Assessment of drug abuse
This last chapter in the first part of the book pertains to assessment of drug abuse. There are at least three assessment domains that one would want to cover in an evaluation of potential drug abusers. First, one would like to know whether or not a pattern of use qualifies as drug misuse, abuse or dependence, as discussed in Chapter 1. Second, one would like to know the details of the extent to which someone’s drug use pervades the rest of their life; that is, where on the continuum of loss of control one falls, as discussed in Chapter 2. Finally, one would like to know the co-morbidity of drug use with other psychological difficulties (for example character disorders, depressions and other compulsive problem behaviours), as discussed in Chapter 3.
Let us suppose we all agree on what drug abuse is; perhaps we use a DSM diagnostic scheme (APA 1994). Still, assessment of drug abuse can be problematic and challenging. Drug users may under-report use because of the perceived and actual negative stigma associated with a drug abuse diagnosis and the illegal nature of many drugs that are used. Alternately, some drug users may over-report use to avoid punishment by legal agencies, or may try to receive financial assistance (for example service connection). Also, there are wide variations in the topography of drug use behaviour for specific drugs. For example, some marijuana smokers use marijuana once a week, some once a day, and others several times per day. Differentiating drug misuse from drug abuse may not always be certain. Finally, there are variations in the manifestation of problem drug use across different types of drugs. Some drugs of abuse are ‘tissue’ addictive and others are not. Some are very highly rewarding because of their pharmacological effects and influence on reinforcing neurobiological processes; some are less so. Some drugs of abuse quickly increase an individual’s risk for negative consequences while other drugs of abuse may not be as noticeably detectable. For example, individuals may abuse alcohol for many years and not experience negative consequences of their use, whereas other individuals may have used heroin for only one or two months and become physically dependent on the drug,