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Psychological Assessment: Case Study of Psychoactive Substance Misuse

Paper Type: Free Essay Subject: Psychology
Wordcount: 4652 words Published: 8th Feb 2020

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The following report details the recommended assessment/screening tools to be used on the following client.

Mr X is a 30-year-old male who has a history of misusing psychoactive substances; including alcohol. Although there have been multiple attempts to rehabilitate the subject, each approach has been unsuccessful. The client has disclosed information highlighting recent episodes of trauma and abuse which has resulted in the patient experiencing dreams of a disturbing nature in addition to having intrusive thoughts. Furthermore, it has been inferred that the patient’s excessive consumption of psychoactive substances; including alcohol, helps the client cope with the negative effects of the trauma and abuse experienced; the risk of suicide is also present.

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In the case of Mr X the recommended screening measure to address the substance and alcohol misuse is The Alcohol Use Disorder identification Test (AUDIT) and Drug Use Disorder Identification Test (DUDIT). Conducting this assessment will provide an understanding of the client’s substance and alcohol usage prior to further assessments (Berman & Kallmen, 2002; Berman, Berman, Palmstierna & Schlyter, 2004). In addition to this the usage of the State of Change Readiness and Treatment Eagerness Scale (SOCRATES) is suggested to be used to assess Mr X’s motivation to change. This will be an important predictor of whether the client will comply with the treatment as well as infer the long-term treatment outcome (Mitchell & Angelone, 2006). The assessment measure PCL-5 is the recommended tool to be utilised to screen for Post-traumatic Stress Disorder (PTSD) as this instrument will address any trauma-related stress Mr X may be experiencing, whilst the Modified Scale for Suicide Ideation (MSSI) should be used to evaluate the risk of suicide.

The psychometric properties for each of the tools previously mentioned will be discussed below, furthermore, details concerning the instruments validity; in terms of sensitivity and specificity, the measures internal consistency, and test and re-test details (where available) will also be documented.

The Alcohol Use Disorder Identification Test

Following the collaboration of The World Health Organisation (WHO) and six worldwide research centres (situated in Australia, Bulgaria, Kenya, Mexico, Norway, and the USA), The Alcohol Use Disorder Identification Test (AUDIT) was developed in 1983 (Saunders, Aasland, Babor, Fuente, & Grant, 1993). This widely used screening instrument primarily aims to identify risky, harmful and hazardous alcohol intake. This is achieved by assessing an individual’s drinking habits whilst also identifying any behaviours or problems which may occur due to the unbalanced consumption of this substance (Babor, Higgings-Biddle, Saunders, Monteiro, 2001); there are two different ways in which the AUDIT can be completed, either via an interview process or as a self-report questionnaire (Bergman, & Källmén, 2002).

The screening tool consists of 10 items which measures three different domains of alcohol consumption; hazardous use, symptoms of dependency and harmful use (Babor et al., 2001). Items 1-3 assess the amount and frequency of alcohol consumed; a question posed to the patient for example, would be: ‘How many drinks containing alcohol do you have on a typical day when you are drinking?’, (Saunders, Aasland, Babor, De la Fuente, & Grant, 1993) whereas items 4-6 assess alcohol dependency, again asking questions such as: ‘How often during the last year have you found that you were not able to stop drinking once you had started (Saunders et al.1993)? Items 7-10 aim to identify any related problems due to alcohol consumption, an example of the type of question used to help identify this could be: ‘How often during the last year have you been able to remember what happened the night before because you had been drinking (Saunders et al.1993)?

A Likert-type scoring system is utilised to collate patients’ scores. The range begins at 0 to 4 and is used as follows; 0 = never, 1 = monthly or less than, 2 = 2 times a month, 3 = 2 to 3 times a week, and 4 = 4 times a week. The minimum total score which can be achieved is 0 and a maximum of 40 (Babor et al., 2001). The accepted cut off score for the AUDIT is 8; if the client scores this amount or higher it will show hazardous (harmful) or dependent use (Babor et al., 2001).

Reinert and Allen (2007) evaluated 18 published studies, which had utilised the AUDIT, and reported a median reliability coefficient of 0.83 with a range of 0.75 to 0.97 which illustrates good internal reliability; akin to that, Shields & Caruso’s (2003) study, consisting of 28 samples, also examined its reliability, and reported a median internal consistency reliability coefficient of 0.81 with a range of 0.59 to 0.91, therefore proving the internal reliability of the AUDIT as efficient and effective.

Examining the measures cut-off score, Meneses-Gaya (2009) and colleagues conducted a systematic review of forty-seven published articles featuring the AUDIT and its psychometric properties. They reported sensitivity of 0.76 and specificity of 0.79 was achieved when the cut-off score was 9, similarly, Fiellin, Reid & O’Connor’s (2000) systematic review; which consisted of 6 studies, documented the AUDIT had a sensitivity of 97% and a specificity of 78% for hazardous use and a sensitivity of 95% and a specificity of 85% for harmful use when applying a cut-off score of 8. Although the evidence from the previous two studies indicate a cut-off score of 8 is suffice, Adewuya (2005) illustrated a cut-off point of 5 delivered results of 0.935 sensitivity and 0.915 specificity, he did however, stipulated a cut-off score of 4 reduced specificity to 0.348, whilst raising the cut-off score to 6 resulted in sensitivity drastically decreasing.

Conducting a test-re-test study of the AUDIT with a sample of 126 primary care patients, Daeppen, Yersin, Landry, Pecoud, Decrey (2000) found the Spearman correlation coefficient indicated a test-retest reliability of 0.81; with an interval period of 6 weeks. Akin to this Selin (2003) utilised the AUDIT on 157 participants, then re-tested the sample a month later and the results demonstrated a test-retest score of 0.83.

Drug Use Disorder Identification Test

The Drug Use Disorder Identification Test (DUDIT) is a screening tool used to investigate an individual’s illicit drug use during the period of the prior year and the consequences which occur due to the individual’s drug usage (Hildebrand & Noteborn, 2015); moreover, this particular assessment tool was also originally designed to be used in conjunction with the AUDIT (Berman et al., 2004).

Akin to the AUDIT, the DUDIT is an 11 item questionnaire to be completed either as a self-report or via interview (Berman et al., 2004). Each item has been selected in accordance with the ICD-10 and DSM-IV guidelines for substance abuse, harmful use and dependency (Sfendla, Zouini, Lemrani, Berman, Senhaji, & Kerekes, 2017; Hildebrand, 2015) and assesses three different domains; the frequency of use, any physical and psychological problems which occur and symptoms of dependency (Matuszka et al., 2013). The first 9 questions which aim to identify frequency of use are scored on a five point Likert-type scale which ranges from 0 to 4; 0 = never, 1 = monthly or less, 2 = 2 times a month, 3 = 2 to 3 times a week, and 4 = 4 or more times a week (an example of the type of questions utilised would be: ‘How often over the past year have you needed to take a drug the morning after a heavy drug use the day before?’(Hildebrand, 2015; Voluse, Gioia, Sobell, Dum, Sobell, & Simco, 2012). Whereas, the remaining two questions are scored using a three point scale with the values of 0 = No, 2 = Yes, but not over the past year, and 4 = Yes over the past year. An exemplar question could be: ‘Has a relative or a friend, doctor or a nurse, or anyone else, been worried about your drug use or said to you that you should stop using drugs?’ (Voluse, et al, 2012).

The minimum total score which can be achieved is 0 and a maximum of 44, if however, the client scores higher, it is a likely indication of a more severe drug problem (Voluse, et al, 2012; Hildebrand, 2015); furthermore, there are two different accepted cut off scores, for females the accepted cut off score is 2 whereas for males it is 6 (Voluse, et al, 2012).

Evaluating the psychometric properties of the DUDIT with a sample of 153; 35 individuals partaking in an outreach treatment programme, 79 abusers already taking part in treatment programme and 39 alcohol abusers who did not claim to have a drug problem, Voluse et al., (2012) reported, results illustrated internal consistency for the DUDIT to be 0.94. Using a cut-off score of 6 showed sensitivity of 0.92 and specificity of 0.77, however, when the cut-off score was inceased to 12, sensitivity reduced to 0.84 and specificity increased to 0.85.

Further support for psychometric properties of the DUDIT can been seen in Hildebrand’s (2015) systematic review. After examining 18 studies which had investigated the DUDIT’s psychometric properties; published between 2005 and 2014, results illustrated an estimated internal consistency Cronbach’s α = 0.90, furthermore, the majority of studies revealed sensitivity ranging from 0.85 to 1.00 and specificity ranging from 0.75 to 0.92.

The State of Change Readiness and Treatment Eagerness Scale (SOCRATES)

As previously mentioned an individual’s willingness to change has a detrimental impact on the outcome of any treatment programme. Project MATCH conducted the largest study (to date) which evaluated substance abuse treatment. The findings illuminated participants with greater readiness to change at the initial meeting demonstrated larger decreases in their substance usage, once treatment was completed, compared to those who displayed lesser readiness to change at the initial meeting (Mitchell & Angelone, 2006).

The State of Change Readiness and Treatment Eagerness Scale (SOCRATES) was developed by utilising the data retrieved from Project MATCH (Mitchell & Angelone, 2006). This self-report readiness to change instrument is designed to specifically identify whether alcohol dependent patients have enough motivation and are ready to change the pattern of substance use (Mitchell & Angelone, 2006). Based on the ‘stage of change model’, this particular assessment tool aims to predict whether the client will comply with treatment as well as indicate the overall outcome of long-term alcohol treatment (Peter, Bartoi, & Sherman, 1997).

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Although there are two different versions of the SOCRATES questionnaires, The SOCRATES Personal Drinking Questionnaire; Form 8A, and The SOCRATES Personal Drug Use Questionnaire; Form 8D, are identical expect for the wording. For example, the term ‘drinking’ is used on the 8A form, whereas, ‘drug use’ is documented on the 8D version (Mitchell & Angelone, 2006): for the purpose of this report the following information will only relate to The SOCRATES Personal Drinking Questionnaire; Form 8A.

The SOCRATES Personal Drinking Questionnaire; Form 8A, consists of 19 items which contain three subscales (Peters, Bartoi, & Sherman, 1997; Mitchell & Angelone, 2006), The Recognition Subscale which establishes the extent the respondent acknowledges they have a problem with substance misuse, and whether they comprehend the harm which will transpire if they do not change (Mitchell & Angelone, 2006). An example of a statement utilised to identify ‘recognition’ would be: ‘If I do not change my drinking soon, my problems are going to get worse’ (Miller & Tonigan, 1996). The Ambivalence Subscale identifies the extent to which the individual is conflicted about the pros and cons regarding their substance abuse patterns (Mitchell & Angelone, 2006); a statement used to acknowledge this would be: ‘I have already changed my drinking, and I am looking for ways to keep from slipping back to my old patterns’ (Miller & Tonigan, 1996). Finally, The Taking Steps Subscale, identifies the extent to which the individual is open to the possibility of changing their substance usage (Mitchell & Angelone, 2006); an example statement may be: ‘I have made some changes in my drinking, and I want some help to keep from going back to the way I used to drink’ (Miller & Tonigan, 1996). Scoring is accumulated using a 5 point Likert-type scoring system ranging from 1 to 5; 1 = NO strongly disagree, 2 = No Disagree, 3 = Undecided or unsure, 4 = Yes agree and 5 YES Strongly agree.

Miller & Tonigan, (1996) evaluated the psychometric properties of SOCRATES by conducting two studies utilising data retrieved from a clinical sample (n = 1672). Results from the first examination illustrated internal consistency Cronbach’s α = .83 for Taking Steps, Cronbach’s α = .85 for Recognition, and Cronbach’s α = .60 for Ambivalence. Study 2, investigated the instruments test re-test reliability, finding showed r = .91 for Taking Steps, r = .99 for Recognition, r = .93 for Ambivalence, which therefore, illustrating SOCRATES has good test re-test reliability.

PTSD checklist for DSM – 5 (PCL – 5)

When an individual is exposed to one or more traumatic events they can develop certain characteristic symptoms, such as fear or helplessness (American Psychiatric Association, 2013). Experiencing these symptoms can have a detrimental impact on a person’s daily functioning. The Post-traumatic Stress Disorder (PTSD) Checklist for DSM-5 (PCL-5; Weathers, Litz, et al., 2013b) is a revised version; developed to incorporate the changes made to the DSM-5 criteria for PTSD (Blevins, Weathers, Davis, Witte, & Domino, 2015; Bovin, et al., 2016) of the widely used PCL (17 items) questionnaire (Bovin, et al., 2016). This assessment measure can be utilised to monitor the following; any changes in the individual’s symptoms during and after treatment, to screen individuals for PTSD and enable a provisional PTSD diagnosis (National Centre for PTSD, 2016).

The PCL-5 is a self-report instrument in the form of a questionnaire and consists of 20 items which correspond to the 20 PTSD symptoms detailed in the DSM-5 (Bovin, et al., 2016). This 4 factor model (Blevins, et al., 2015) assesses; Re-occurrence, Avoidance, Negative Alterations in Cognitive Mood (NACM), Alterations in Arousal and Reactivity (Armour, et al., 2016). Items 1 – 5 evaluates re-occurrence using phrases such as: ‘repeated, disturbing memories, thoughts or images of a stressful experience’, whilst items 6 and 7 explores ‘avoidance’ utilising phrases such as ‘avoid external reminders of the stressful experience for example, people, places, conversations, activities, objects or situation’. Items 8 -14 on the other hand investigates NACM with phrases such as: ‘blaming yourself or someone else for the stressful experience or what happened or after it’, whereas, items 15 -20 examines Alteration in Arousal and Reactivity for example ‘taking too many risks or doing things that could cause you harm’ (Armour, et al., 2016).

The client will be required to indicate how the PTSD symptoms have effected them over the last month, using a 5-point scale range with values of 1 = not at all, 2 = a little bit, 3 = moderately, 4 = quite a bit and 5 = extremely (Blevins, et al., 2015). The total symptom severity score, ranges from 0 to 80 with higher scores indicating higher severity of PTSD symptoms (Blevins, et al., 2015).

Bovlin (2016) and colleagues conducted a study which examined the psychometric properties of the aforementioned instrument. Utilising two independent samples consisting of 468 veterans; sample 1 = n 328, sample 2 = n 140, they evaluated the instruments internal consistency, test-retest reliability and the convergent and discriminant validity of the PCL-5 scores. The results illustrated the instrument had good internal consistency (Cronbach’s α = .96), and the test-retest reliability results showed r = .84.

Further support for the instruments internal consistency and test re-test reliability was provided Blevin, et al., (2015). Utilising a sample of trauma-exposed college students, Blevin (2015) and colleagues conducted two studies which investigated the psychometric properties of the PCL-5.

To establish the test-retest reliability, internal consistency and convergent and discriminant validity of the assessment measure. Study 1, used a sample; of (n = 278) participants, and compared the PCL-5 to three other self-report PTSD measures; PCL, The Post-traumatic Stress Diagnostic Scale (PDS; Foa, 1995 as cited in Blevin, et al., 2015) and the Detailed Assessment of Posttraumatic Stress (DAPS; Briere, 2001 as cited in Blevin, et al., 2015). The finding showed the PCL-5 demonstrated high internal consistency (α = .94). Test-retest reliability of the instrument was identified using (n = 53) returning participants after a week’s interval; short enough to ensure the reliability coefficients would not be affected, the results also illustrated a good test re-test reliability r =.82. Convergent validity was reported as (rs=.74 to .85) and discriminant validity was (rs=.31 to .60), the optimal PCL-5 score of 37 illustrated .66 sensitivity and .97 specificity, when the criterion was reduced to 31 sensitivity increased to .77 and specificity .96. The second study utilised (n 558) participants and replicated study 1, however, the PCL and PDS measuring tools were excluded. The results demonstrated high internal consistency (α = .95).

The Modified Scale for Suicide Ideation (MSSI)

The Modified Scale for Suicide Ideation (MSSI; Miller, Norman, Bishop, & Dow, 1986) is a revised version of the Scale for Suicide Ideation (SSI) (Miller, et al., 1986). The particular assessment technique measures the intensity, pervasiveness and the characteristics of suicidal ideation in adults whilst also aiming to evaluate the risk of future attempts of suicide in subjects who have thoughts, plans or wishes to commit suicide (Holi, et al., 2005).

This self-report measure consists of 18 items (13 items from the SSI measure and 5 new items; which correspond to intensity of ideation, courage and competence to attempt and talk and write about death (Clum & Yang, 1995).The MSSI is a ‘subjective’ measuring tool in the form of a semi-structured interview which assesses any suicidal symptoms which have been present from the point of the interview and the previous 48 hours (Miller, et al., 1986). Each item is scored using a 0-3 point Likert Scale with a total value score ranging 0.54 (Clum & Yang, 1995). A total score equal to or higher than 21 indicates severe suicidal ideation (Miller, et al., 1986)

Miller, et al., (1986) conducted two studies which examined the reliability and validity of this measuring instrument. Study 1, consisted of 113 participants; all had been diagnosed with major depression. Each participant was administered the MSSI, the results illustrated high internal consistency (coefficient α=.86). Additionally item-total correlations ranged from .57 to .79. Furthermore, data retrieved from the subjects who meet the screening criteria; 54, illustrated the MSSI showed a high level of internal consistency (coefficient α = .94).

Study 2 consisted of 50 participants; inpatient admissions. Following the administration of the MSSI, results highlighted, the patients who were identified as a suicide risk by a psychiatrist (n 13), had higher MSSI scores than those who had not been identified (n 36), t(47) = 4.2, p < .001. The patients with suicidal thinking and had been admitted to hospital (n 24) also scored significantly higher on the MSSI than those who did not have suicidal thoughts on admission (n 25) t(47) =4.1, p < .001.


As can be seen from the information provided in this report, all of the instruments discussed in the have good reliability and validity, as well as test and re-test reliability.


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