Diagnosis methods
Diagnosis methods in the context of addiction play a crucial role in distinguishing between substance abuse and addiction. This process typically begins with an initial assessment, often initiated by the patient or their family, and involves healthcare professionals, such as primary care doctors or specialized therapists. Accurate diagnosis is essential, as it informs the subsequent treatment plan. To evaluate a patient's condition, practitioners utilize various assessment tools, including the CAGE questionnaire, AUDIT, and T-ACE, each designed to uncover patterns and implications of alcohol or drug use. These tools often involve answering specific questions regarding recent behaviors related to substance consumption. Medical professionals adhere to established criteria to differentiate between substance abuse and addiction, focusing on behavioral patterns and psychological factors like withdrawal and tolerance. Upon diagnosis, healthcare providers can recommend appropriate treatment options, which may include therapy, counseling, or medication, tailored to the individual’s needs. Understanding these diagnosis methods is vital for those seeking help or information about substance use and recovery pathways.
Diagnosis methods
DEFINITION: Before treating addictions, health practitioners must be sure that the addiction actually exists. They must differentiate between alcohol and drug abuse and alcohol and drug addiction. To do this, health practitioners must complete an initial assessment of their patients’ conditions and then make their diagnosis. A diagnosis is the identification of an illness or a condition. After a health practitioner diagnoses a patient, they must develop a suggested method of treatment for the patient’s condition.
Assessment Methods
The diagnosis process is typically initiated by the patient or the patient’s loved ones. The patient and their family may request the help of their family doctor. Depending on the family doctor’s knowledge of and experience with diagnosing alcohol and drug addictions, the doctor may decide to perform the addiction assessment themselves or refer the patient to a specialist or therapist.
Physicians perform addiction assessments to determine whether the patient is abusing or is addicted to drugs or alcohol. Though the general public does not typically differentiate between these two conditions, medical professionals adhere to strict guidelines that define abuse and addiction. This is important, as the treatment that the professional recommends is affected by whether they believe the patient is abusing drugs or is addicted to them.
To make this determination, the physician performing the addiction assessment instructs the patient to think about their behavior in the previous twelve months. The physician then asks the patient questions based on one of many assessment tools, including CAGE, AUDIT, AUDIT-C, SASQ, T-ACE, and AA20. While these surveys were initially developed to diagnose alcohol addiction, they can be altered and used to uncover a drug addiction.
CAGE. This tool remains widely used, but many professionals consider it an outdated screening method. This short four-question survey is meant to identify a drinking problem in the lifetime of the patient. The physician will ask the patient each of the following questions, expecting a yes or no response:
C—Have you ever felt you should cut down on your drinking?
A—Have people annoyed you by criticizing your drinking?
G—Have you ever felt bad or guilty about your drinking?
E—Eye opener: Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?
Answering yes to two of these questions indicates that the patient has a serious drinking problem. CAGE is a popular test because it can be administered in any setting and is useful for all genders, ages, races, and socioeconomic backgrounds. However, because it assesses already-occurring negative repercussions of substance abuse, professionals assert prevention opportunities may be missed using CAGE.
T-ACE. This survey is based on CAGE and also consists of four short questions; however, it is used to uncover a drinking or drug problem in pregnant women. This survey helps physicians identify a drinking problem in the woman’s lifetime and during pregnancy. The physician will ask the patient to answer the following questions:
T—Tolerance: How many drinks does it take to make you feel high?
A—Have people annoyed you by criticizing your drinking?
C—Have you ever felt you ought to cut down on your drinking?
E—Eye opener: Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?
The physician scores the patient’s responses to these questions. If the patient has a score of two or higher, the physician can assume that the patient may have a drinking problem and will need further assessment. The scores attributed to these questions are as follows: 1 point for a positive answer for A, C, or E; 2 points for answering T with a number higher than 2.
AUDIT (Alcohol Use Disorder Identification Test) and AUDIT-C (Alcohol Use Disorders Identification Test–Consumption). This survey is favored by medical professionals because it provides more details about the patient’s drinking habits than other shorter surveys. The AUDIT consists of ten questions and presents five answer options for the first eight questions and three answer options for the last two questions. The AUDIT-C assesses the patient's drinking frequency and quantity using three questions scored on a 0 to 12 scale. The patient is to select the option that best captures their honest answers. AUDIT and AUDIT-C can be used to assess patients of all genders, ages, races, and backgrounds. The questions on the AUDIT include:
- How often do you have a drink containing alcohol?
- How many drinks containing alcohol do you have on a typical day when you are drinking?
- How often do you have six or more drinks on one occasion?
- How often during the last year have you found that you were not able to stop drinking once you started?
- How often during the last year have you failed to do what was normally expected from you because of drinking?
- How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?
- How often during the last year have you had a feeling of guilt or remorse after drinking?
- How often during the last year have you been unable to remember what happened the night before you had been drinking?
- Have you or someone else been injured as a result of your drinking?
- Has a relative or friend, or a doctor or other health worker, been concerned about your drinking or suggested you cut down?
Questions on the AUDIT-C include:
- How often did you have a drink containing alcohol in the past year?
- How many drinks did you have on a typical day when you were drinking in the past year?
- How often did you have six or more drinks on one occasion in the past year?
A score of 8 or more on AUDIT or a score of 3 or more on AUDIT-C tells the physician that the patient may have a drinking problem that needs to be addressed. Scores for the first eight questions can be 0 to 4 points each. Scores for the last two questions are worth 0, 2, or 4 points.
AA20. An assessment survey developed and distributed by Alcoholics Anonymous (AA). As its name indicates, the survey includes twenty questions designed to determine whether a person has a drinking problem. In a clinical setting, the physician asks the patients to answer yes or no to the following questions:
- Do you lose time from work due to drinking?
- Is drinking making your home life unhappy?
- Do you drink because you are shy with other people?
- Is drinking affecting your reputation?
- Have you ever felt remorse after drinking?
- Have you gotten into financial difficulties as a result of drinking?
- Do you turn to lower companions and an inferior environment when drinking?
- Does your drinking make you careless of your family’s welfare?
- Has your ambition decreased since drinking?
- Do you crave a drink at a definite time daily?
- Do you want a drink the next morning?
- Does drinking cause you to have difficulty sleeping?
- Has your efficiency decreased since drinking?
- Is drinking jeopardizing your job or business?
- Do you drink to escape from worries or trouble?
- Do you drink alone?
- Have you ever had a complete loss of memory as a result of drinking?
- Has your physician ever treated you for drinking?
- Do you drink to build up your self-confidence?
- Have you ever been to a hospital or institution on account of drinking?
According to AA, answering yes to three of these questions indicates a serious drinking problem. The physician should order further assessment to determine if the patient is abusing alcohol or is addicted to alcohol.
Other important screening tools for substance use and addiction include CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble), SBIRT (Screening, Brief Intervention, and Referral to Treatment), DAST-10 (Drug Abuse Screen Test), TAPS (Tobacco, Alcohol, Prescription medication, and other Substance), and SASQ (Single Alcohol Screening Question).
Abuse versus Addiction
Medical professionals rely on criteria set by the American Psychological Association's Diagnostic and Statistical Manual of Mental Disorders to determine if a patient is combating alcohol or drug abuse or addiction. To make an accurate diagnosis, physicians urge their patients to answer all questions honestly.
A physician may diagnose a patient as a substance or drug abuser if the patient has been in one or more of the following situations within the past year:
- The patient has failed to meet obligations, such as skipping classes at school, missing shifts at work, or neglecting to spend scheduled time with a friend or family member.
- The patient has engaged in reckless activities, such as driving or starting a fight while under the influence of drugs or alcohol.
- The patient has encountered legal troubles, such as being accused of a serious crime, getting arrested, or neglecting to pay fines.
- The patient has continued to drink or take drugs even though they have encountered personal difficulties or problems, such as frequent disagreements with family members or coworkers.
A physician may diagnose a patient with a substance or drug addiction if the patient has experienced two specific psychological factors—withdrawal and an increased tolerance for their drink or drug of choice—and one or more of the following behavioral patterns:
- Inability to stop once using starts
- Failure to adhere to self-imposed limits
- Limiting time spent on other activities to consume drugs or alcohol
- Spending a disproportionate amount of time consuming drugs or alcohol
- Continuing to use a drug or drink even though the patient is in poor health
Once the physician has diagnosed the patient with either a substance or drug abuse problem or an addiction, the physician can then speak with the patient about the next course of action: treatment. Addictions may require more aggressive treatments, such as medications and various types of therapy. Abusers will be encouraged to seek help for their problems through group therapy, drug and alcohol counseling, and familial support.
Bibliography
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th rev. ed., APA, 2022.
Chambers, James. Drug Abuse Sourcebook. 7th ed., Omnigraphics, 2023.
"Drug Use Screening Tests." Medline Plus, National Library of Medicine, 26 Aug. 2024, medlineplus.gov/lab-tests/drug-use-screening-tests. Accessed 20 Sept. 2024.
Hoffman, John, and Susan Froemke, editors. Why Can’t They Just Stop? Rodale, 2007.
National Institute on Alcohol Abuse and Alcoholism. Assessing Alcohol Problems: A Guide for Clinicians and Researchers. 2nd ed., DHHS, 2003.
Orford, Jim. Excessive Appetites: A Psychological View of Addictions. 2nd rep. ed., Wiley, 2007.