Screening, Assessment, and Diagnosis
What this domain tests
Screening, assessment, and diagnosis are three distinct steps, and the exam checks whether you can keep them apart. Screening is brief, standardized, and designed to flag risk; assessment is a comprehensive biopsychosocial process; diagnosis is a formal clinical determination using DSM-5-TR criteria, made within your scope of practice.
Core rules
- Use validated instruments: AUDIT or AUDIT-C for alcohol, DAST-10 for drugs, PHQ-9 and GAD-7 for mood and anxiety, and SBIRT for brief intervention.
- Cover the ASAM six dimensions: intoxication/withdrawal, biomedical, cognitive/emotional, readiness to change, relapse potential, and recovery environment.
- Assessment includes history, collateral information (with consent), mental status, trauma, culture, and social determinants.
- Diagnosis requires meeting criteria and ruling out other causes; severity is mild (2–3 criteria), moderate (4–5), severe (6+).
- Document the tool, date, score, cutoff, and interpretation. Record strengths as well as problems.
Worked example
A 34-year-old reports blackouts. AUDIT score is 16, DAST-10 is 2, PHQ-9 is 12. The correct sequence is: screen positive → complete a full assessment including ASAM dimensions → refer for a diagnostic evaluation. A score alone is not a diagnosis, and a single high score does not determine level of care.
Traps
Treating screening as diagnosis; using unvalidated quizzes; skipping collateral or cultural context; ignoring suicide risk; and documenting a diagnosis outside your credential.