Screening, Assessment, and Engagement
Two different jobs
Screening is a brief, standardized process that answers one question: does this person need a fuller assessment, a referral, or no further service? Assessment is the ongoing, comprehensive, biopsychosocial process that establishes diagnosis, severity, strengths, and the ASAM placement picture. Questions frequently punish candidates who blur the two.
Know the common instruments well enough to match them to purpose: AUDIT or CAGE for alcohol, DAST-10 for other drugs, TCU Drug Screen for criminal-justice settings, PHQ-9 and GAD-7 for mood and anxiety, and a validated tool such as the C-SSRS for suicide risk. Know the DSM-5-TR substance use disorder criteria: eleven symptoms across impaired control, social impairment, risky use, and pharmacological indicators, with 2-3 symptoms mild, 4-5 moderate, and 6 or more severe.
Assessment content and placement
A complete assessment covers presenting problem, substance use history and pattern, withdrawal and medical history, psychiatric and trauma history, family and social supports, legal and employment status, cultural and linguistic context, and readiness to change. Those findings map onto ASAM's six dimensions: intoxication and withdrawal risk, biomedical conditions, psychiatric and cognitive conditions, readiness to change, relapse potential, and recovery environment.
Engagement
The engagement portion tests motivational interviewing: the spirit of partnership, acceptance, compassion, and evocation; OARS skills; eliciting and reinforcing change talk; and resisting the righting reflex. Stage of change shapes what you do - educate and build alliance in precontemplation, explore ambivalence in contemplation, and support planning in preparation.
Traps and a worked example
Common traps: treating a positive screen as a diagnosis; recommending a level of care from a urine result alone; omitting suicide and withdrawal risk; and assuming tolerance and withdrawal are required for a diagnosis. They are not, and "legal problems" is no longer a criterion.
Worked example: a client scores 16 on the AUDIT, drinks daily, and had his last drink ten hours ago with tremor and a pulse of 110. The score is a reason to assess, not a diagnosis; the tremor and pulse signal withdrawal risk on ASAM Dimension 1, so standard outpatient alone is a poor fit.