Traditional approaches to assessment
Alcohol and drug problems were conceptualized as being binary, that is,
people were seen as being in either a state of addiction or not in a state of
Traditional approaches hold subjective, non-theoretical and non-empirical
assumptions about assessment for addictions treatment.
Traditional approaches hold the notion that substance abuse is a chronic,
progressive disease phenomenon. However, we know that addiction does
not progress like a disease—severity increases to a point and then levels off.
Traditional approaches hold the belief that all clients are in a state of denial.
However most substance abusers who deny having a substance abuse
problem, truly do not believe that they have a problem, and therefore aren’t
in denial in the classical sense. Moreover, there is the view that self-report
data obtained from substance abusers is unreliable because of this false
assumption of the presence of a state of denial. In fact, this is not true
because, as mentioned above, substance abusers are rarely in an actual state
Traditional approaches tend to focus on lifetime use patterns. However, the
focus should be on CURRENT patterns because how much drugs you used
early in life is not very relevant.
Traditional approaches usually involve poor interviewing techniques such as
non-structured interviews and semi-subjective structured interviews.
Moreover, interviewers tend to make assumptions about their clients and ask
Traditional approaches tend to have a rudimentary and simplistic
understanding of client motivation—they don’t take into account empirical
theories of motivation such as Prochaska’s transtheoretical model. (stages of
What defines an “alcoholic”
What is an “addict”?
What defines “problematic” use?
What is “substance abuse”
What is “substance dependence” More recent conceptualization of
Nowadays, substance abuse is seen as something that lies on a continuum
from non-use all the way to serious use. The DSM4 looks at substance abuse
on continuums of “use” “abuse” and “dependence”. This is consistent with use
patterns that are seen in offenders.
It is now accepted that clients can provide accurate, reliable information and
that much can be determined from asking questions and listening to their
Core content areas
These are the main things that you want to find out when performing an
How severe is his problem?
Problems associated with his substance use and abuse
What’s his treatment history?
What are his treatment goals? ( is the client saying that he can’t or won’t
What’s his treatment readiness and motivation?
Objective assessment instruments
These are the objective, theory-based, empirical tools used in carrying out
The Alcohol Dependence Scale asks questions such as:
How much did you drink the last time you drank?
Do you often get hangovers?
Do you pass out from drinking?
Do you have a convulsion fit following a period of drinking
The Michigan Alcohol Screening Test—which is a bit dated—asks questions such
Do you feel you are a normal drinker?
Does your spouse/parent ever worry about your drinking?
Do you ever get into physical fights while drinking
For other drugs The Drug Abuse Screening Test asks questions such as:
Can you get through a week without using drugs?
Have you ever lost friends because of your use of drugs
Have you ever gotten into fights while under the influence of drugs?
Have you ever experienced withdrawal?
Have you ever gone to anyone for your drug problem?
The 5 question Severity of Dependence Scale
Do you think your use of [drug] is out of control?