Search Appropriateness Statement Package
Substance Use Screening and Evaluation – Evidence-based practice
Summary of the Evidence
- Substance use screening and evaluation are evidence-based practices.
- Strong empirical evidence supports the use of evidence-based screenings and evaluations.
- If possible, probation staff should outsource their screening and evaluation to clinical staff trained to diagnose behavioral health disorders.
- Risk-assessment tools are not effective SUD screeners or evaluations.
What Are Substance Use Screenings and Evaluations?
- Screening is the process of evaluating the possible presence of a problem. The outcome is typically yes or no.
- Evaluation is the process of defining the nature of the problem, determining the diagnosis, and developing specific treatment recommendations for addressing the problem or diagnosis (SAMSHA).
- Alcohol and substance abuse is one of the more prevalent needs individuals exhibit on community supervision.
- Substance use behavior is often a symptom of other needs the client has (e.g., mental health).
- Clinical experts recommend that all clients receive a substance-use screening upon intake to supervision.
How Are They Used?
- When possible, an evidence-based screener should be used (e.g., Drug Abuse Screening Test [DAST]). (See additional sources for more information.)
- Most risk-need assessment tools are not effective screeners.
- Substance use screening should focus on use within the past 30 days.
- When an evidence-based tool is not available, departments should develop a screener that includes the following domains:
- type of substance used (alcohol, marijuana, opioids, other hard drugs)
- frequency of use by substance category
- negative impact (social, legal, employment, family) of substance use
- negative impact by substance category
- Officers should discuss the results of any screenings. Clients should then be informed if an evaluation is necessary.
- Evaluations should be administered with all clients identified by the screener as potentially having a problem.
- In-depth substance use evaluations are best administered by a trained clinician.
- If administered by an outside practitioner, evaluation results should be communicated to the supervising officer.
- Officers should discuss the evaluation results with the client and work collaboratively with them to incorporate those results into the client’s case plan.
How Can They Be Used to Monitor Compliance?
- Officers should not use treatment evaluation as a form of punishment for their clients.
- When a client is referred to treatment through the evaluation process, officers should discuss the consequences of noncompliance (e.g., relapse, not completing).
- Emphasis should be on helping the client address substance use need.
- Officers should minimize the use of authoritarian communication when using these tools or discussing their results.
How Can They Be Used as Supervision Tools?
- Screening and evaluation are best viewed as a therapeutic process.
- If administered correctly, the screening and evaluation process can solidify an officer as a helper, improving the working alliance.
- Screening and evaluation should never be used as a control tool.
What Are the Costs of Screening and Evaluation?
- There may be a cost of obtaining an evidence-based screener or evaluation and for training staff on the use of the tool.
What Do Supervision Staff Think?
- Supervision staff report that Substance Use Screenings and evaluations are
- sometimes appropriate for all low-risk clients and
- always appropriate for all medium- to high-risk clients.
What Should You Expect When Using Substance Use Screening and Evaluation?
- Screeners/evaluations identify whether a client has a substance use disorder and the proper treatment.
- When used in response to noncompliance, screeners/evaluations should be presented as a way to help the client succeed.
- Using screeners and evaluations as punishment can limit the effectiveness of the prescribed treatment.
Are Screenings and Evaluations Evidence-Based Practices?
- Yes, there is strong evidence supporting the effectiveness of using evidence-based Substance Use Screenings and evaluations.
What Do People Formerly Involved in the Criminal Legal System Think About Screening and Evaluation?
- People with lived experience in the criminal legal system (the “criminal justice” or “legal” system is referred to as the criminal legal system in this document) report that Substance Use Screenings and evaluations are
- sometimes appropriate for all low-risk clients and
- sometimes appropriate for all medium- to high-risk clients.
Communication That Strengthens the Officer-Client Relationship (Messaging)
- Officers should explain why the screening/evaluation is being used and how they benefit the client.
- If screening is a standard procedure, officers should explain this to clients.
- Officers should present themselves as helpers and use their experience on the job to counter clients’ ideas when dealing with conflict surrounding screening/evaluations.
- Officer should explain precisely how they will respond to noncompliance.
Special Considerations When Using Screening and Evaluation with Subpopulations
Intimate Partner Violence
IPV clients have a high likelihood of a history of substance abuse. Research suggests that addressing any substance use disorders should be part of an intervention plan for IPV clients. Identification of any substance use disorder is therefore important for both client success on supervision and the safety of victims.
Serious Mental Illness
Substance use is the norm rather than the exception for this group, with rates as high as 85% for individuals with mental illnesses who are involved with the criminal legal system. Aside from the typical reasons that individuals use substances, individuals with mental illnesses often use substances to deal with their mental health symptoms— anxiety, paranoia, auditory and visual hallucinations, etc.
Substance Use Disorder
Because of the strong connection between substance use behaviors and recidivism, all people should be screened for substance use (and referred to treatment as appropriate) using an evidence-based screener that measures type of substance, frequency, and negative impact. Traditional criminogenic/risk needs assessments are usually not sufficient indicators of substance use and abuse.