The longer interview schedule is not intended to be covered in one session. Assessment should not be an interrogation. Assessment and reassessment is an intervention in its own right.

Both the client and counsellor will benefit from knowing the purpose of assessment. Boundaries of confidentiality, including statutory obligations of the worker, should be explained prior to assessment.

Other useful information is available at Assessment Index.

Brief (initial) drug assessment

More detailed drug use assessment

Past Use

Current Use

Degree of dependence

Functionality

Problems

Co-existing disorders

Overdoses

Signs of Safety

Stage of Change

Drug use goals

Helps and Hinders of Change

Any other issues or questions?

Other sources of information

Possible Specific Questions relating to problems of Liver, Lover, Livelihood and Law

Confidentiality

Use screening instruments if available (e.g.AUDIT)

Can you tell me a little about your alcohol or other drug use?

Has this been a problem for you or your family? (Liver, Lover, Livelihood, Law)

Is there any relationship to your current issue?

What have you done, or are doing about your drug use? (If any other agencies or drug workers, seek written permission to contact these agencies/workers).

Would you like to deal with any of the issues raised?

Reflect issues back to client, incorporate into case management plan if required, further assessment/intervention if required (e.g. motivational interviewing, goal setting, self monitoring, provision of information, self-help manual, skills development, relapse prevention, referral).

(if indicated by initial assessment that drug use is a primary reason for intervention - seek former assessments from other agencies if available)

Starting from the beginning, can you tell me about your drug use?

When did drug use first become a problem?

Periods of controlled use or abstinence?

Previous drug treatment?

If injecting, ever shared equipment? Unprotected sex? Blood borne virus test? Immunisation against Hepatitis B?

Have any of these drugs been prescribed for you?

Any other history you think is important?

What drug(s) are you currently using?

Any other prescribed medications?

Do you use these together or separately?

Describe your current drug use pattern. (i.e. daily, intermittent binge)

Assess the daily and weekly amounts used as well as during binge episodes

Describe a typical day to identify the sequence of events associated with drug use using open-ended questions.

What time do you normally have your first…?

With whom?

What triggers you to stop?

What triggers you to start?

Can you describe what's happening before you get intoxicated (high, stoned), what's happening when you are intoxicated, when you come down and in-between (including how you get your drug/s). Possibly draw the ups, downs and in-betweens graphically to illustrate what you mean)

How do these ups and downs relate to your presenting issue (state issue)?

Which drug/s are causing you the most problems? (if more than one drug used)

Self-monitoring can also be used to assess client's current drug use, as well as being a powerful intervention in its own right (requires motivation and literacy).  See Self-Help Material

(Use standardised questionnaires to measure dependence: See Screening or Jarvis, Tebbutt and Mattick (1995) Treatment Approaches for Alcohol and Drug Dependence An Introductory Guide Wiley Chichester pp 17 & 30-34)

Withdrawal Do you get any withdrawal symptoms or do you use to avoid withdrawal symptoms?

Tolerance Are you using more now for the same effect?

Compulsion Do you feel like you've lost control or have sudden urges and cravings to use which you can't resist?

Priority Do you find that your drug use has become one of (or the most) important aspect of your life?

Conflict Do you ever find yourself doing things around your drug use which you regret, but continue to do them anyway?

Drugs are most commonly used to enhance pleasure and avoid pain (pleasure seeking and trough avoiding). However, other functions can include feelings of power, source of income, friends, image, prestige and reputation enhancement, aids developmental separation from family of origin, draws attention, etc. Many of these will not be articulated by the client.

How does drug use help?

What do you like about your drug use?

What do you think would happen if you decreased or stopped your drug use?

(further detail for problems given at Specific Questions of Liver, Lover, Livelihood and Law. Drug-related problems regarding child protection are at Risk Assessment Checklist for Parental Drug Use)

What sort of problems do your drugs cause?

Relate to Liver, Lover, Livelihood, Law and Intoxication, Regular Use, Dependence as well as the relationship of drug problems to the presenting issue.

(See Coexisting disorders )

Examples can be depression, anxiety, agoraphobia, anger problems, psychotic disturbances.

Do you have any problems with your moods?

Any other psychological or psychiatric problems?

Can you tell if these came before your drug use or after you started using drugs?

Have you ever planned and/or attempted to harm yourself, or to suicide?

Have you had any overdoses in the past year (or ever)?

Do you think these were mostly accidental or on purpose?

Have you ever passed out, blacked out, had memory lapses as a result of your drug use?

What were the circumstances and consequences?

Was there more than one substance involved?

Signs of Safety

What sort of things are you doing to reduce the impact of the drug-related problems we've been discussing? (eg What steps do you take to make plans for the safety of your child/ren when you are using drugs? What control strategies do you use to manage your life while you are using drugs? What's working for you in managing your drug use issues?).

When don't you have these problems?

What are the positive things which are going on in your life?

Are you thinking about cutting down or quitting your drug use? (or any particular drug)

Would you like to reduce any of the problems associated with your drug use?

Have you made any plans about changing your drug use?

Have you talked to anyone about making changes (or has anyone talked to you about changes)?

What changes have you made regarding your drug use?

Do you have any overall goals around drug use?

What about other goals?

How might these (a) reduce problems &/or (b) improve your life?

How will you know you've achieved your goal(s) (Use SMART goal-setting Specific, Meaningful, Assessable, Realistic, Time-bounded)

What are the things which might get in the way of making changes to your drug use or problems associated with your drug use?

What are the things which have previously helped or might help you make changes to your drug use?

Is your partner willing to get involved in this matter?

Who will (do) you get support from?

(For those with children) How will you manage your child/ren while you address your own issues and how will their needs be met?

Is there anything else that you would like to tell me about your or other's drug use?

Are there any other family issues regarding drug use?

Do you have any questions about what we have been discussing so far?

Where required, confirmation and additional information may be obtained from:

§ Family and friends

§ Other professional agencies

§ Medical examination

§ Neighbours

§ Home visit

Informing the client of the intention to gain confirmatory and additional information early, may yield a more accurate initial assessment.

Issues which relate to gaining additional information include: confidentiality, release of information, professional working relationship, child safety and reciprocal agreements.  

The questions below are samples only. Ask clients questions most appropriate to their situation and level of understanding. Client are first encouraged to identify their perception of any problems associated with drug use.  The following questions may help as prompts in certain areas which the client may have missed.

If answer is yes to any of the questions below, assess the relationship to substance use. E.g. Which came first? Does substance use make things worse or better or both?

Has drug use affected your mental or psychological health?

Have you ever been diagnosed with a psychological or psychiatric condition?

Have you had problems with anxiety?

Do you have mood swings?

Consider using the Beck Depression Inventory, the Beck Anxiety Inventory, or the General Health Questionnaire (GHQ) which provides a general mental health assessment.

Do you have any problems with your temper? (anger management)

Do you get anxious when you are in crowds or in open spaces? (agoraphobia)

Do you feel that your life has lost meaning? (existential crisis)

Do you sometimes find yourself being overly suspicious? (paranoia)

Do you sometimes hear voices, see or feel things that you're not sure of? (Hallucinations)

Have you ever thought about harming yourself or committing suicide?

Are you taking any medications for any psychological or psychiatric condition?

You may need to repeat some or all of this assessment following any change in drug use. Withdrawal can sometimes precipitate severe psychological reactions including psychosis, severe anxiety and depression and suicidal ideation.

Has drug use affected your physical health?

When was the last time you had a medical check-up? (and what were the results?)

Have you had any accidents (caused any accidents) from your drug use?

Have you had any memory lapses or black-outs from drug use?

General health problems such as weight loss or gain, infections, gastric problems, heart problems, lung problems?

Any blood-borne virus infections? (Hepatitis C & B, HIV)

Have you had any withdrawal symptoms? (sweating, tremor, aches and pains, nausea)

Do you suffer from hang-overs?

Alcohol can cause brain damage, particularly if there are heavy bouts or prolonged excessive use. However, this is difficult to detect while the person is currently drinking. Observe memory lapses and difficulty in recalling day-to-day information. Consider using the Mini-Mental State Examination.

May need to independently provide support/intervention for children, partner, parent or others closely affected by the drug using person.

Has your drug use affected your relationships with your partner, children, friends or co-workers?

What does your partner or others in your family think about your drug use?

Did any of them encourage you to get help?

Has drug use affected your relationship with your children?

Have you or someone else who uses substances harmed or posed a risk to your child/ren?

Has drug use affected your sex life?

Have you ever lost your temper with family, friends or co-workers either because you were intoxicated or strung out (hang-over)?

Have you ever done anything regrettable with your family or friends as a result of your drug use?

Does your partner (others in your family, friends) use drugs?

Has your drug use affected your performance at work (or getting a job or your study)?

How much does your drug use cost you? (a day, a week, over one year)

Have you had to pawn any possessions in order to obtain drugs (or because of drug-related unemployment)?

Do you find your drug use interferes with doing other things in your life?

How has drug use affected your interests and hobbies?

Do you have adequate and stable accommodation?

Has your drug use affected your ability to provide (shelter, clothing, material possessions, food, etc) for your family and child/ren?

Has your drug use ever got you in trouble with the authorities?

Have you been convicted for drink-driving or driving under the influence of a substance?

Are you facing any current convictions?

Have you needed to commit a crime to obtain your drugs?

Have you ever been convicted for illegal possession or sale of a drug?

Are you currently being coerced into treatment because of a legal issue?

Have you ever had a restraining order placed against you because of your drug use?

Are there any child protection issues which have resulted from your drug use?

Some questions relating to sexual problems, child abuse and domestic violence which may cover different aspects of Liver, Lover, Livelihood & Law.

Violence and Abuse within Families - Physical, Sexual, Emotional, Social & Neglect - (are there current issues & any relationship to drug issues?)

Has your drug use ever affected your relationship with your child/ren or any other family members?

Have you ever regretted any behaviour towards your child (or any other child) or other family member, while intoxicated?

Have you ever blacked out (when caring for your child)?

Have you ever lost your temper as a result of your drug use?

Has anyone in your family (or others) been frightened or harmed by you when you've been affected by drugs.

Have you ever hit your partner, child or other when intoxicated?

Sexual problems or sexual abuse
* drug use to cope with sexual abuse (past or present);
* drug use leading to sexual abuse as either victim or perpetrator;
* decreased sexual performance or fertility
* reliance on drugs for sexual performance.

Have you had any unwanted sexual contact?

Has drug use affected your sex life?

What is the relationship between any of these drug-related problems and the reason for your being here today?

It is important for each agency to develop its policy on confidentiality including boundaries of confidentiality.  This is particularly important in the context of statutory and safety issues.  In particular, clients should be informed about limits of confidentiality in the context of child protection, domestic violence, suicidal ideation, criminal behaviour - particularly that which effects the well-being of others or as it might relate to a court order.

Generally, information acquired as part of a professional relationship is seen as confidential. However, the issues above relate to professional duty of care to third parties who may have significant vested interests and may be at risk if information is not disclosed.

Where a policy does not exist and there is an element of doubt concerning disclosure, supervision should be sought.  In these instances, it may be necessary to use a fictitious name and present the situation as a hypothetical to safeguard the confidentiality of the client.  If a supervisor is not available, contact the Alcohol and Drug Information Service in your state for professional advice.