD
- Section Editor — Substance Use Disorders
- Professor and Director, Addiction Psychiatry Residency Program, Department of Psychiatry & Behavioral Sciences
- University of Washington
Substance use disorders (SUDs) are highly prevalent. According to a 2015 national survey in the United States, approximately 8 percent of individuals age 12 or over had a diagnosable SUD in the past year, including about 6 percent with an alcohol use disorder and 3 percent with an illicit drug use disorder . Illicit drug use and nonmedical use of medications alone or in combination with alcohol are associated with a substantial proportion of emergency department visits in the United States .
A thorough substance use assessment includes a detailed inventory of the type, amount, frequency, and consequences of the patient's substance use, their perception of their use and readiness to change, an assessment of co-occurring psychiatric disorders, a medical history, physical examination and laboratory tests, the presence of substance use disorder in the patient's family, and review of social factors that may contribute to substance use or facilitate treatment.
The clinical assessment of substance use disorders is reviewed here. Screening for substance use is reviewed separately. The clinical presentation and diagnosis of SUDs specific to individual classes of substances are also reviewed separately. (See "Screening for unhealthy use of alcohol and other drugs in primary care" and "Risky drinking and alcohol use disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis" and "Opioid use disorder: Epidemiology, pharmacology, clinical manifestations, course, screening, assessment, and diagnosis" and "Methamphetamine use disorder: Epidemiology, clinical manifestations, course, assessment, and diagnosis" and "Cocaine use disorder in adults: Epidemiology, pharmacology, clinical manifestations, medical consequences, and diagnosis" and "Cannabis use and disorder: Epidemiology, comorbidity, health consequences, and medico-legal status".)
Patients receive a substance use disorder (SUD) assessment when the possibility of an SUD has been established, for example, through screening, history, or one or more clinical findings. The purpose of a comprehensive SUD assessment is to:
●Determine the type and severity of a patient’s substance use
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- SUBSTANCE USE
- Type, frequency, and amount
- - History of prior SUD, treatment
- Route of administration
- MENTAL HEALTH
- Mental status examination
- GENERAL MEDICAL
- Physical examination and medical history
- Laboratory tests
- FAMILY HISTORY
- SOCIAL HISTORY
- DSM-5 diagnostic criteria
- - Severity
- - Diagnostic tools
- Multidimensional assessment
- Progress monitoring
- Withdrawal potential
- APPLICATION TO TREATMENT PLANNING
- SUMMARY AND RECOMMENDATIONS