V. Diagnostic Tools

[QN.No.22.Symptoms of Substance Dependence include:]

[QN.No.23.Of the following does not fit the criteria for a diagnosis of substance abuse according to the DSM IV-TR]

B. CAGE Questionnaire

• Have you ever felt you should cut down on your drinking?
• Have people annoyed you by criticizing your drinking?
• Have you ever felt bad or guilty about your drinking?
• Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (eye opener)?

Scoring:
Item responses on the CAGE are scored 0 or 1, with a higher score an indication of alcohol problems.
A total score of 2 or greater is considered clinically significant.
(NIAAA, 2002)

[QN.No.25.The CAGE questionnaire is used to:]

C. Michigan Alcohol Screening Test

Another test that can be used to assess the level of alcohol use and dependence further is the Michigan Alcohol Screening Test (MAST). This system uses a point system based on the answers to 25 questions. Examples of questions include:"Have you gotten info fights when drinking?", "Have you ever neglected your obligations, your family, or your work for 2 or more days in a row because you were drinking?" and "Have you ever been told you have liver trouble?" This test can be taken online and seen at this link:
http://alcoholism.about.com/gi/dynamic/offsite.htm?zi=1/XJ&sdn=alcoholism&zu=http://webpages.charter.net/rfhale/masttest.htm

D. PDFA Assessment

The Partnership for a Drug-Free America also provides self-assessment tests that can be used by practitioners to assess the level of substance abuse by a client. These questions include: "Are you unable to stop using drugs when you want to?", "Do your spouse or parents ever complain about your involvement with drugs?", and "Have you engaged in illegal activities in order to obtain drugs." The link to this and other screening tests is here: http://www.drugfree.org/Intervention/Assessing/

In addition, the "Partnership" provides other useful resources including information for local treatment centers. There is also helpful information available to those who have loved ones or friends who may be using drugs or abusing alcohol, and tips to help them.

The tests mentioned, and others like them, assist the healthcare practitioner and the client to view through objective and measurable ways how the use of alcohol may be adversely affecting the client's life. As in most problem-solving, the first step is to accept that there is a problem.

In addition to assessment through questioning, the trained and informed healthcare professional can detect substance abuse through the observation of behaviors and physical symptoms. These symptoms are addressed more specifically for each drug in the table at the beginning of the course and there is no sense in being repetitive here. It is, however, important to not conclude that every presenting symptom is a sign that someone is using drugs. There are other circumstances that may cause behavioral and physical symptoms to appear that are independent of drug use. For example, a client could reasonably come in after working an overnight shift, presenting drowsiness, difficulty focusing and maybe anxiety if things were tense at work. These represent symptoms of multiple drugs.