Addiction Assessment Tools

Addiction Assessment - Screening Blitz

• Screening tools are brief, validated questionnaires used to rapidly identify individuals potentially at risk for substance use disorders (SUDs), guiding further comprehensive assessment.

Diagnostic Tools - Severity Sleuths

Key instruments for quantifying addiction severity and guiding withdrawal management.

• Addiction Severity Index (ASI)
  • Purpose: Comprehensive interview; 7 areas: medical, employment, alcohol, drug, legal, family/social, psychiatric.
  • Scoring: Severity ratings (0-9) & composite scores guide treatment.
• Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar)
  • Purpose: Quantifies alcohol withdrawal; guides benzodiazepine therapy.
  • Key Items: N/V, tremor, sweats, anxiety, agitation, sensory disturbances (tactile/auditory/visual), headache, orientation.
  • Scoring:
    • <8-10: Mild (supportive care).
    • 10-15: Moderate (consider meds).

    • 15: Severe (meds needed, max score 67).

  ⭐ CIWA-Ar score >15 strongly indicates need for pharmacological intervention to prevent progression to severe withdrawal (e.g., seizures, delirium tremens).

• Clinical Opiate Withdrawal Scale (COWS)
  • Purpose: Assesses opioid withdrawal; guides symptomatic treatment/buprenorphine induction.
  • Key Items: Pulse, sweat, restlessness, pupil size, aches, rhinorrhea/lacrimation, GI upset, tremor, yawn, anxiety/irritability, gooseflesh.
  • Scoring:
    • 5-12: Mild.
    • 13-24: Moderate.
    • 25-36: Mod-Severe.

    • 36: Severe.

Withdrawal Management Decision Aid:

Specific Tools - Nicotine Nabs

• Fagerström Test for Nicotine Dependence (FTND)
  • Purpose: Quantifies the level of physical dependence on nicotine.
  • Items: 6 questions assessing smoking patterns (e.g., time to first cigarette, cigarettes per day).
  • Scoring: Total score ranges from 0 to 10.
  • Interpretation of Dependence:
    • 0-2: Very low dependence
    • 3-4: Low dependence
    • 5: Medium dependence
    • 6-7: High dependence
    • 8-10: Very high dependence
  • Clinical Use: Guides treatment intensity (e.g., Nicotine Replacement Therapy dosage).

  ⭐ The question "How soon after you wake up do you smoke your first cigarette?" is a key predictor of nicotine dependence within the FTND, often carrying the highest weight in scoring (3 points if within 5 minutes).

High‑Yield Points - ⚡ Biggest Takeaways

• CAGE questionnaire: 4 quick questions for alcohol dependence screening; 2+ positive suggests problem.
• AUDIT: WHO's 10-item tool for alcohol use disorders, covering consumption, dependence, and problems.
• ASSIST: WHO tool for screening multiple substance use (alcohol, tobacco, illicit drugs).
• CIWA-Ar: 10-item scale to objectively measure alcohol withdrawal severity and guide treatment.
• COWS: 11-item scale to assess and monitor opioid withdrawal severity, guiding management_