Alcohol and other drug (AOD) abuse and AOD abuse-related problems are among society's most pervasive medical and social concerns. Reliable, valid, and clinically useful instruments, as well as procedures for wide general use in screening and assessment for AOD-abusing adults, are available as complements to clinicians' experience.
A panel of experienced researchers and clinicians who work with AOD-abusing adult offenders was convened in 1993 by the Center for Substance Abuse Treatment (CSAT) to develop guidelines for screening and assessing drug users' problems as the basis for appropriate program referral and treatment. This treatment improvement protocol (TIP) on screening and assessment is an outgrowth of that meeting. It should be viewed as a companion volume to two other TIPs that are available or being developed for use by State AOD abuse agencies and AOD abuse treatment programs in the criminal justice system that are funded with Substance Abuse Prevention and Treatment Block Grant funds. The other two TIPs are:
Combining Alcohol and Other Drug Abuse Treatment Services with Intermediate Sanctions for Adults in the Criminal Justice System
Planning for Alcohol and Other Drug Abuse Treatment for Adults in the Criminal Justice System
The panel on AOD abuse screening and assessment among adults in the criminal justice system was charged with developing guidelines to:
Identify AOD abuse screening and assessment services that need to be provided to offenders with various levels of AOD abuse problems and concurrent needs for correctional supervision
Identify specific screening and assessment tools that appear to be particularly appropriate for offender populations and help to facilitate treatment planning
Assist criminal justice agencies in the use of screening and assessment tools to enhance treatment outcomes.
The emphasis of this document is on practical screening, assessment, and treatment planning procedures that can help to improve care and treatment outcomes. Underlying the clinical experience reflected in the consensus panel membership, and in this TIP, is the goal to prepare guidelines, based on best practices, that can be used easily by clinicians and other workers in the field. This TIP summarizes the results of the consensus panel's deliberations. The intention is to provide guidelines, based on best practices, to criminal justice and AOD abuse treatment personnel based on considerations by individuals with broad experience in the field. The TIP does not prescribe any particular screening or assessment tool. Nor is it a manual for learning how to administer instruments. However, it does provide a starting point for increased and improved coordination among providers of AOD abuse services to adults at various points in the criminal justice process.
Three basic principles guided the panel's efforts:
Adult offenders should receive effective and appropriate care. Thus, health and social service agency personnel, corrections staff, prosecutors, judiciary, police, and a variety of other personnel who come into regular contact with adult offenders should use appropriate and effective means to identify potential AOD abuse problems among this group. In turn, adult offenders have an obligation to follow screening and assessment procedures with appropriate treatment and interventions that are indicated by the results of the assessment procedures when the interventions are available.1
Adult offenders have a right to privacy and to the confidential handling of any information they provide. Screening and assessment are not neutral or passive procedures. Used intelligently, they can provide vital information to appropriate professionals, thus contributing to effective care. Used in a careless or unprofessional manner, there is the potential for significant harm to the individuals who need help. In the discussions that follow, the offenders' rights to privacy and confidentiality are emphasized to make clear the need for professional and sensitive handling of information at each step of the screening, assessment, and treatment planning process.
Cultural, ethnic, and gender concerns must be considered in all aspects of the screening and assessment process. It is vital for program staff to keenly understand the impact that culture, ethnicity, and gender of both the adult offender and the staff member can have on everything discussed herein. Multicultural programs are essential in today's society. People involved in screening, assessment, and treatment planning must understand how their own culture, ethnic background, and life experiences affect this process. These concerns are discussed in the TIP.
This TIP and the others that address the continuum of AOD abuse among adults in the criminal justice system discuss the interface between two delivery systems -- AOD abuse treatment and criminal justice -- with different generic mandates. In Appendix B, the CSAT Criminal Justice Treatment Planning Chart illustrates interfaces between the two delivery systems where screening, assessment, and treatment planning for AOD abuse can be most effectively provided. It is critical for personnel in both systems to know and understand each other's vocabulary. Attaining this shared knowledge and understanding will lead to improved outcomes for both systems.
To facilitate shared understanding, terms that may have different meanings in the two fields are used as defined below by the consensus panel:
Abstinence --
the complete abstention from the use of alcoholic beverages and/or other drugs of abuse.
Acculturation --
the process of change in which the members of one culture take on the elements of another, after continuous contact with that culture.
Addiction --
Drug craving accompanied by physical dependence that motivates continuing use, resulting in a tolerance to a drug's effects and a syndrome of identifiable symptoms when the drug is abruptly withdrawn.
Adult offender --
Any person over the age of 17 charged with a criminal offense.
AIDS --
Acquired immunodeficiency syndrome, a severe manifestation of infection with the human immunodeficiency virus (HIV).
AOD abuse --
the use of alcohol or other drugs at a level that creates problems in one or more areas of functioning and requires intervention.
Assessment --
the collection of detailed information concerning the client's AOD abuse, emotional and physical health, social roles, and other relevant areas.
Case management --
A problem-solving activity designed to address inadequacies in the service delivery network that become barriers to a client's acquiring needed benefits, support, and care.
Classification --
the process by which a jail, prison, probation office, parole, or other criminal justice agency assesses the security risk of an individual offender and the individual's need for social services.
Community corrections --
Adjudications that provide alternatives to incarceration such as court diversion programs, house arrest and electronic monitoring, intensive supervision, probation and parole, restitution, community service, and work release.
Constitutional law --
the legal rules and principles that define the nature and limits of governmental power and the duties and rights of individuals in relation to the State.
Court-mandated treatment --
A court order to participate in treatment as part of a sentence or in lieu of some aspect of the judicial process.
Cultural appropriateness --
Demonstrating both sensitivity to cultural differences and similarities and effectiveness in using cultural symbols to communicate a message.
Cultural competence --
A set of academic and interpersonal skills that helps individuals to increase their understanding and appreciation of cultural differences and similarities within, among, and between groups. It requires a willingness and ability to draw on community-based values, traditions, and customs, and to work with knowledgeable persons from the community in developing focused interventions, communication, and support.
Cultural sensitivity --
An awareness of the nuances of one's own and other cultures.
Culture --
the shared values, norms, traditions, customs, art, history, folklore, and institutions of a group of people.
Gender issues --
Factors, problems, and concerns that are specific to members of a particular gender.
Habilitation --
A person's initial socialization into a productive and responsible way of life (as contrasted with a return to a way of life previously known and perhaps to the term "rehabilitation," which emphasizes the forgotten or rejected).
HIV --
Human immunodeficiency virus, the causative agent of AIDS.
Three Basic Principles
Adult offenders should have effective and appropriate care.
Adult offenders have a right to privacy and to confidential handling of any and all information they provide.
Cultural, racial, ethnic, and gender concerns must be considered in all aspects of the screening and assessment process.
Jail --
Local detention facility for temporary confinement.
Multicultural --
Designed for or pertaining to two or more distinct cultures.
Parole --
the status of being released from a correctional institution after serving part of a sentence, on the condition of maintaining good behavior and remaining under the supervision of an agency until a final discharge is granted.
Presentence investigation --
An investigation into the background and character of a defendant that assists the court in determining the most appropriate disposition.
Prison --
A correctional institution maintained by a State or the Federal Government for the confinement of convicted felons.
Probation --
A sentence not involving confinement that imposes conditions and retains authority in the sentencing court to modify the conditions of the sentence or to resentence the offender if he or she violates the conditions.
Readiness for treatment --
A client's perception and acceptance of his or her need for treatment in order to achieve personal change.
Screening --
A gathering and sorting of information used to determine if an individual has a problem with AOD abuse, and if so, whether a detailed clinical assessment is appropriate.
Split sentence --
A sentence involving a short period of incarceration followed by probation or some other form of community supervision.
Treatment planning --
the process of planning a client's total course of treatment.
Treatment progress assessment --
A process that determines the value of the chosen course of treatment, its suitability for the client, and how it should be extended or adjusted if necessary.
Urinalysis --
the testing of a urine sample for the presence of drugs.
The comprehensive screening, assessment, and treatment planning process described in this volume exists in only a few criminal justice systems. In hopes of remedying this situation, CSAT consensus panel members worked to identify and develop the guidelines and related basic requirements for an integrated and practical screening, assessment, and treatment planning system that could be put into practice in a variety of criminal justice settings.
Chapter 2 provides an overview of the criminal justice setting and the screening, assessment, and treatment planning that should occur there.
Chapter 3 covers treatment screening, needs assessment, and readiness for treatment, including how the AOD-abusing adult offender enters the criminal justice system, who should do the assessment, assessment indicators and sources of information, and issues involving availability and nonavailability of treatment. It also covers clinical assessment and treatment planning, including such areas as assessment and diagnosis, setting treatment goals, and identifying available treatment resources. Specific instruments are reviewed, and some samples are included in the appendices.
Chapter 4 discusses assessments for treatment progress, its components, sources of information, related criminal justice issues, issues of integrity, and limitations in reaching treatment goals.
Chapter 5 addresses special issues such as race, ethnicity, gender, sexual orientation, physical disability, infectious disease risk and status, history of abuse, and the incorporation of these relevant data into the treatment plan.
Chapter 6 reviews constitutionality, confidentiality, and ethics as these relate to the rights of the AOD-abusing adult offender.
There are several appendices at the end of this document. Appendix A is a list of references cited and a brief bibliography. A more comprehensive bibliography regarding screening and assessment appears in Appendix D. Appendix B is the CSAT Criminal Justice Treatment Planning Chart. Appendix C consists of several screening and assessment instruments, and Appendix D is a description of numerous supplementary assessment instruments.
1 Although most professionals involved with treating adult offenders with AOD problems believe these offenders have the right to treatment, this philosophy has not been upheld by the courts.
In O'Connor v. Donaldson (422 U.S. 563), a 1975 case involving mental patients, the U.S. Supreme Court refused to decide on the matter of rights to treatment. Other decisions, while recognizing the right of prisoners to basic medical care, have specifically ruled that there is no constitutional duty imposed on a government entity to rehabilitate prisoners. AOD abuse treatment is not universally considered an aspect of basic medical care by everyone in the medical and legal professions.
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