Screening, Assessment, and Diagnosis
What to know
Distinguish screening (brief, broad, identifies risk - e.g., AUDIT, AUDIT-C, DAST, CRAFFT for adolescents, PHQ-9 for depression) from assessment (comprehensive, multidimensional) and diagnosis (DSM-5-TR criteria). Know the 11 DSM-5-TR criteria grouped into impaired control, social impairment, risky use, and pharmacological criteria; severity is mild (2–3), moderate (4–5), severe (6+). Understand ASAM criteria dimensions (intoxication/withdrawal, biomedical, psychiatric, readiness to change, relapse potential, recovery environment) - these drive level-of-care placement. Know biopsychosocial assessment elements: history, pattern/route/frequency, consequences, prior treatment, medical/psychiatric history, suicide risk, and collateral information. Understand motivational and cultural considerations, and the role of toxicology (urine, blood, hair) with awareness of detection windows.
Traps
Questions confuse tolerance and withdrawal as standalone diagnoses - in DSM-5-TR they count toward SUD but are not separate disorders. Watch for items that treat a positive screen as a diagnosis. Distinguish legal consequences from clinical criteria. Note that craving is a criterion. Hair testing detects longer windows than urine; beware items assuming urine detects weeks-old use.
Rule of thumb
Screen → assess → diagnose → place. A screening score alone never determines level of care; the ASAM six dimensions do.
Worked example
A patient meets 7 DSM-5-TR criteria, including tolerance and withdrawal. Severity = severe (6+). The presence of tolerance/withdrawal does not change the diagnosis; it only contributes to the count.