The purpose of the assessment is to determine whether an addiction is present, the extent of the addiction, and to assist in the development of a treatment plan (recommendations).
Screening versus Assessment
The purpose of screening is to determine whether an individual needs an assessment.
In the workplace an initial screening, or triggering event occurs when a worker has a positive alcohol/drug test, or self-reports a substance use problem. Either of these two events indicate the possible presence of a substance use problem and a need for further evaluation (SAP assessment).
Assessment is a process for defining the nature of the problem, determining a diagnosis, and developing specific treatment recommendations for addressing the problem or diagnosis.
Screening versus Assessment
The purpose of screening is to determine whether an individual needs an assessment.
In the workplace an initial screening, or triggering event occurs when a worker has a positive alcohol/drug test, or self-reports a substance use problem. Either of these two events indicate the possible presence of a substance use problem and a need for further evaluation (SAP assessment).
Assessment is a process for defining the nature of the problem, determining a diagnosis, and developing specific treatment recommendations for addressing the problem or diagnosis.
No Predetermined Outcomes
Every individual is unique. We believe the purpose of an assessment is to determine if your alcohol and drug use is a problem, and if so, what kind of help would be beneficial. For some individuals early intervention (education) is all that’s necessary, for others counselling or treatment.
Since all decisions are based on the results of the assessment it is not possible to pre-determine an outcome or Return-to-Duty timeframe for any worker.
Assessment Tools
Every client completes a battery of evidence based assessment tests before their assessment interview. This information is used to identify areas needing a “deeper than normal” inquiry during the assessment interview.
The evidence based tools we use are:
Michigan Alcohol Screening Test (MAST)
Drug Abuse Screening Test (DAST)
Cannabis Use Disorders Identification Test-Revised (CUDIT-R)
The Cannabis Use Problems Identification Test (CUPIT)
Substance Abuse Subtle Screening Inventory-4 (SASSI-4)
The Mental Health Screening Form III
The Overall Anxiety Severity and Impairment Scale (OASIS)
Patient Health Questionnaire (PHQ-9)
The Behaviors & Attitudes Drinking & Driving Scale (BADDS)
Unless requested, only client’s involved in an alcohol related motor vehicle incident are required to complete The Behaviors & Attitudes Drinking & Driving Scale (BADDS).
Review of Drug Test Results/MRO Consultation
We also request employers provide us a copy of the test results.
As part of the assessment process review the results and consult with the Medical Review Officer (MRO) who verified the employee’s drug test. In these consultations we discuss information not available to employers, testing facilities or C/TPAs. This information is used in formulating our evidence based, individualized recommendations.
Assessment/Evaluation Interview
We conduct a semi-structured interview based on The Structured Clinical Interview for DSM-5 (SCID-5). This approach means each assessment is conducted in a consistent manner. We also discuss in greater depth the gathered from the assessment tests and our consultation with the MRO.
Each assessment consists of:
A face-to-face evaluation, either in-person or virtually (per applicable guidance), of the client.
A review of the events leading up to the positive test or self-report.
A review of the employee’s psychosocial history.
A review of the employee’s legal history.
An in-depth review of the employee’s drug and alcohol use history
A review of the emotional and physical characteristics related to their substance use.
A review health, work, family, personal, and interpersonal problems related to substance use.
An evaluation of the employee’s current mental status.
Decision Making
Using the information gathered in the assessment interview, our review of the test results, and the MRO consultation, we formulate a diagnosis, treatment recommendations (education, counselling, treatment or other referral), and a treatment plan the worker must complete before becoming eligible for the required follow-up evaluation and subsequent return (if the employer desires) to safety-sensitive functions.
In order to be diagnosed with a substance use disorder the worker must meet criteria from the following tools:
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V)
The International Classification of Diseases (ICD-11)
Recommendations
Our level of care recommendations follow the ASAM Criteria from the American Society of Addiction Medicine. In use since the 1980’s the ASAM Criteria, formerly known as the ASAM patient placement criteria (ASAM-PPC), is the most widely used and comprehensive set of guidelines for level of care placement for individuals with addiction and co-occurring conditions
