By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.
Assessment in substance abuse counseling has a different focus.
The Addiction Severity Index (ASI) is an instrument that is used in assessing the extent of a substance use disorder that has resulted in someone being referred to treatment. Sometimes it may be required by a governmental agency to help them determine if they will require a person to undergo addiction (chemical dependency) treatment. I have written elsewhere about the shift from the terms addiction, alcoholism and chemical dependency to the new DSM-5 term Substance Use Disorders. See recommended books for more on the DSM-5 and the APA.
The ASI is a proprietary instrument, if you use it commercially, you need to buy it from the owner or license an online version. You can take a look at a sample at ASI Training Edition.
The primary goals of the ASI are, as I see them, to develop a comprehensive picture of the client’s alcohol and drug use and how this use has affected other parts of their life. Once you see what substances they have used, how much and for how long, you can more effectively move on to exploring the parts of their life that have been affected by substance use and abuse.
The ASI can be used to develop a comprehensive treatment plan. Recovery involves a lot more than just not using substances. The client may have many aspects of their life they need to work on to stabilize that recovery.
Areas of concern on the ASI include medical issues, employment, and financial issues, legal issues. Specifically, crimes, incarcerations, and parole or probation status are areas of concern.
Relationships with family, friend, and primary sexual partners have all likely been disrupted or created by drug-using affiliations. The last area the ASI explores is psychiatric issues. This page of the ASI is brief and is not intended to diagnose mental illness but having yes answers about symptoms on this page is common. Mental health symptoms reported on the ASI should trigger a longer and more complete psychiatric evaluation to look for issues that may impact substance use or have been caused by that use.
Is the ASI a good assessment tool?
In my opinion, the ASI is a useful tool but like any other tool, the skilled craftsman gets better results from it than the beginner.
When I mentor beginning counselors I caution them about over-reliance on an assessment form. Whether you are using the ASI, a biopsychosocial assessment form or any other one, the form never gives you an absolutely full picture of the person. Clinical psychologists not only give “batteries” of tests but also spend a lot of time learning to interpret those tests.
The difference between a good assessment and a just so-so assessment is not the instrument you use. If the client says something unexpected I like to follow-up with more questions. I want to know what the client thinks about this item. The really good counselors who use the ASI also include some “stuff” in the comment sections where they tell me more about this person. When I read a client’s assessment I want to know more than just which boxes got checked. It helps me and them if the assessment paints a clear picture of the person and their problem.
If you’re doing assessments, make more comments so we can better help that client. If you are the one being “assessed” the more you tell that clinician the more they can help you.
FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.
You might also want to check out these other counselorssoapbox posts.
More “What is” posts will be found at “What is.”
Staying connected with David Joel Miller
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For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.