Clinical Evaluation
Screening is not assessment
Clinical evaluation in the AADC exam covers two distinct jobs. Screening is brief, standardized, and answers one question: does this person need a fuller look? Assessment is a multi-session, biopsychosocial process that establishes diagnosis, severity, and level of care. Exam items usually test the next step, not definitions - a positive AUDIT or a single 'yes' means 'assess further,' never 'diagnose.'
The framework you must know
- DSM-5 substance use disorder: 11 criteria across impaired control, social impairment, risky use, and pharmacological indicators. Two or three in 12 months = mild, four or five = moderate, six or more = severe. Craving was added; legal problems were removed. Tolerance and withdrawal do not count toward early remission when a substance is taken as prescribed.
- ASAM Criteria, six dimensions: (1) intoxication and withdrawal potential, (2) biomedical conditions, (3) emotional, behavioral, or cognitive conditions, (4) readiness to change, (5) relapse or continued-use potential, (6) recovery environment. Placement is a match between dimension needs and level of care - not a function of which drug is used or how many prior treatments there were.
- Withdrawal risk: alcohol and benzodiazepine withdrawal can be fatal and require medical management; opioid withdrawal is severely uncomfortable but rarely life-threatening.
- Co-occurring disorders, trauma history, medications, collateral information gathered with a signed release, and cultural context all belong in the record.
Traps
Treating a screening score as a diagnosis; skipping dimension 1 and placing a daily heavy drinker straight into outpatient; interviewing family without a release; letting one dramatic detail crowd out the full picture.
Rule of thumb
Screen wide, assess deep, and never place before you have asked dimension 1.