Demystifying assessment of teen substance abuse

By Kailley Lindman

If a teen were suffering from diabetes or another debilitating illness, most parents wouldn’t hesitate to make an appointment with a specialist and take the teen in for a medical evaluation.

In the case of discovering that the child is abusing alcohol or drugs, however, parents often feel overwhelmed and conflicted by fear, guilt, confusion and other emotions. They realize something must be done immediately, but they don’t know where to turn.

While getting proper assessment for a teen affected by substance abuse is uncharted territory for most parents, assessing the teen and recommending appropriate care are well-established protocols among longstanding treatment providers.

“Substance abuse is a serious health issue that is potentially fatal,” said Mary Egan, Rosecrance Director of Outreach. According to the Drug Abuse Warning Network, there were 280,000 emergency room visits in 2011 due to overdoses of alcohol, illegal drugs or pharmaceuticals by youth between the ages of 12 and 17. The Centers for Disease Control reported 38,329 drug overdose deaths in 2010 among adults and adolescents. Taking quick action for substance abuse is “no different” from any other grave illness, Egan said.

Rosecrance provides assessments where parents talk to an intake specialist who records concerns and gathers information about the family and teen.

“Our primary goal during this conversation is to remove any barriers that may stand in the way of the family getting help for the teenager,” Egan said. “The specialist can be very flexible to quickly schedule an assessment for the family.

“We understand the urgency parents feel at this point. They’re frightened by what’s happening, and they want to move as quickly as they are able to get the right kind of help for the child.”

The assessment, step by step

  1. When the family arrives, the parents and the teen are asked to complete necessary paperwork addressing confidentiality and client rights. They sign a form consenting to the evaluation, and the clinician addresses questions or concerns.
  2. The family describes the problem as they see it and in as much detail as possible to help the clinician make the best recommendation.
  3. Parents then are asked to leave the room for the remainder of the assessment, allowing the clinician to speak directly with the teen. Clinicians use a standard comprehensive bio-psychosocial evaluation.
  4. The teen is asked about school, work, relationships, recreational activities and family life, then more about his or her substance use and legal and psychiatric histories. These questions help the clinician understand if substance use is the most pressing issue or if a coexisting condition such as an eating disorder, self-harming behaviors or depression must be addressed as well. If the clinician concludes that the primary diagnosis is not substance use, the family will be referred to a reputable specialist in that area.
  5. Following the interview, the clinician asks the teen to provide a urine sample for analysis.
  6. Before the teen and the family leave the assessment, they have an opportunity to bring up any lingering concerns. The clinician gives the family a quick timeline for receiving a treatment recommendation.

Recommendation for care

The treatment recommendation is based on careful analysis of several factors: the interview, the teen’s apparent motivation to change, drug test results and information gathered from referral sources such as schools and court officials.

“The goal is to match the teen with the lowest, most-appropriate level of care,” Egan said. “For example, if the teen reports only drinking alcohol once and is able to provide a negative drug test sample, he or she might be recommended for early intervention services.

“Similarly, if the teen reports drinking until blacked out several nights a week, he or she might be recommended to seek residential services.”

There also are levels of care in between, according to American Society of Addiction Medicine guidelines:

  • Level 0.5: Early intervention/prevention services
  • Level I: Outpatient services
  • Level II: Intensive outpatient/partial hospitalization services (9-12 hours/week)
  • Level III: Residential inpatient services
  • Level IV: Medically managed intensive inpatient services

After the family receives a recommendation, they may choose to enter a program. Families are not required to follow the recommendation, except if it comes from the courts, but parents are urged to act in their child’s best interest.