Evidence-Based Screening Tools for Substance Abuse

DrugAbuse.gov has compiled a list of no-cost and easily available screening tools for drug and alcohol abuse. This list is relatively frequently updated (last update was Sept. ’15) and includes direct links to the screening measures, as well as a mark as to whether it is appropriate for adolescents and whether it is self- or practitioner-administered.

These tools include prescreen and full measures:

  • NIDA Drug Use Screening Tool (Prescreen and Full)
  • CRAFFT (Prescreen and Full)
  • Alcohol Use Disorders Identification Test (AUDIT) (Prescreen and Full)
  • Opioid Risk Tool (Prescreen)
  • CAGE and CAGE-AID (Adapted to Include Drugs) (Full)
  • Drug Abuse Screen Test (DAST-10) (Full)
  • DAST-20: Adolescent version (Full)

This chart is available at:

https://www.drugabuse.gov/nidamed-medical-health-professionals/tool-resources-your-practice/screening-assessment-drug-testing-resources/chart-evidence-based-screening-tools-adults

 

Evidence-Based Approaches to Adolescent Substance Use Disorders

Though as school psychologists and teachers, we will likely not be undergoing a large amount of actual treatment for substance abuse disorders, it is important to know what the evidence-based treatments and interventions are.

The National Quality Forum published a document (link below) called “Evidence Based Treatment Practices for Substance Use Disorders” outlining recommended practices, background, and much more, which may serve as a starting point for research on the topic.

http://www.apa.org/divisions/div50/doc/Evidence_-_Based_Treatment_Practices_for_Substance_Use_Disorders.pdf 

This document recommends that treatment for SUDs is part of a continuum of services that includes screening and assessment, active treatment, and continued engagement as part of a long-term plan

Important recommendations included in this document include:

  • Screening: whenever there is an opportunity
  • Initial Brief Intervention: and then referral as needed
  • Treatment Plans: written recommendations for further care and the quantity/time/etc of the service
  • Psychosocial interventions: motivational interviewing, motivational enhancement therapy, CBT, structured family/couples therapy, contingency management, community reinforcement therapy, and/or 12 step facilitation therapy
  • Pharmacotherapy: in addition to psychosocial, if needed for withdrawal/detox
  • Patient Engagement and Retention: both of which are crucial
  • Recovery/Post-care: on-going follow-up and management is also crucial

An “Initial Brief Intervention” may be the extent of our role as school psychologists in many cases. This involves (p. 6):

  1. Give feedback about screening results, relating the risks of negative health effects to the patient’s presenting health concerns.
  2. Inform the patient about safe consumption limits and offer advice about change.
  3. Offer to involve family members in this process to educate them and solicit their input (consent is required).
  4. Assess the patient’s degree of readiness for change (e.g.,“How willing are you to consider reducing your use at this time?”).
  5. Negotiate goals and strategies for change.
  6. Schedule an initial follow-up appointment in two to four weeks.
  7. Monitor changes at follow-up visits by asking patient about use, health effects, and barriers to change.
  8. If the patient declines referral to specialty evaluation or treatment, continue to encourage reduction or cessation of use and reconsider referral to specialized treatment at subsequent visits.

Specific DON’Ts include:

  • Detox as a standalone
  • Acupuncture, relaxation therapy, didactic group education, or biological monitoring as a standalone treatment (and may not be very helpful at all).
  • Individual psychodynamic therapy
  • Unstructured group therapy
  • Confrontation
  • Discharge from treatment in response to a relapse

 

 

Hard Choices: A Digital Comic (Spiderman & Fantastic 4 on Alcohol)

For a kid-friendly resource, one thing I found was the “Spiderman and the Fantastic Four in Hard Choices” comic book.

This comic book is a free giveaway from SAMHSA to promote substance abuse awareness, and may be valuable for a student who really enjoys superheroes but may not understand the social or physical ramifications of making poor choices, such as alcohol abuse.

This comic is available at: https://marvel.com/digitalcomics/view_white.htm?iid=23418 

A teacher’s guide for this comic is available at: http://www.elks.org/dap/pdfs/teachersguide.pdf

The Elks Kid Zone (http://elkskidszone.org/) is a larger affiliated website about Drug Awareness, including comics, videos, and information in a kid-friendly format.

Hopefully it is not our students who are abusing drugs and alcohol, but these resources may also be valuable as a preventative factor, along with supportive relationships at school, that may offset risk factors in their home or community.

Ohio Resources for Heroin Addiction

Resources recommended by the professionals from Operation Street Smart include:

  • mha.ohio.gov (Providers by county)
  • drugabuse.com (Abuse/addiction treatment)
  • recovery.org (Recovery process/ratings/major cities in Ohio)
  • InterventionAmerica.com (National Resource on Recovery)
  • Rehabhotline.org (Rehab referral/placement)

The HeroinHopeLine website (http://www.heroinhopeline.org/) is a great local resource that breaks down a lot of the specific locations of rehab facilities and resources in Southwest OH and parts of Indiana. Their phone number for contact is 1-877-695-6333 for Warren and Clinton Counties, and 1-844-427-4747 for Butler County.

Their website also breaks down the types of heroin treatment:

  1. Medically Supervised Detoxification
  2. Rapid Detoxification
  3. Residential Rehab Program
  4. Medically Assisted Treatment
  5. Naltrexone

Other resources include the Butler County Coalition, which has its own page of resources at http://butlercountycoalition.org/resource-links/.

 

Operation Street Smart – Notes and Resources

Drug and Alcohol Abuse is an area of interest to me, and thus I recently attended a professional development seminar on the topic called “Operation Street Smart.” This presentation was hosted by the sheriff’s department of Franklin County (Columbus). Information about this program can be found at: https://sheriff.franklincountyohio.gov/programs/operation-street-smart-drug-education.cfm, but its general format covered alcohol, marijuana, synthetics (K2/Spice), and then moving into prescription medication and heroin. The whole presentation is often as long as a few days according to the speaker, but we attended the condensed, 3 hour version. If you are a parent or administrator interested in learning more, particularly about signs of abuse and concealment, I would recommend this presentation, though I wished it provided more information about interventions.

Web sites they recommended:

  • Urbandictionary.com
  • erowid.org
  • bluelight.com
  • odh.ohio.gov
  • dancesafe.org
  • streetdrugs.org
  • projectghb.org
  • drugabuse.gov
  • inhalants.org
  • nida.nih.gov
  • samhsa.gov
  • teens.drugabuse.gov
  • DrugFreeActionAlliance.org
  • drugfree.org

Ohio-Specific Resources will be a separate post, as I believe that is worthy and crucial.

Some of the notes I took from this presentation, that others might find helpful, include:

  • Alcohol is by far the most abused drug, and causes by far the most deaths
  • The absurd amount of prescription drugs used by Americans above the rest of the country – 75% of all pharmaceuticals, according to the presenters. These legal drugs often are abused and then lead to heroin addictions, as heroin is a cheaper form.
  • Approximately 80% of all heroin addicts began with pharmaceutical drugs.
  • The prescription drug and opioid epidemics are continuing to grow
  • Heroin often comes in little balloons, or balls of foil.
  • Things to look for that I wouldn’t have known about were: ped eggs (foot files), oil clamp rings, and sandpaper, all of which are used to shave pills. Also, for heroin, things like aluminum foil and spoons, needles, tie-offs, melted straws, or “cookers” (e.g. the bottom of an aluminum can). Lumps from missed veins also last 10-14 days, and can be noticed.
  • Common terms for Xanax including “footballs,” “school busses,” and “ladders”
  • Percocets are the instant release form of Oxycodone
  • Some apps for identifying drugs are Pillbox and iPharmacy
  • Narcan is growing in importance as a drug that reverses the effects of an opioid, commonly used as a “Lazarus” drug to reverse an overdose. Now available OTC.