That’s not usually the way I open a dialogue with a client around substance use. Rather, I’ll say “Everyone’s exposed to alcohol growing up and there’s lots of marijuana, coke, E, meth and other stuff. What’s been your experience?” Better to normalize things and then begin with an open-ended question. It beats “So, do you abuse alcohol and street drugs?”
In my opinion ACT teams don’t need substance use screening tools like the CAGE, the AUDIT or the DAST as much as they need tracking tools. Most individuals have had lots of contact with services before getting to ACT. And screening tools are a pretty ‘blunt instrument’, so to speak.
There are lengthy survey tools that have been used, including those detailed in Allness and Knoedler’s PACT manual. My team came up with a modification of those. Clinicians print off the Drug&AlcoholUseTemplate (click to view) – and either go through it with the client or, simply have the client fill it out. The format is straight-forward, if the answer to the first question, for example: Have you ever used an amphetamine or crystal meth, what some people call an ‘upper’ or ‘speed’ on your own, either without a doctor’s prescription or in greater amounts or more often than prescribed? is a No, you just flip to the next page.
The results are put in the PACTwise database (yes, a flagrant product placement/plug) and out comes a one page Drug and Alcohol Review (click to view). This single page report provides an overview – age of first use for each drug, last use, use in the past 12 months – that gives clinicians an understanding of the client’s pattern of use over time.
This is certainly not the only way to track this kind of info. What do you use? How is it? What do you think would be the ideal tool?