Self-Assessment
Thankfully, timely detection and intervention are effective at treating early-stage substance use disorders (SUDs) and preventing them from posing a serious risk to patients. Self-assessment tests have proven particularly useful for quickly and reliably identifying one’s risk of having a SUD. Both clinicians and policymakers have started to make these tests more accessible to the public, as the early identification of risks through these tests can reduce the complexity of SUD treatments as well as the cost of healthcare and law enforcement
This article aims to shed some light on drug and alcohol self-assessment tests, explaining what they are, what they are intended to do, and the context behind their use.
What Are Self-Assessment Tests?
As the name suggests, self-assessment tests are self-administered tests intended to find out someone’s risk of having a SUD. They can be specific for just one type of SUD, such as alcohol use disorder, or be more general. These tests can also be specifically designed for certain at-risk groups, such as adolescents, military personnel, pregnant women, and others.
Self-assessment tests are primarily intended as a screening tool. Contrary to popular belief, they are not used for making a diagnosis. However, they might also be used by a clinician as part of initial screening before they do a more in-depth examination for a diagnosis.
These tests can be taken through a paper or online questionnaire. In the former case, scoring can be done by the respondent or the clinician facilitating the test. In online questionnaires, scoring can be automated to further improve testing accuracy.
Why Are Self-Assessment Tests Used?
Even the best self-assessment questionnaires tend to make some compromises in their accuracy that make them unsuitable for diagnostics. This is because self-assessment tests are generally meant to be used by regular people, which means they tend to have fewer items compared to a full diagnostic test or a screening test designed for clinicians. Questions are also constructed in easy-to-understand language to further improve accessibility for the general population.
Nevertheless, self-testing is encouraged by healthcare workers and public policymakers alike as a preventative measure. When used in the correct context, regular people can use these tests to reliably identify if they or people they know are at risk of having a substance use disorder. While these tests are generally not as accurate as a test that might be used by a clinician for establishing a proper diagnosis, they are often good enough for gauging relative risk.
This means that they can be used to tell someone that they should be seeking help from a doctor even before obvious signs of a substance use disorder begin to manifest. When substance use disorder cases are treated before they become severe, the cost of treatment tends to be lower and the chances of recovery improve. People who start having treatment early are also far less likely to suffer from mental and physical health issues and are less likely to be involved in incidents with law enforcement officers. When taken in the context of millions of drug and alcohol users, having these tests widely available can also have benefits in terms of reducing the burden on healthcare and law enforcement.
Examples of Self-Assessment Tests
Many self-reported tests are known by acronyms that correspond to the test questions or the specific focus of the test. Here are just a few of the most commonly used self-administered drug and alcohol tests as well as the meaning of the acronyms, when appropriate:
- ADDIS – alcohol and drug diagnostic instrument
- ASI – addiction severity index
- Atluri six-point screening tool
- CAGE – cut down, annoyed, guilty, eye-opener (keywords in the standard four-question form)
- CCI – chemical coping inventory
- Chabal five-point prescription opioid abuse checklist
- COMM – current opioid misuse measure
- CUAD – chemical use, abuse, and dependence scale
- DAPA-PC – drug abuse problem assessment intended for primary care
- DAST – drug abuse screening test
- DIRE – diagnosis, intractability, risk, efficacy
- KMSK scale – Kreek-McHugh-Schluger-Kellogg scale
- MAST – Michigan alcohol screening Test
- ORT – opioid risk tool
- PDUQ – prescription drug use questionnaire
- PMQ – pain medication questionnaire
- POSIT – problem-oriented screening test for adolescents
- RAFFT – relax, alone, friends, family, trouble
- SASSI – substance abuse subtle screening inventory
- SCID-P – alcohol and drug sections of the DSM-III-R
- SISAP – screening instrument for substance abuse potential
- SMAST – short Michigan alcoholism screening test
- SOAPP – screener and opioid assessment for patients with pain
- STAR – screening tool for addiction risk
- SUDDS – substance use disorder diagnostic schedule
- TICS- two-item conjoint screen
You can learn more about these tests through the National Institute of Drug Abuse as well as through qualified psychiatrists and clinicians.
How Are Drug and Alcohol Self-Assessment Tests Conducted?
These tests are most often conducted through a paper or online questionnaire. Shorter tests can be memorized and taken verbally as well. Scoring can be done by the respondent, an attending clinician, or automatically, as is the case in some online forms.
Tests can be anonymous, which helps remove some of the chances of social desirability bias affecting the results. In cases where the test is conducted by a clinician, they must build trust with the patient so that they are better able to give honest answers. It’s also important that the respondent trusts the test and scoring system to further improve accuracy.
Are Self-Assessed Drug and Alcohol Tests Reliable?
For initial risk screening, self-assessed tests for drug and alcohol use endorsed by mainstream medical institutions are generally reliable. However, this reliability can be undermined if the respondent does not trust the test. These tests are also generally inappropriate for diagnostic use, as they are designed for accessibility to the public rather than for directly diagnosing SUD. In any case, if you do score a positive result on a self-reported drug or alcohol screening test, chances are you will want to consult with a clinician to discuss the next step.
What Are the Limitations of Self-Assessed SUD Tests?
Self-reporting tests are reliable, but they suffer from a few limitations. Some of these limitations include but are not limited to the following:
Some Tests May Be Outdated
The latest updates to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) came out in 2013, well past the time many popular drug and alcohol self-assessment tests currently in use were devised. These tests were designed in a time when substance abuse and substance dependence were considered separate illnesses and our understanding of substance misuse was slightly different. Today, we have a more nuanced understanding of chronic substance misuse than when many of the most popular self-assessment tests were devised. As a result, some but not all tests have been updated to reflect this better understanding of SUD.
Social Desirability Bias
Social desirability bias is when a respondent answers a test in a way they think will please other people. Alcohol and drug use are highly stigmatized in contemporary society, which can cause respondents to knowingly or unknowingly change their answers. Making these tests anonymous and the scoring transparent can help reduce the effects of this bias.
Unsuitable for Diagnostics
As discussed earlier, self-assessed alcohol and drug tests are designed to be accessible to most people. This necessarily reduces accuracy, as these tests need to be relatively short to be useful. This generally makes them unsuitable as a diagnostics tool.
Not all Tests Are Appropriate for all Respondents
The specific type of self-assessment test use can matter. For the best results, it’s important to choose a type that is most relevant to your situation.
I Scored Positive in a Self-Assessed Test. What’s Next?
Scoring a positive on a self-assessed test does not mean you have an alcohol or drug use disorder. However, it might mean that you are at risk of having a SUD. You can choose to take a different type of test that might be more suited to your situation for a more accurate idea of your risk. In any case, it may be best to get in touch with a qualified treatment specialist to find out for sure if you have a substance use disorder.
Conclusion
Self-assessment tests for drug and alcohol use can help prevent the worst effects of severe substance use disorders. By allowing regular people to identify if they are at risk of a SUD, they can seek help early on, potentially prevent the onset of a SUD or keeping an existing one from becoming worse. Early detection is always a good thing for a SUD patient as it can can improve their chances of recovery and reintegration into society.
