A comprehensive assessment is the critical first step in the treatment of adolescent substance use, due to the plethora of factors involved in the aetiology of AOD misuse. A well-conducted assessment can increase engagement in treatment and be a therapeutic intervention in and of itself. However, clinical judgement is required so that it does not become an intrusive process that can negatively impact on the engagement with the young person.

The type of assessment conducted depends largely on the professional's role. For an outreach worker, where brief contact usually occurs, the worker may simply obtain information on demographics and presenting issues and conduct a risk assessment (if required). For a specific AOD service, the assessment is likely to be more comprehensive. With the young person's consent, valuable information may be sought from the young person's family, other supportive persons and other treatment agents (Buckstein et al., 1997).

There are a number of key areas that should be covered in any assessment with a young person (Buckstein et al., 1997; Department of Human Services, 2000; Howard & Arcuri, 2003a):

  • Chief complaint/issue — elicit from the young person his or her understanding of what has brought him or her to the point of assessment. If the chief issue is not an AOD problem, then assess the history of the chief issue, ie. duration, impact upon the young person's life, steps taken to resolve the issue and the results of these steps. Then appropriate referral would follow. If the chief issue is primarily AOD related, then move to the areas described below.

  • Background demographic information — include here any important relationships (family or significant others) and other important connections, current vocational and educational pursuits and current living arrangements.

  • Initial drug use history — given that polydrug use is the norm for young people, all drug groups should be covered. Explore current intake, type and levels of use and how long they have used each drug.

  • Comprehensive substance use history — a systematic enquiry of all drug classes and differentiating the psychostimulants, as there are many of them with differing impacts on individuals. For each drug, include age at first and last use, reasons for continued use, method of administration (including any changes), sharing of injection equipment, where they use (e.g. street, home, dealer's place) and whether they use alone or in a group, impact of drug use on functioning, periods of non-drug use, attempts to control/stop use and the young person's goals in relation to his or her drug use.Top of page

  • Severity of the problem — use of standardised measures to assess the severity of the problem is recommended; e.g. Severity of Dependence Scale (SDS, Gossop et al., 1995), Diagnostic and Statistical Manual of Mental Disorders — IV (DSM-IV, American Psychiatric Association, 2000), or the International Classification of Mental and Behavioural Disorders (World Health Organisation, 1992).

  • Previous treatment — include perceived usefulness of such treatments and reasons for cessation/continuation of treatment.

  • Leisure and social functioning — include connections with family, school, peers and significant others. Working with these connections is vitally important in enhancing protection and minimising risk.

    1. Family — explore who is in the young person's family, who resides with whom, the family's place of residence, how the young person gets along with parents and siblings (possibly using simple scales, such as the psychometrically sound General Functioning scale of the 'Family Assessment Device' (Byles, Byrne, Boyle & Offord, 1988); contacts with extended family; young person's wishes for family involvement; and likelihood that family may become involved in treatment.

    2. Peers — investigate how they spend their time together, the young person's perspective of how they compare to peers, the young person's wishes for peer involvement in treatment (where appropriate) and the likelihood that peers may become involved in treatment.

    3. Hobbies and leisure activities — including any changes in these over time (particularly as a result of escalation of problems related to drug use). Explore whether the young person wishes, or perceives the possibility, that he/she might re-engage with these activities.

    4. Educational/employment history — investigate the young person's attitude to school, highest grade attained, best subject(s), worst subject(s), changes of school, special education, attendance, disciplinary record (suspensions and expulsions) and ability/desire to return to schooling or alternative education. Include work history and current employment, if relevant, employment aspirations and current income source.Top of page

  • Physical and mental health — included in this part of the assessment is an examination of past medical history, any allergies, past psychiatric history (individual and family) and current medications and medical compliance.

    Upon completion of assessment, a more comprehensive assessment could be undertaken in any of the aforementioned areas, by a more specialised medical practitioner, if required.

    1. Given the potential for mental health problems, a comprehensive assessment may be necessary, especially where harmful use of psychostimulants is evident. As such, a mental state examination should be conducted with every young person. This includes questions about:

      • General feelings and moods — possible questions could cover areas such as how the young person feels about him or herself, how the young person generally feels (e.g. sad, happy, irritated) and other specific indicators of depression, such as whether the young person cries a lot or isolates him or herself, has reduced levels of energy or activity, or if 'acting out' may indicate avoidance of negative mood.

      • Suicidal ideation — a suicide screen should be conducted with the young person, exploring any ideation and/or attempts by the young person to deliberately harm or kill him or herself, the reasons behind any such attempt and any current thoughts about, intentions or plans to kill him or herself.

      • Cognition — thought processes and thought content (delusional, hallucinatory or suicidal thoughts).

      • Attention should be paid to general appearance, attitude, behaviour, mood, speech and gait of the young person.

  • Offending history — include the number of offences, types of offences and links with substance use, number of times incarcerated (and length of time), current legal status and any upcoming legal appearances.

  • Trauma history — explore abuse, violence, torture and experience of armed conflict and natural disasters (e.g. fire, flood and famine).

  • Sexual practices — investigate past sexual activity, number of partners, gender of partners and the practice of safe sex.
Reassessment and monitoring will need to occur over time, especially during the first two weeks, as withdrawal and other symptoms may develop during the first week of abstinence.

Assessment instruments can be useful tools in screening for and determining the frequency, quantity and severity of substance use in young people. Furthermore, structured interviews such as the Structured Clinical Interview for DSM-IV (SCID) (Spitzer, Williams & Gibbon, 1994) and the Composite International Diagnostic Interview (CIDI) (Training and Reference Centre for WHO and CIDI, 1993) may be useful in determining whether young people meet DSM-IV or ICD-10 criteria for abuse or dependence, potentially requiring more intensive intervention. However, most assessment tools are not youth specific, or they require adaptation for Australian populations. A comprehensive review of diagnostic and screening instruments was recently conducted (see Dawe, Loxton, Hides, Kavanagh & Mattick, 2002).