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Coexisting Disorders

Psychiatric and Substance Use Assessment

In most cases, up-to-date assessment procedures of most agencies should identify primary issues which may be associated with mental health and substance use. 

The areas provided below are a guide only and may be supplemented with the links to various mental health disorders at the bottom of the page. Assessments should not be an interrogation and should be conducted over a period of time. Re-assessments will help track progress over time.  For example, suicidal ideation may emerge during drug detoxification.

The following assessment is adapted from John Davies (2000) A Manual of Mental Health Care in General Practice, National Mental Health Strategy, Canberra.


Psychiatric - Substance Use Assessment

Use screening tools
Standardised screening tools can greatly assist reliability in identifying mental illness and/or substance abuse problems.  Many are self-completion. They can take from 2 to 15 minutes to complete.

Initial data
If the client has case notes, review previous assessments, issues and summaries.

The presenting issue
Listening and listing the presenting issue/complaint(s) may unfold symptomatology surrounding the issue and social context. e.g.
"What brings you here?"
"How has that affected you?"
"What did this make you think/feel?"
"How long has this been going on - when were you last your normal self?"
"How has this affected the rest of your life - work,  interests. sleep?"
"When was the last time you enjoyed yourself?"
"Is this affecting the other members of the family?  How are your children going at school?
"Have you had this problem before? What did you do? What worked?" Are you getting help from anyone else?

Assessment of suicidality and dangerousness
"Does it ever seem that life is not worth living?"
"Have you ever thought of ever harming or even killing yourself?"
"Have you ever had any previous suicide attempts or tried to hurt yourself?"
Investigate further if there is any indication of suicidal or self-harm thoughts or behaviour.

Past psychiatric history
- Time and nature of previous presentations
- Past and current treatments and their effectiveness
- Names of previous therapists
- Past admissions

Past medical history

Current medication

Alcohol and other substance use
- The amount consumed and the period and pattern of use
- Tolerance: increasing amounts required to acheive the same effect
- Withdrawal symptoms
- Previous attempts to cut down - were they successful
- Salience of drug use: ie how central is drug us to the person's life - time spent at the expense of other life areas
- Complications: physical (eg. alcohol associated liver disease, peptic ulcer) psychological (eg. amphetamine induced depression)
- Disability and handicap: loss of job, legal (eg. driving under the influence), social (eg. neglect of children, marital breakdown)

Family psychiatric history

Personal history
Childhood, Schooling, Work history, Marital/relationship history, Current interests, Goals

Pre-morbid personality
- "What sort of person are you when you are well?"
- Some underlying personality disorders may predispose to the development of mental disorder: eg. antisocial personality leading to drug addiction leading to depression.

Mental State Examination

General appearance, grooming, etc.  Caution regarding cultural norms. For example the 'grunge' look is appropriate for some youth culture

Slow or accelerated movements, anxious looking, etc.

Note volume and rate of speech. For example, pressure of speech (speaking very fast) may indicate amphetamine use, mania or both.

Mood refers to the sustained emotional tone as reported by the individual. For example depressed, angry, elated,irritable or anxious.
Affect refers to the varying emotional response witnessed during the interview. For example, appropriate, flat, labile, fatuous.

Perception (hallucinations)
While those with schizophrenia may experience hallucinations in any sensory area (visual, gustatory, olfactory, auditory), the most common hallucinations are auditory.
Psychotic symptoms which are organic in origin may have hallucinations arising in any sensory area (eg. alcoholic hallucinosis tend to feel things crawling over their skin and have illusion).

Thought disorder

Thought form
Loose associations to incoherence (eg schizophrenia). Concrete thinking without the ability to abstract (eg alcoholic brain disease or schizophrenia)

Thought content
Delusions are a psychotic symptom. They may be persecutory, grandiose, nihilistic, bizarre. Delusions are different from people with overvalued ideas (eg those with hypochondriasis). Those with anxiety disorders may exhibit phobias, obsessions or compulsions.

Thought possession
A person with schizophrenia may experience thought insertion, thought withdrawal, thought broadcast, or thought block.  Some of these symptoms (eg thought block) can be associated with chronic drug use and depression.

Thought stream
From flight of ideas to psychomotor retardation.

(Click here for the mini-mental status examination commonly used to determine cognitive functioning.   If using this click here for norms against age and educational status - USA)
- Level of consciousness
- Orientation to person, place and time
- Attention
- Memory
- General knowledge, abstract thinking and judgement
- Intelligence

Related Internet Resources


Click here for online psychiatric assessments (including substance use) from Internet Mental Health . (Questions tend to be framed around dysfunction although the generated report includes areas without dysfunction as strengths. Can tailor range of screening questions to suit particular needs.)

Click here for the Beck Inventory for the Screening of Depression (Virtual Hospital)

Click here (PDF 50 KB) for full psychiatric examination including Mini Mental Status Examination
(Click here for the Mini-Mental Status Examination only (Cognitive functioning)

Click here for Severity of Dependence Scale (SDS)

Click here for Alcohol Use Disorders Identification Test (AUDIT)

Click here for the CAGE alcohol dependence screening test

Questionnaires from the WA Drug Abuse Strategy Office web site (in PDF format)

Drug, Social & Psychological

Click here (PDF 44 KB) for the Opiate Treatment Index (OTI) 
The OTI has 7 sections: Demographics/Treatment History; Drug Use; Injecting & Sexual Practices; Social Functioning; Crime; Health; Psychological Adjustment - General Health Questionnaire.


Click here (PDF 4 KB) for the Severity of Dependence Scale 

Click here (PDF 8 KB) for the Severity of Alcohol Dependence Questionnaire - Form C 

 Click here (PDF 8 KB) for the Benzodiazepine Withdrawal Symptom Questionnaire 


Click here (PDF 8 KB) for the CES Depression Scale

Click here (PDF 12 KB) for the Assessment of Suicide Risk 

Click here (PDF 8 KB) for the Rosenberg Self Esteem Scale 

Click here (PDF 8 KB) for the Mind Over Mood Anxiety Inventory

Click here (PDF 12 KB) for the Peritraumatic Dissociative Experiences Questionnaire



Click here or close this window to return to Coexisting Disorders


Other DrugNet Pages in this Subject Heading

Introduction ] [ Psychiatric and Substance Use Assessment ] Symptoms ] Anxiety Disorders ] Depression ] Suicide ] Personality Disorders ] Schizophrenia ] Impact on Parenting ] Disability & Drugs ] Psychiatric Drugs ]

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