Specific Assessment Measures

Perhaps the most practical means by which the typical outpatient therapist can assess for the depressed patient's use of, abuse of, or dependence on alcohol and other drugs is to use a self-report screening instrument. Mueser at al. (2003) note that many such extant measures developed for the general population often lack strong predictive utility for identifying substance use disorders in clinical populations. A notable exception is the Alcohol Use Disorder Identification Test (AUDIT; Saunders, Aasland, Babor, De La Fuente, & Grant, 1993), "which has shown good sensitivity and specificity in detecting alcohol use disorders in persons with severe mental illness" (Mueser et al., 2003, p. 56). Another useful measure, the Dartmouth Assessment of Lifestyle Instrument (DALI; Rosenberg et al., 1998), is a brief, convenient screening device that can be used as a self-report questionnaire on paper or on computer, and may also be used in clinical-based interview form. The DALI has been found to have high specificity and sensitivity for the detection of alcohol, cannabis, cocaine, and other substance use disorders in clinical populations. Mueser et al. (2003) provide a copy of the DALI, along with scoring instructions, and note that a "positive score on the DALI indicates a high probability (80-90%) that the patient meets DSM criteria for a recent substance use disorder" (p. 56).

Once a depressed patient has been assessed to have a problem with alcohol or other drugs (regardless of whether he/she meets full criteria either for abuse or dependence), additional measures may be used to investigate related variables pertinent to the patient's functioning. One such mea sure is the Addiction Severity Index (ASI: McLellan et al., 1992), a structured interview that assesses the levels of functioning and impairment across numerous life domains in patients who experience problems with alcohol and other drugs. These domains include medical status, extent of alcohol and other drug use, employment, family and social relationships, legal involvement, and psychological status (including formal psychiatric diagnoses; e.g., depression). As is the case for most standardized instruments, the ASI is best administered periodically to measure the patient's progress over the course of treatment.

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