Most addiction workers who have been properly trained understand the role, function, and difference between addiction screening tools and addiction clinical measures. They also understand that no screening tool or clinical measure alone is absolute. Similar to the prime objective of the DSM IV-TR, both have a role in assisting clinical decision-making.

This article reviews the differences between an addiction screening tool and an addiction clinical measure, and introduces a screening tool that addiction workers can incorporate into the addictive disorder screening process.

Addiction screening tools are used to assist the addiction worker and the client during the initial assessment process. The goal is to discover potential risk areas so the addiction worker selects tools that are designed to assess the risk that is being screening for. Screening tools are not designed to make clinical diagnosis; their role is to educate and identify potential risk.

A tool like the Addiction Disorder Screen (ADS) – 7© that has been developed for addiction screening, often lacks the statistical research needed to be proven to have internal validity and statistical reliability. This means it has not been studied to ensure it measures what it says on a consistent and regular basis. That being said, there is still a place for addiction screening tools because they are often free, in the public domain, easy to administer, fast to score, of short duration to complete, and can uncover potential risks that merit further investigation. As well, they can increase a client’s internal motivation by informing and educating them about potential risks.

After a screening tool picks up a potential risk, the next step in the assessment process is to investigate it in more detail by using a diagnosing instrument that has more scientific rigor. For example, I have developed the ADS-7© for public domain use as a brief screening tool to uncover the signs and symptoms of seven addictive disorders. However, to use the ADS-7© alone to make an assessment would be negligent. First, it does not meet the rigor needed for a scientific clinical measure such as the Substance Abuse Subtle Screening Inventory (SASSI), nor does it have built-in sensitivities for assessing gender and diversity differences. But if an addiction worker used the ADS-7© as a screening tool and uncovered a potential risk area such as alcohol abuse or dependency, this insight would lead to further investigation. In that case this screening tool would have served an important role in the treatment continuum.

It is important to remember that clinical measures like the SASSI have been designed to assist in clinical decision-making and treatment planning. The SASSI, being a psychological instrument, has significant published clinical findings and research that can be found at the SASSI website www.sassi.com.

Perhaps one effective way to determine if an instrument should be used as a screening tool or clinical measure in the assessment process is for the addiction worker to first determine what research supports its reliability and validity. Most clinical measures, like the SASSI, that have met the scientific rigor, require clinical training so that addiction workers are certified to administer them.

There are exceptions. Some instruments, like the Beck Inventories, are extremely user friendly and do not require a lot of training or certification; and have met the scientific rigor that states they do and measure what they say. The bottom line is that addiction workers need to do their research and be clear of what tools and measures they are using in regard to clinical validity and reliability.

This brief introduction reviews the differences between a screening tool and clinical measure and their roles in the assessment process. I find it so important when I teach my addiction counseling students that they can never forgo clinical decision-making based on the results of any one instrument. I see three important elements that can influence clinical decision making and treatment planning recommendations: 1) clinical rigor – completing a detailed biopsychosocial clinical assessment, using effective screening tools, clinical measures, and clinical referring materials (e.g., DSM IV-TR); 2) experience – the more practice and coaching you have from an experienced clinician the more tacit skills you will develop; 3) intuition – trusting your gut. If you have a question or are not sure, always ask.

Introducing the ADS 7©
One of the new and exciting challenges of teaching addiction counseling in 2005 is that we no longer are just teaching our students how to assess and treat drug and alcohol concerns. The field of addiction has exploded and we are now faced with a wider continuum of addiction disorders. It seems the continuum has grown on a fairly regular basis over the last 10 years. For example, in my private practice I could not find one brief screening tool that screened potential risk behavior across a continuum of addictive disorders such as alcohol, drug, food, gambling, work, sex, and buying that fit all the types of clients I was getting.

While working with the late Dr. Robert Coombs when I was doing my Post Doc at UCLA, I had the opportunity to be a reader for him on his book Handbook on Addictive Disorders. This expanded my scope on the topics of addictive disorders and I decided to create my own screening tool, ADS-7© that I am presenting here. Each question used in this screening tool was vetted against the literature presented by Coombs (2004) and DSM IV-TR (American Psychiatric Association, 2000) to assist in ensuring it was meaningful, accurate, and practical. Judge for yourself if you find any value in this tool.

Summary
One may ask, what about Internet addictions? Yes, I could have developed the ADS-8 by adding Internet addictions – maybe next year. And I agree the addictive disorder continuum is wider than seven categories. This tool is intended only to provide screening for seven addictions to assist in determining where further, more in-depth assessment is needed. It is imperative that addiction workers are clear about the difference between a screening tool and an addiction measure, so they do not mislead their clients or themselves.

Note: The Addictive Disorders Screen–7 (ADS-7)© 2005 is an addictive disorder screening tool to predict potential risk for seven addictive disorders: chemical dependency (drugs),chemical dependency (alcohol), compulsive buying, compulsive gambling, eating disorders, workaholism, and sex addictions. The ADS-7© has been designed to assess new clients’ potential risk. This addictive disorder-screening tool is for assessing risk in the assessment process; it is not a diagnostic tool.

The ADS-7© has 49 questions, which are to be answered with regard to behavior over the past six months, including today. Scoring is as follows for each question:

0 Never
1 Once
2 Fewer than three times
3 Fewer than six times
4 More than seven times

The client’s scores indicate potential risk in certain addictive disorders. The scoring grid will help establish potential risk levels and where further investigation may be warranted. Read each question carefully and select the response that best fits the present situation and behaviors. The ADS-7© will take approximately 20 minutes to complete.

Addictive Disorders Screen (ADS-7)©

Questions
Over the last six months:

1. Have family or peers expressed a concern about your drug use?
2. Have you tried to stop gambling and been unsuccessful?
3. Have you thought you have a problem with alcohol?
4. Have you worried about food and calories?
5. Have you not bought groceries or paid bills because of your
buying habits?
6. Have you lost interest in friends, hobbies, school, work, or other pursuits because of your drug use?
7. Have partners, peers, or family members expressed a concern about your sexual behavior?
8. Have you noticed a connection between your financial problems and gambling?
9. Have you purged food or used laxatives or diuretics as a strategy for maintaining body weight?
10. Have you noticed that during weekends you cannot relax unless you are working?
11. Have you missed work or family functions because of your sexual behaviors (e.g., people or cyber sex)?
12. Have you driven any kind of motor powered vehicle under the influence of alcohol?
13. Have family or friends suggested you have an eating disorder (anorexia or bulimia)?
14. Have you started the day drinking to avoid feeling sick?
15. Have you used sex (people or cyber sex) as a way to get away from the stress of the world?
16. Have any relationships failed as a result of work?
17. Have you felt depressed after a buying spree?
18. Have you acted on an internal drive to eat large amounts of food at one sitting?
19. Have you noticed that food seems to be a major source of pleasure for you?
20. Have you lost time (e.g., blackouts) during a drinking episode?
21. Have you lied about your sexual behaviors?
22. Have you ever committed a crime to obtain drugs (e.g., stealing)?
23. Have peers or family expressed a concern over the amount of time you work?
24. Have you used sex as a way to escape from the world?
25. Have you noticed you gamble to escape or as a means of excitement?
26. Have you noticed it takes more alcohol to feel good?
27. Have you lied about your eating habits?
28. Have you lied about your buying habits?
29. Have you chosen drugs over people or work?
30. Have you noticed that your sense of self-worth is directly related to your work?
31. Have peers personally or professionally expressed concern about your drinking?
32. Have you tried to control your sexual behavior (people or cyber sex) and failed?
33. Have you tried to stop drinking?
34. Have you lied about your gambling?
35. Have you felt regret, guilt, or remorse over your drug use?
36. Have noticed gambling is causing stress at home, but you continue to gamble?
37. Have you found yourself buying things knowing you cannot afford them?
38. Have your buying habits created money problems for you?
39. Have you experimented with different kinds of drugs to find a better high?
40. Have you noticed that you feel most in control when you are working?
41. Have you felt a deep sense of depression after sex (people or cyber sex)?
42. Have you attempted to keep your buying secretive?
43. Have you lied to family or peers to stay at work longer?
44. Have you used a system to increase your chances of winning when you gamble?
45. Have you lost money gambling and felt OK?
46. Have you spent the majority of a day obtaining drugs?
47. Have you made projects more complex and time consuming than they need to be?
48. Have you attempted to control your eating habits and failed?
49. Have you noticed buying helps you feel a sense of control?

Addictive Disorders Scoring Key

Chemical Dependency (Drug)
1
6
22
29
35
39
46
Total Risk Level:

Chemical Dependency (Alcohol)
3
12
14
20
26
31
33
Total Risk Level:

Compulsive Buying
5
17
28
37
38
42
49
Total Risk Level:

Compulsive Gambling
2
8
25
34
36
44
45
Total Risk Level:

Food Addictions
4
9
13
18
19
27
48
Total Risk Level:

Workaholism
10
16
23
30
40
43
47
Total Risk Level:

Sex Addiction
7
11
15
21
24
32
41
Total Risk Level:

Potential Risk Levels

0-2 Subclinical - May not be a concern - however, it is still important to explore this area in more detail with the client.

2-8 Medium Concern - Has the potential to be a serious concern. It is recommended that the client do a more in-depth assessment in this area.

9-28 Serious Concern - This score indicates the client is at risk and there is a need for a more in-depth clinical assessment.

William A. Howatt, PhD, EdD, ICADC, serves on the faculty of Nova Scotia Community College and is co-editor (with Robert H. Coombs) of the Wiley Book Series on Treating Addictions. He can be reached at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

References
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington: American Psychiatric Association.
Coombs, R. H. (Ed.). (2004). Handbook on addictive disorders, New York: John Wiley & Sons.

This article is published in Counselor,The Magazine for Addiction Professionals, February 2006, v.7, n.1, pp.48-53.

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