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Successful treatment of substance use disorders depends on a careful, accurate assessment and diagnosis.

Accurate assessment is facilitated by interview settings that provide privacy and patient confidentiality and that permit adequate time to ask key questions, to follow up on positive patient responses, and to give feedback to the patient.

A substance use history should be obtained from all patients presenting for treatment.

Patient assessment can be influenced by a number of patient characteristics including the patient's age, gender, ethnicity, legal, marital, and employment status; degree of insight into the nature of the problem; medical or psychiatric comorbidity; stage in the course of illness (e.g., recovery, recent relapse, first treatment); current phase of use (e.g., intoxication, withdrawing, interepisode); and stage of readiness for change and motivation.

In addition to diagnosing a substance-related disorder (e.g., a substance use disorder or a substance-induced disorder), it is important to assess individuals for harmful or hazardous use of substances.

A complete substance use assessment will include eliciting history use for all the major categories of substances addressing age of first use, frequency and amount used, consequences of use, and substance abuse treatment history, as well as complete psychiatric, medical, family, and social and developmental histories.

Biological markers that might be helpful in assessment include sampling of breath, urine, blood, hair, and saliva. The most commonly used biological markers are breath alcohol testing, urine toxicology screens, and serum testing of liver transaminases and carbohydrate-deficient transferrin.

Assessment can be enhanced by routine use of standardized screening instruments such as the Alcohol Use Disorders Identification Test (AUDIT), the Drug Abuse Screening Test (DAST), the TWEAK or T-ACE, the Addiction Severity Index (ASI), and the Risk Behavior Survey (RBS).

Significant others can both corroborate and provide additional information about the patient's reported substance use history, and their early involvement can be helpful in treatment planning.

For ambivalent patients who are contemplating their readiness to change, the interviewer can use motivational interviewing techniques that include a nonjudgmental and supportive stance to explore the patient's ambivalence about changing addictive behaviors.


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