What Are the Substance Use Disorder Criteria? What To Expect

A substance use disorder evaluation is often one of the first steps toward entering a treatment program. The goal of the evaluation is to determine whether your alcohol or drug use is causing problems in your life.

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Seeking care for substance use disorders, such as opioid use disorder (OUD), can be intimidating. In this article, you’ll learn about the criteria for diagnosing substance use disorder, as well as what happens during and after a substance use disorder evaluation.

What Is a Substance Use Disorder Evaluation?

A substance use disorder evaluation is the process a healthcare provider or a mental health provider uses to identify people who may have a problem with drugs or alcohol. A formal substance use evaluation involves a healthcare provider conducting a structured interview or offering a questionnaire to answer.

Healthcare providers may use a test called TAPS to assess if you’ve had any substance misuse in the past 90 days.

The tools healthcare providers use for a substance use disorder evaluation have been proven by clinical research to provide reliable and consistent information to help identify people who have or are at risk for a substance use disorder. A healthcare provider can also use the results of the evaluation to guide treatment options.

The type of substance use disorder evaluation you have depends on several factors, including:

• Your age
• The type of substance being evaluated
• Whether you take the evaluation yourself or a healthcare provider administers the test

At first, your healthcare provider may see if you’re at risk of a substance use disorder with a screening test. If the screening test shows you’re at risk, additional tests can help diagnose your condition.

Who Needs a Substance Use Disorder Evaluation?

You may have a substance use disorder evaluation as part of your regular healthcare. You might also seek one for several reasons, including:

• You’re worried you have a substance use disorder.
• Your friends, family members, or healthcare provider request a substance use disorder evaluation.
• Your healthcare provider has prescribed pain medication.
• You’ve been diagnosed with certain medical conditions associated with substance misuse.
• You have a court order requiring a substance use evaluation.

Specialists recommend that everyone be screened for substance use disorder before getting a prescription for an opioid pain medication.

Substance Use Disorder Screening Tests

Screening tests can check for substance use disorder even before you’re aware of any symptoms. These tests are often given as part of your regular healthcare visits to help identify a problem before it gets bigger. Some screening tests are interviews with your healthcare provider. Other screening tests are given as a questionnaire, which you answer yourself.

Most screening tests don’t take very long to complete. The type of screening test your healthcare provider offers depends on which substance you may be at risk of misusing. Some screening tests evaluate the risk for alcohol, other drugs, or both.

Screening Tests for Alcohol

The U.S. Preventive Services Task Force recommends primary care providers screen all adults for unhealthy alcohol use. There are several tools for alcohol screening. Each alcohol use screening test aims to determine your drinking habits and the impact alcohol has on your life.

The Alcohol Use Disorders Identification Test (AUDIT) is a 10-question test that can help identify people at risk for alcohol-related problems. This tool asks questions to determine:

• How often and how much you drink
• If you feel you can stop drinking once you start
• How alcohol affects your life and relationships
• How you feel about your drinking

Shorter versions of AUDIT with just one or three questions are also available. This tool assigns points to each answer. More points indicate a higher risk of alcohol use disorder.

Screening Tests for Alcohol and Drugs

Some screening tests can check for harmful use of both alcohol and drugs. One tool that estimates the use of multiple substances is the Tobacco, Alcohol, Prescription Medication, and Other Substance Use Tool, also known as TAPS. Healthcare providers can use this tool to assess if you’ve had any substance misuse in the past 90 days. This screening tool takes five minutes or less to complete.

Additional tests and a longer structured interview can help healthcare providers diagnose a substance use disorder.

The Cut Down, Annoyed, Guilty, Eye-Opener (CAGE) screening tool has just four yes or no questions that can be applied to alcohol or drug use. The questions are:

• Cut down — Have you ever felt you should cut down on your drinking or drug use?
• Annoyed — Have people annoyed you by criticizing your drinking or drug use?
• Guilty — Have you ever felt guilty about your drinking or drug use?
• Eye-opener — Have you ever had a drink or used drugs first thing in the morning to steady your nerves?

If you answer yes to two or more of the four questions, it indicates you may have a problem with alcohol or drugs.

Screening Tests for Opioid Use Disorder

If you’re at risk of opioid use disorder, your healthcare provider may use a screening tool specifically for opioids. Specialists recommend that everyone be screened for substance use disorder before getting a prescription for an opioid pain medication. People with an opioid prescription have an increased risk of opioid use disorder, opioid overdose, and death. Screening tools can help identify people at risk of opioid use disorder before it becomes a problem.

There are several tools available for opioid use disorder. The Rapid Opioid Dependence Screen (RODS) test is an eight-question tool that can be given in less than two minutes. RODS helps determine if you have opioid dependence by asking questions about:

• How much and how often you use opioids
• Whether you’ve had withdrawal symptoms (felt “dope sick”)
• Whether you find it difficult to stop using opioids
• How much time and energy you spend recovering from being high
• Whether you’ve missed important life events due to opioids
• Whether you feel anxious about your opioid use or missing a dose

The opioid risk tool is another short screening tool for opioid use disorder recommended before and during pain management with opioid drugs. This screening tool asks questions about your personal and family history of substance use disorder and your mental health history to estimate your risk of developing opioid use disorder. In general, a higher score indicates a higher risk.

Diagnosing Substance Use Disorder

If the results of your screening test indicate you’re at risk for substance use disorder, a more thorough substance use assessment may be needed. Additional tests and a longer structured interview can help healthcare providers diagnose substance use disorder.

Longer structured interviews can give more information about which symptoms of substance use disorder you have. Healthcare providers can compare your symptoms to the diagnostic criteria in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR).

According to the DSM-5-TR criteria, substance use disorder can be diagnosed if you’ve had two or more of the following symptoms in the past year:

• Feeling cravings to use the substance
• Continuing to use a substance despite worsening effects on your physical or mental health
• Continuing to use a substance despite the effect on your personal and professional relationships
• Having difficulty performing responsibilities at home and work
• Spending lots of time getting the substance or recovering from using it
• Being unable to stop or slow your use
• Taking more of a substance or prescription drug than you’re meant to
• Needing more of a substance to get the same effect
• Experiencing withdrawal symptoms or using more of the substance to avoid withdrawal
• Continuing to use a substance despite the danger it poses

Additional Testing

As part of the process of diagnosing substance use disorder, your healthcare provider may order additional tests. These tests may include:

• A physical exam
• Pain evaluation
• Mental health assessment
• Urine drug tests
• Blood tests to evaluate your health
• Tests to check for infections associated with intravenous drug use, such as HIV, hepatitis A and B, syphilis, and tuberculosis

Talk to your healthcare provider to learn more about which tests may benefit you.

What Happens After a Substance Use Disorder Evaluation?

After you have a substance use disorder evaluation, your healthcare provider can offer more information about the types of treatment available to you. If you’re at risk for or have a mild substance use disorder, your healthcare provider may give you more information about the effect of your substance use and how to cut back.

If you have a severe substance use disorder, a treatment program may help. Talk to your healthcare provider about getting a referral for the help you need.

Talk With Others Who Understand

On MyOpioidRecoveryTeam people share their experiences with opioid use, get advice, and find support from others who understand.

Have you or a loved one gone through a substance use disorder evaluation? Let others know in the comments below.