Substance Use Assessment & Treatment

Related to the individual:

• Being male
• Tendency for disinhibited behaviour (e.g. engaged in risk-taking behaviours in childhood)
• Early age of first use (e.g. risk of alcohol dependence is 4x higher for people who first tried alcohol before the age of 15 years, compared to before the age of 20 years)
• Personal beliefs (e.g. beliefs that substance use does not have a negative impact on health, or lack of belief in conformity or moral order)
• Low self-esteem
• Underachievement at school or low commitment to school
• Traumatic experiences (e.g. abuse as a child, or being bullied)
• Childhood ADHD or conduct disorder
• Other mental disorders (e.g. depression, anxiety)
• Poor coping skills (e.g. responding to interpersonal conflicts in an aggressive manner)
  
  

Related to the family:

• Parents or family members have a substance use disorder (heritability of substance dependence is estimated at 30-60%)
• Parental attitude towards drugs and alcohol and parental role-modelling (e.g. seeing parents engaging in drug use)
• Low parental monitoring or discipline
• Poor family cohesion
• Patterns of negative communication in the family
  
  

Related to the community and society:

• Peers use drugs or alcohol
• Drugs or alcohol are readily available
• Acceptability of substance use
  
  

References

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C: American Psychiatric Association.

2 White, V. B., & Bariola, E. (2013). Australian secondary school students' use of tobacco, alcohol, and over-the counter and illicit substances in 2011. Report prepared for: Drug Strategy Branch Australian Government Department of Health and Ageing. December 2012.

3. Australian Institute of Health and Welfare 2011. Young Australians: their health and wellbeing 2011. Cat. no. PHE 140 Canberra: AIHW

4. Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593-602.

5. Reavley, N. J., Cvetkovski, S., Jorm, A. F., & Lubman, D. I. (2010). Help-seeking for substance use, anxiety and affective disorders among young people: results from the 2007 Australian National Survey of Mental Health and Wellbeing. Australian and New Zealand Journal of Psychiatry, 44(8), 729-735.

6. Gore, F. M., Bloem, P. J., Patton, G. C., Ferguson, J., Joseph, V., Coffey, C., ... & Mathers, C. D. (2011). Global burden of disease in young people aged 10-24 years: a systematic analysis. The Lancet, 377(9783), 2093-2102.

7. Begg S, Vos T, Barker B, Stevenson C, Stanley L, Lopez AD, 2007. The burden of disease and injury in Australia 2003. PHE 82. Canberra: AIHW.

8. National Health and Medical Research Council (Australia). (2009). Australian guidelines to reduce health risks from drinking alcohol. Canberra: National Health and Medical Research Council.

9. Bonomo, Y., Coffey, C., Wolfe, R., Lynskey, M., Bowes, G., & Patton, G. (2001). Adverse outcomes of alcohol use in adolescents. Addiction, 96(10), 1485-1496.

10. Masten, A. S., Faden, V. B., Zucker, R. A., & Spear, L. P. (2008). Underage drinking: A developmental framework. Pediatrics, 121(Supplement 4), S235-S251.

11. Macleod, J., Oakes, R., Copello, A., Crome, I., Egger, M., Hickman, M., ... & Smith, G. D. (2004). Psychological and social sequelae of cannabis and other illicit drug use by young people: a systematic review of longitudinal, general population studies. The Lancet, 363(9421), 1579-1588.

12. Riggs, P., Levin, F., Green, A. I., & Vocci, F. (2008). Comorbid psychiatric and substance abuse disorders: recent treatment research. Substance Abuse, 29(3), 51-63.

13. Teesson, M., Slade, T., & Mills, K. (2009). Comorbidity in Australia: findings of the 2007 national survey of mental health and wellbeing. Australian and New Zealand Journal of Psychiatry, 43(7), 606-614.

14. Meyers, J. L., & Dick, D. M. (2010). Genetic and environmental risk factors for adolescent-onset substance use disorders. Child and Adolescent Psychiatric Clinics of North America, 19(3), 465-477.

15. Stone, A. L., Becker, L. G., Huber, A. M., & Catalano, R. F. (2012). Review of risk and protective factors of substance use and problem use in emerging adulthood. Addictive Behaviors, 37(7), 747-775.

16. Crome, I., Macleod, J., Bloor, R., & Hickman, M. (2007). Predictive factors for illicit drug use among young people: a literature review. UK: Research Development and Statistics Directorate, Home Office

Assessment

In the DSM-5, a substance use disorder is diagnosed based on evidence of at least 2 of the following features (1):

Impaired control:

(1) Substance often taken in larger amounts or over a longer period than was intended

(2) Persistent desire or unsuccessful efforts to cut down or control substance use

(3) Significant time spent trying to obtain substance, or recovering from its effects

(4) Craving, or a strong desire or urge to use substance

Social impairment:

(5) Recurrent substance use resulting in a failure to fulfil major role obligations (e.g. at work, school, or home)

(6) Continued substance use despite recurrent social or interpersonal problems related to substance use

(7) Important social, occupational, or recreational activities are given up or reduced because of substance use

Risky use:

(8) Recurrent substance use in situations in which it is physically hazardous

(9) Continuing substance use despite knowing that it is likely to have caused or exacerbated a physical or psychological problem

Pharmacological criteria:

(10) Developing tolerance to the substance

(11) Experiencing withdrawal symptoms

Severity of the disorder is determined by the number of diagnostic criteria met:

• Mild: 2-3 symptoms
• Moderate: 4-5 symptoms
• Severe: ≤ 6 symptoms

Assessment Tools

There is not a common list of symptoms that can be used to tell if someone is misusing drugs, as different drugs have different effects on different people. To decide whether a young person may be experiencing a substance use disorder, a comprehensive assessment in required. Assessing substance use is also important when someone is presenting for other issues (such as mental health issues). Assessment involves asking questions about a range of aspects of a person's life including substance use and their:

• Home and environment;
• Education and employment;
• Activities;
• Relationships and sexuality;
• Conduct difficulties and risk-taking;
• Anxiety and eating;
• Depression and suicide risk;
• Psychosis and mania
  
  

A comprehensive assessment would include questions to find out the types of substances used and method of ingestion (ie inhaled, injected, etc), the frequency and duration of use, and the age of first use.

There is a large number of screening and assessment tools used to establish substance abuse in young people (2,3).  Commonly used tools in Australia (4) include the Alcohol Use Disorders Identification Test (AUDIT), the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), and the CRAFFT Screening Tool.