Resource Center: Screening and diagnosis, Printable form/checklist

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TICS

Description: 
The Two-Item Conjoint Screening (TICS) scale is a brief screening tool. It screens for current substance use or dependence in a primary care population.

The Two-Item Conjoint Screening (TICS) consists of 2 questions about substance use:

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DAST-10

Description: 
The Drug Abuse Screening Test, or DAST, is a self-administered test designed to provide a brief screening for drug abuse, followed by further assessment by a health care professional if necessary.

The 28-item, self-reporting Drug Abuse Screening Test (DAST) was created to screen for substance use in a clinical or treatment evaluation setting (Skinner 1982).

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Assessment and Screening Instruments
Description: 
This document provides a comprehensive collection of screening instruments and withdrawal assessments.
Source: 
Substance Abuse and Mental Health Services Administration (SAMHSA)
4.57143
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DSM-IV-TR Criteria for Substance Abuse and Substance Dependence

Description: 
DSM-IV-TR Criteria for Substance Abuse and Substance Dependence

The following lists the DSM-IV-TR Criteria for Substance Abuse and Substance Dependence.

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Patient Assessment Checklist

Description: 
Before starting office-based buprenorphine treatment, the following Patient Assessment Questions should be answered for each patient. Topics addressed in these questions include: Diagnosis, Medications, Drugs/Alcohol, Psychiatric and Medical Comorbidities, Psychosocial Issues, Treatment, Patient Management, and Resources.

Diagnosis

Does the patient have a diagnosis of opioid dependence?

  • Approximately how long has the patient been dependent?
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Commonly Used CPT Codes – Primary Care (PDF)
Description: 
PDF of Commonly Used CPT Codes in Primary Care
Source: 
Clinical Tools, Inc.
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Self-Administered Addiction Severity Index (ASI-Self Report)
Description: 
The ASI Self-Report Form asks questions about the following topics: your background and employment, your health and family relationships, your legal situation, and your drug and alcohol use.
Source: 
Center for Health Care Evaluation (CHCE)
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DSM V-Development: Opioid Use Disorder
Description: 
The new version of the Diagnostic and Statistical Manual (DSM V) is scheduled for publication in May 2013. The following website lists the new proposed criteria for a "Opioid Use Disorder" diagnosis.
Source: 
American Psychiatric Association
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Clinical Opioid Withdrawal Scale (COWS)
Description: 
This PDF Document contains the Clinical Opioid Withdrawal Scale (COWS), a common instrument used to assess a patient's opioid withdrawal severity.
Source: 
California Society of Addiction Medicine (CSAM)
3.6
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Objective Opiate Withdrawal Scale
Description: 
A checklist that allows the physician to determine if the patient is in withdrawal in order to administer initial buprenorphine dose.
Source: 
American Academy of Addiction Psychiatry (AAAP)
4.333335
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