Screening and Assessment Tools Used In Addiction - Research Paper Example

Screening and Assessment Tools Used In Addiction Introduction The recent years have witnessed a considerable number of people who experience psychological and psychiatric complications which results from alcohol or drug addictions. Moreover, the emerging psychiatric and psychological complications which are brought about by drug abuse and alcoholism addictions have proved to have severe implications on the prosperity of contemporary mental treatment services. Moreover, the drug and alcohol related psychological complications ranges from mere anxiety and low mood to undetected major psychiatric illness (Dennis, Scott, Funk, & Foss, 2005). The ever-increasing complexities of addictions related mental complications have therefore resulted to the introduction of considerable measures and assessment tools to counter the threatening increase cases of mental dysfunctions among young people. Present studies have indicated that a good number of the psychiatric complications among substance abusers go undetected. Additionally, contemporary health experts have come up with various screening and assessment tools for diagnosing and treating drug addicts. However, to minimize legal, ethical, individual, and social implications, the clinicians ought to consider and evaluate major aspects in the assessment tools which include: validity, reliability, sensitivity, and sensitivity. The essay below therefore seeks to explore the significance of reliability, sensitivity, validity and specificity in proper assessment and screening tools. The essay will compare and contrast three main screening and assessment device in references to their validity, sensitivity, specificity and reliability. Issues specific to the development of screening and diagnostic instruments Reliability Instrument reliability is measured in terms of correlation coefficients. Correlation coefficient of a tool is examined by considering the association between two variables. In most cases, correlation coefficient entails two main elements, magnitude and direction. A positive correlation between two scores means that, the increase of one score is to some extent influenced by the other score. Negative correlation means that, an increase in one score leads to decrease in another score. In reference to magnitude, the close the coefficient towards one another, the stronger the two sores are related. In many instances, a coefficient demonstrates a perfect association between two scores while a coefficient of zero indicates a limited association between two scores. The instrument reliability ought to be assessed by determining the stability of the measurement across time. That is, for an instrument to be stable it ought to demonstrate high level of internal consistency as test-retest reliability (Grisso, 2005). Validity Validity in an instrument refers the ability of instrument to produce accurate results. Validity in a tool is ascertained by examining its independent in producing accurate results. A tool is considered to have content validity if it has the capability of measuring all aspects of the specified condition. An effective tool should demonstrate construct strength. Construct validity is the ability of an instrument to measure accurate characteristics in a specified condition. The measurement of the construct validity of a tool is examined in different varying methods. Statistical method entails the use of factor analysis to examine whether the instrument have the capability of measuring a theoretically thought domains (Grisso, & Barnum, 2006). Factor analysis is a statistical procedure which is used to evaluate inter-relationship in a set data. Moreover, questionnaires items are used to examine the correlation of different domains. Sensitivity and specificity Specificity and sensitivity are statistical measures to examine the performance of an instrument. In general terms, sensitivity refers to the ability of a tool to obtain positive results. To examine whether an instrument is comparing favorably with the previous instruments, it is essential for health care professionals to be in a position to interpret the scores. In reference to sensitivity, an instrument must correctly identify the subject under study with current diagnosis. Specificity helps in identifying tools and instruments that do not meet the set requirements. Specificity also helps in the identification of the negative aspects in a tool (Wasserman, McReynolds, Fisher, & Lucas, 2005). Assessment and Screening Tools The Composite International Diagnostic Interview (CIDI) The Composite International Diagnostic Interview is a fully standardized and all-inclusive interview schedule which is designed to facilitate effective assessment of psychological disorders. The Composite International Diagnostic Interview can either be administered through computer or by a trained health care professional. The Composite International Diagnostic Interview was designed in early 1980s by World Health Organization. To facilitate its efficiency, there are a number of other tools which has been designed to support its operations. Some of this instrument include: the predecessors of the CIDI, Schedule for Clinical Assessment for Neuropsychiatry (SCAN) and the Diagnostic Interview Schedule (Cherpitel, 2005). All these tools were designed to help healthcare professionals and other trained interviewers to undertake a standardized interview and evaluation to detect and identify the presence or absence of psychological disorder among drug addicts. The tool has over years proved to be very effective especially among alcoholism and drug addicts. The Composite International Diagnostic Interview is used to train interviewers who are planning to familiarize themselves with interview structures. A part from examining psychiatric complications, The Composite International Diagnostic Interview is effective in detecting other complications such as eating disorder, post-traumatic disorder, anxiety disorder psycho-sexual disorder, dissociative disorder, somatoform disorder and organic mental disorder (Grisso, & Vincent, 2005). Reliability and validity of the Composite International Diagnostic Interview The validity and reliability of The Composite International Diagnostic Interview have over years been examined by several scholars. By referring to the available literature review, The Composite International Diagnostic Interview have demonstrated acceptable level of inter-rate reliability and substantial level of test-retest for alcohol and drug related mental complications, organic brain syndrome, schizophrenic disorder and anxiety disorder. Compared to other devices, The Composite International Diagnostic Interview has proved to be more efficiency and effective in providing accurate information. The available research findings have confirmed that, the entire diagnostic concordance between The Composite International Diagnostic Interview and the information which is available in clinician checklist are similar. The Composite International Diagnostic Interview also appears to provide information which is more similar to clinically generated diagnosis thus proving its validity and reliability. Similarly to other assessment and screening devices, The Composite International Diagnostic Interview is common applied in research settings as a mean of assigning group membership (Grisso, Vincent & Seagrave, 2005). Moreover, The Composite International Diagnostic Interview has offered valid results in regard to different types of drugs which have stronger reliability for dependence as lower reliability for less intricate substance abuse complications. The Composite International Diagnostic Interview Specificity and Sensitivity Compared to other commonly used tools for screening drug and alcohol related complications, recent researches have confirmed a relatively poor specificity and sensitivity on The Composite International Diagnostic Interview. Recent observations have confirmed that, The Composite International Diagnostic Interview does not provide accurate information on ethical issues that governs the diagnosis and treatment of alcohol and drug related complications. Compared to clinical assessment tools, The Composite International Diagnostic Interview undermines other mental disorders including schizophrenic diagnosis as presence of other complications such as delusions and hallucinations. To approve the information collected by The Composite International Diagnostic Interview, clinicians and other healthcare professionals are always compelled to conduct clinical assessment on acquired information (Breakey, Calabrese, Rosenblatt, & Crum, 2008). Khavari Alcohol Test A Khavari Alcohol Test tool is incredibly useful in calculating the consumed alcohol. The simple mathematical formula used in Khavari Alcohol Test helps clinicians and researchers to evaluate the volume of alcohol consumed in a years in terms of milliliters. Khavari Alcohol Test is composed of 12 items which addresses the quantity and frequency of the consumed alcohol as cases of heavy consumption of alcohol. Among these items, four items are designed to examine the consumed beer; the other four are for examining the consumed wine and the other four are for examining the consumed spirits while the final four items are for examining other forms of drugs. For each class of alcohol, the client is requested to state the drinking frequency, the maximum level of drink consumed as the frequency at which the maximum number is consumed. After the interview, the annual absolute alcohol intake is estimated using mathematical calculations (Chan, 2011). Khavari Alcohol Test reliability and validity Compared to other tools used to examine alcohol and drugs addiction, Khavari Alcohol Test has proved to have excellent reliability and validity. The tool has over years been used to examine college populations, geriatric, and possibilities of alcohol misuse. However, the tool has to some extent failed to provide accurate assessment on the social and psychological repercussions of addictions. Moreover, the tool does to offers information on whether the clients perceive drinking to be a problematic experience. In addition, with 2-weeks test-retest reliability, Khavari Alcohol Test has shown good chronological stability. The tool has demonstrated a considerable number of similarities in terms of reliability and stability with others commonly used tools such as Composite International Diagnostic Interview. Compared to the information which is collected through clinical method, Khavari Alcohol Test has demonstrated reliability in providing accurate information on the annual consumption level of alcohol among many addicts. Moreover, compared to other tools for assessing drug and alcohol addictions, Khavari Alcohol Test is more effective in offering valid and testable information. Therefore, Khavari Alcohol Test provide more accurate in providing valid information regarding the frequency and the level of alcohol consumed by the client (Carey & Correia, 2008) Sensitivity and Specificity of Khavari Alcohol Test A part from appearing to offer reliable and accurate information, Khavari Alcohol Test do not offer precise fact on the problems that are associated with excessive alcohol intake thus demonstrating low level of specificity. Moreover, to acquire information that is beyond the statistics on simple alcohol consumption, clinicians and researchers are forced to incorporate the AUDIT tool along with Khavari Alcohol Test (Shufelt, & Cocozza, 2006) AUDIT in this case is used to examine the frequency and quantity of binge and regular episodes as short term and long term impacts of addiction. Moreover, despite providing quantitative and frequency data, Khavari Alcohol Test lacks the required sensitivity in detecting the changes in drinking patterns. Additionally, Khavari Alcohol Test is not useful in examining the treatment outcomes. Timeline Follow-back Method Timeline Follow-back Method is an effective tool in obtaining precise information regarding the amount of the consumed alcohol and drugs over a specified period of time as the duration of each drinking session. The key component of this method is a black calendar which is filled by healthcare professional together with the client to acquire detailed information regarding the frequency and level of alcohol and drug consumption over a specified period of time (Estroff & Hoffmann, 2009). The Timeline Follow-back tool offers detailed pattern of consumption. Moreover, the time required in completing Timeline Follow-back Method is based on the client’s drinking pattern as the time available to examine the client. To necessitate accurate re-calling of past incidences and to provide a working framework, the tools offers a platform for noting all events that may facilitate accurate and effective memory. Reliability and validity of Timeline Follow-back Method Compared to Khavari Alcohol Test, Timeline Follow-back Method has proved to have very high test-retest reliability in a range of drinking population. There is also high level of agreement between official records and the client self-reports. Moreover, compared to other tools, the recent computerized version has also shown temporal stability with a good number of studies finding with test-re-testing correlation going beyond 85. Therefore, the similarities between the clinically collected information and the information which is collected using Timeline Follow-back Method tool has demonstrated the validity and reliability of the tool in examining and treating drug and alcohol related mental complications. Recent studies have confirmed the presence of high level of agreement between the information collected by using Timeline Follow-back Method and the biochemical indices of alcohol related liver dysfunctions. Specificity and Sensitivity of Timeline Follow-back Method Similarly to other commonly used assessment tools, Timeline Follow-back Method has low level of sensitivity and specificity. Recent studies that were aimed at examining alcohol consumptions using Timeline Follow-back Method within a period of 30 days have confirmed the fact that, the information collected by Timeline Follow-back Method to some extent underestimates actual alcohol consumptions. This therefore means that, the tool has low specificity. Moreover, Timeline Follow-back Method does not consider individual differences in reporting past experiences and happenings (Vincent, Grisso & Terry, 2007). The Timeline Follow-back Method low sensitivity can be confirmed by the tools inability to incorporate behavioral changes that may be taking place during the examination period. The Most Effective Assessment and Screening Tool Based on the available facts, the most effective tool in accessing drug addiction is The Composite International Diagnostic Interview (CIDI). This is due to the fact that, The Composite International Diagnostic Interview (CIDI) is more reliable compared to other tools. The Composite International Diagnostic Interview (CIDI) has over years proved to offers the most accurate and valid information regarding drug addiction compared to other methods. Moreover, despite lacking the required specificity and sensitivity, the tool has over years played a substantial role in accessing the economic, social, and psychological impacts of excessive use of drugs. Moreover, compared to other tools, The Composite International Diagnostic Interview (CIDI) is effective in examining a considerable number of mental implications brought about by excessive use of alcohol and other drugs (Andrews & Dowden, 2006). How the identified tools can be used in other settings A part from examining mental complications, The Composite International Diagnostic Interview (CIDI) can be used to examine other health conditions such as, organic brain syndrome, schizophrenic disorder and anxiety disorders. Moreover, despite being effective in hospital settings, Khavari Alcohol Test is essential in examining mental complications in other social settings such as in examining the nature of drug addiction in colleges and other higher learning institutions. Finally, Timeline Follow-back Method is used in conducting mental health and drug abuse researches in many high learning institutions. Ethical, Legal, Individual or Socio-Cultural Implications of Screening and Assessment to Consider When Selecting an Appropriate Tool Legally, health professionals are expected to ensure maintenance of maximum confidentiality to the client’s health information. However, by using the available screening and assessment tools, health professionals are at times expected to share their findings with other professionals thus creating legal implications. Clinicians are ethically expected to ensure that, the tools used in screening addiction have a considerable level of sensitivity and specificity. However, most of the tools used in assessing addictions have very limited level of specificity and sensitivity thus bringing about ethical implications. Moreover, in most culture and social settings, drug addiction is linked with discriminations and segregation. To avoid social cultural implications, healthcare professionals ought to select assessment and screening method that can minimize cases of social discriminations. In accessing and screening drug addicts, individual implications may emerge in the situation where the clients are not willing to provide the required information to the health professional (Etter, Vu Duc & Perneger, 2009) Conclusion In the light of the above analysis, it is clear that, drug and alcohol addiction is an uncontrolled experience in the modern society. The emerging psychiatric and psychological complications which are brought about by drug abuse and alcoholism addictions have proved to have severe implications on the prosperity of contemporary mental treatment services However, to counter the vice, healthcare professionals have developed effective tools to necessitate systematic and intensive evaluations and screening. To minimize legal, ethical, individual, and social implications, the clinicians ought to consider and evaluate major aspects in the assessment tools which include: validity, reliability, sensitivity, and sensitivity. Most of the identified tools are reliable and provides valid information. Moreover, to facilitate the identification of the most effective and legally acceptable too health care professionals ought to undertake intensive consultation with all involved players. Researches are also essentials in the identification of modern and more effective tools for screening and assessment. References Andrews, D. A., & Dowden, C. (2006). Risk principle of case classification in correctional treatment: A meta-analytic investigation. International Journal of Offender Therapy and Comparative Criminology, 12, (50), 88–100.retrieved on 8th December 2012. From: intl-alx.sagepub.com/lookup/ijlink?...ABST&journalCode...50/.../88 Breakey, W. R., Calabrese, L., Rosenblatt, A., & Crum, R. M. 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(2007). Mental health screening and assessment in juvenile justice. In C. L. Kessler & L. Kraus (Eds.), Mental health needs of young offenders: Forging paths toward reintegration and rehabilitation (pp. 270–287).Cambridge, England: Cambridge University Press. Retrieved December 8, 2012. From www.tapartnership.org/docs/jjResource_screeningAssessment.pdf Wasserman, G. A., McReynolds, L. S., Fisher, P., & Lucas, C. P. (2005). Diagnostic Interview Schedule for Children: Mental health screening and assessment in juvenile justice (pp. 224–239). New York, NY: Guilford Press. Retrieved December 8, 2012. From www.tapartnership.org/docs/jjResource_screeningAssessment.pdf Read More