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What to Expect From a Drug & Alcohol Evaluation

Elena Hill, MD, MPH profile image
Medically Reviewed By Elena Hill, MD, MPH • Updated Feb 20, 2023 • 7 cited sources

“How much is too much” is a common question when it comes to determining whether or not someone is living with a substance use disorder or not. Unfortunately, it’s not as cut and dried as X amount of a substance equates to a substance misuse issue, while Y amount equates to a substance use disorder.

Because there are a number of factors at play and the answer can be highly personal, a drug and alcohol evaluation can help. This evaluation can help determine whether a substance use disorder is present and how best to proceed in terms of treatment, if needed.

What Is a Drug or Alcohol Assessment? 

A drug and alcohol assessment is done by a medical or psychiatric professional, such as a counselor or a substance abuse treatment specialist, to evaluate a person’s use of drugs and/or alcohol. [1] A drug and alcohol assessment can be as informal as simply asking a patient if they use substances during a routine medical visit, or as in depth as an hour long one on one meeting with a substance use or addiction specialist filling out various questionnaires or responding to a number of in depth questions about alcohol or substance use. 

The assessment typically involves a thorough review of a person’s substance use history, as well as any related physical or mental health issues. The purpose of a drug and alcohol assessment is to determine the extent of that person’s substance use, the impact it has on their life, and the level of treatment or support they may need to address the issue if they are motivated to do so.

During a drug and alcohol assessment, the subject of the evaluation may be asked to provide information about their substance use habits, including how often they use drugs or alcohol, which substances they use, and how much they use. 

The assessment may also include a physical examination, laboratory tests, and/or psychological testing to help the professional better understand the substance use and any related health issues.

The results of a drug and alcohol assessment can be used to determine the appropriate level of treatment or support, including whether inpatient or outpatient treatment is indicated, and which support groups, medication, and/or other forms of intervention will be most appropriate.

Why Do People Get Drug & Alcohol Evaluations?

There are several reasons why people may get a drug and alcohol evaluation, including:

  • To assess their substance use: A drug and alcohol evaluation can help the subject of the assessment to better understand the extent of their substance use and its impact on their life. This can be useful for people who are unsure if they have a substance use disorder or those who want to better understand the risks and consequences of their substance use.
  • To determine treatment needs: A drug and alcohol evaluation can help identify the appropriate level of treatment or support needed to address substance misuse. This may include inpatient or outpatient treatment, support groups, medication, or other forms of intervention.
  • To fulfill a requirement for court or legal proceedings: In some cases, a drug and alcohol evaluation may be ordered by a judge or other legal authority as part of a criminal case or as a condition of probation or parole.
  • To meet the requirements of an employer or professional licensing board: Some employers and professional licensing boards may require employees to undergo a drug and alcohol evaluation as a condition of employment or to maintain their professional license.
  • To support recovery: Many people who are in recovery from substance use disorders find it helpful to have regular evaluations to track their progress and identify any potential setbacks or challenges.

Drug and alcohol evaluations may be undertaken voluntarily, involuntarily, or somewhere in between depending on the situation.

How Do Drug & Alcohol Screening Assessments Work? 

Drug and alcohol screening assessments generally follow these steps:

  • Screening: This is the initial step in the assessment process during which the subjects’ substance use is screened for potential problems. This may involve a brief questionnaire or interview to gather information about their substance use habits and any related problems. If no issues are identified during the screening, the evaluation process will usually stop here.[2]
  • Follow-up: If the screening indicates that the person may have a substance use disorder or is at risk for developing one, a more comprehensive assessment is usually conducted. This may involve a longer interview or additional testing to gather more detailed information about their substance use and issues that may be resulting from that use.
  • Assessment: During the assessment phase, the professional conducting the evaluation will review all of the information gathered during the screening and follow-up steps to determine the person’s level of substance use and any related problems. This may involve using standardized assessment tools or criteria to diagnose a substance use disorder or to identify any co-occurring mental health disorders.
  • Referrals: If the assessment indicates that treatment or support is a positive next step, the professional may recommend a referral to a specialized treatment program or other appropriate resources. The referral may be made to an inpatient or outpatient treatment program, a support group, or a mental health professional for further evaluation or treatment.

It’s important to note that the specific steps and procedures involved in a drug and alcohol screening assessment may vary depending on the person’s needs and the professional conducting the evaluation as well as the requirements of the person or entity that requested or required the evaluation.

Who Conducts Alcohol & Drug Evaluations? 

Alcohol and drug evaluations are typically conducted by professionals with specialized training in substance misuse assessment and treatment. This may include the following professionals:

  • Primary care physicians: It is possible that a primary care doctor may conduct a rudimentary drug and alcohol evaluation to help the person to determine whether or not further investigation is needed, but in many cases, a thorough evaluation and assessment will be referred out to another provider.
  • Substance abuse counselors: Substance abuse treatment counselors are trained to help people who are living with substance use disorders to identify and address the issues that contribute to their substance misuse.
  • Clinical psychologists: Clinical psychologists are trained to assess and treat mental health issues, including substance use disorders.
  • Psychiatrists: Psychiatrists are medical doctors who are trained to diagnose and treat mental health issues, including substance use disorders. They are legally able to prescribe medication as part of a comprehensive treatment plan.
  • Social workers: Social workers are trained to help people living with complex social and emotional issues related to substance use disorders and mental health issues. They can also provide support to the families, as everyone works together to navigate how to address the problem.

In some cases, alcohol and drug evaluations may also be conducted by other health care professionals, such as nurse practitioners or physician assistants who have specialized training in substance abuse assessment and treatment. It may also be the case that multiple professionals will take part in a single evaluation to make sure that it is thorough, especially in the event that the evaluation is court-ordered.[3]

CAGE Alcohol Assessment: What Is It?

The CAGE alcohol assessment is a tool that is used to screen for alcohol use disorders.[4] The CAGE assessment is a quick and easy way for health care providers to identify people who may be at risk for developing an alcohol use disorder or who may benefit from further evaluation for an alcohol use disorder.

The CAGE assessment consists of four questions:

  1. Has cutting back on the amount of alcohol you drink ever been a focus for you?
  2. Do people ever tell you that you drink too much?
  3. Has drinking or your choices under the influence ever caused you to feel guilty?
  4. Do you ever start the day with a drink or had alcohol because you felt that you could not get through a certain event or issue without it?

A positive response to two or more of these questions is considered a positive CAGE assessment, indicating a potential alcohol use disorder.

Health care providers may use the CAGE assessment as part of a more comprehensive evaluation for an alcohol use disorder, or they may refer the person to a substance abuse treatment specialist for further evaluation and treatment.

Will Insurance Cover the Cost of Drug & Alcohol Evaluations?

Usually these evaluations will take place in a primary care or psychiatric office. They would therefore usually be covered by your medical health insurance. If your evaluation is taking place at a rehab or specialized facility, there may be co-pays or other fees.

Medically Reviewed By Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where ... Read More

  1. 1. Appendix D Examples of Screening and Assessment Tools for Substance Use Disorders. National Center on Substance Abuse and Child Welfare. Accessed December 2022.
  2. Substance Abuse Treatment: Addressing the Specific Needs of Women - Screening and Assessment. National Library of Medicine. Accessed December of 2022.
  3. Guideline for Drug Courts on Screening and Assessment. American University. May 1998. Accessed December of 2022.
  4. Use of Family CAGE-AID Questionnaire to Screen the Family Members for Diagnosis of Substance Dependence. Indian Journal of Medical Research. June 2016. Accessed December 2022.
  5. Health Benefits & Coverage. Accessed December 2022.
  6. Insurance Barriers to Substance Use Disorder Treatment After Passage of Mental Health and Addiction Parity Laws and the Affordable Care Act: A Qualitative Analysis. Drug and Alcohol Dependence Reports. June 2022. Accessed December 2022.
  7. Holding Insurers Accountable for Parity in Coverage of Mental Health Treatment. Psychiatric Services. November 2019. Accessed December 2022.

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