User:Kbsutton8/sandbox

Versions for GBI Page
The construction site for the GBI Page can be found here: User:Kbsutton8/sandbox2

Lengths
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Respondents
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General Behavior Inventory/Parent-General Behavior Inventory (GBI/PGBI)
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GBI 10-Item Mania Short Form/P-GBI 10-Item Mania Short Form (GBI-10M/PGBI-10M)
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GBI Depression A Short Form/P-GBI Depression A Short Form (GBI-DA/PGBI-DA)
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GBI Depression B Short Form/P-GBI Depression B Short Form (GBI-DB/PGBI-DB)
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GBI 7 Up 7 Down Inventory
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Normative Data on GBI Clinical Measures
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GBI Sleep-Scale
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Teacher-Report General Behavioral Inventory

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LAMS 12 Item self report
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Lewinsohn's 12-item version

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Jensen et al. Impulsive Aggression Scale

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Link to Cody's Sandbox
https://en.wikiversity.org/w/index.php?title=User:Cody_naccarato/sandbox&redirect=no

Evidence-Based Assessment
--General Ones

--Alcohol Ones

--Opioid Ones

--Marijuana Ones?

Need to Create Table With Assessments: Screener Assessments vs. Comprehensive Severity Assessments, Etc.

--Include: Format (questionnaire/Interview, Age, Time, Qualifications to give assessment, Substance assessed, Purpose of Assessment, and cost)

Everything below is what I added, up until the end of the chart. Cody naccarato (discuss • contribs) 19:28, 14 September 2020 (UTC)

Purposes of Assessment: Initial screening, Diagnosis of problem, Treatment Planning, Assess Treatment

Also, I removed "CRAFFT" from the "HGAPS" section because it is duplicated in the "AAP Ones" Section Cody naccarato (discuss • contribs) 19:27, 14 September 2020 (UTC)

This is where I finished. Cody naccarato (discuss • contribs) 19:28, 14 September 2020 (UTC)

HGPAS! (Make this a footnote at bottom of table so people can know its free and from HGAPS

-CRAFFT

-POSIT

-POSIP

-(AUDIT will be added to HGAPS soon)

Chung:

-Screening to Brief Intervention (S2BI)

-Brief Screener for Tobacco, Alcohol, and Other Drugs (BSTAD)

-Teen Addiction Severity Index (T-ASI)

-calendar-based Time Line Follow-Back (TLFB)

-The GAIN-Initial (GAIN-I)

-The Rutgers Alcohol Problems Index (RAPI)

-Marijuana Adolescent Problem Inventory (MAPI)

-Drinking Motives Questionnaire (DMQ),

-Comprehensive Marijuana Motives Questionnaire (CMMQ)

-Contemplation Ladder (Biener & Abrams, 1991)

-The Readiness Ruler

-Comprehensive Adolescent Severity Inventory (Meyers, McLellan, Jaeger, & Pettinati, 1995)

-GAIN full

--Toxicology Reports

(AAP ones)

-NIAAA Youth Alcohol Screen (Youth Guide​)

-CRAFFT (Car, Relax, Alone, Friends/Family, Forget, Trouble)

-GAIN (Global Appraisal of Individual Needs)

-AUDIT (Alcohol Use Disorders Identification Test)

Chung: Comprehesive

-Adolescents: MI and confidentiality for accurate info.

Currently in Wiki:

-Personal Experience Screening Questionnaire (PESQ)

-Drug Use Screening Inventory - Adolescent (DUSI-A)

-TAPS Tool

-Adolescent Drug Abuse Diagnosis (ADAD)

-Adolescent Problem Severity Index (APSI)

-Teen Addiction Severity Index (T-ASI)

-Comprehensive Addiction Severity Index - Adolescents (CASI-A)

-Adolescent Diagnostic Interview (ADI)

-The Addiction Severity Index (ASI)

-The Pain Medication Questionnaire (PMQ)

-Prescription Opioid Misuse Index (POMI)

-Toxicology Reports

-Substance Dependence Severity Scale (SDSS)

Importance of/Purposes of Assessment: Initial screening, Diagnosis of problem, Treatment Planning, Assess Treatment

According to the integrative Evidence-Based Assessment (EBA) model, clinical psychological assessments should be used to determine the three P's of a mental health disorder: prediction, prescription, and process. With "prediction" of adolescent substance disorder, consistent use of brief screeners for substance use in mental health and medical care settings can catch substance use that would otherwise go undetected, allowing for early intervention and treatment implementation. (Would like to cite chung here as well, but don't know if we can since it's not in print.) Clinical judgement alone underestimates adolescent substance use and often doesn't identify the problem until late-stage behavioral issues become apparent. With "prescription," assessments can help a clinician determine the best treatment plan for an adolescent with a substance use disorder, considering the individual holistically. In this vain, assessments can help the clinician determine the substance use severity, motivation for the substance use, and the adolescent's readiness to change while ideally also considering caretaker reports, toxicology testing, and external school, medical, and legal reports. (CHUNG) After developing a treatment plan in collaboration with the adolescent based on the comprehensive evaluation, assessments should be continuously used through out the treatment to gauge the "process," allowing for the treatment plan to adapt as needs change and for outcome goals to be measured.

There are many options of evidence-based screeners for initial assessment of adolescent substance use. These validated screeners assess substance use along a continuum based on frequency and intensity of use. Screening to Brief Intervention (S2BI) asks about the frequency of use in the past year of eight types of substances (tobacco, alcohol, marijuana, illegal drugs like cocaine or ecstasy, non-prescribed prescription drugs, misuse of OTC medication, inhalants, and herbs or synthetic drugs) with six responses from "never" to "daily." Brief Screener for Tobacco, Alcohol, and Other Drugs (BSTAD) asks about the individual's and their friends' substance use in the past year, along with their individual frequency of use in the past 30, 90, and 365 days. The Global Appraisal of Individual Needs Short Screener (GAIN-SS) is a broader assessment, looking at four sub-scales for internalizing disorders, externalizing disorders, substance use disorders, and crime/violence. This can be helpful in determining co-morbid disorders in addition to substance use issues. The substance use items focus on the frequency of usage, priorities of substance use, and problems related to substance use. The CRAFFT screener is an acronym for Car, Relax, Alone, Friends/Family, Forget, Trouble. The screener asks about frequency of substance use and identifies problems associated with substance use related to the dimensions listed above. Alcohol Use Disorders Identification Test (AUDIT) specifically screens for risky drinking, asking questions about frequency of use, alcohol dependence, and alcohol related problems. While the screener was created for adults, research supports its use for adolescents ages 14-18.

If substance use is indicated in a brief screener, further assessment can help a clinician gain insight on the severity of the substance use, along with other individual and environmental characteristics that can help inform the optimal treatment plan. The Problem Oriented Screening Instrument for Teenagers (POSIT) is a longer screener with 139 items that explore an adolescents current functioning, focusing on substance use, physical and mental health, family and peer relations, educational and vocational status, social skills, recreational activities, and agressive/criminal behavior. The Problem Oriented Screening Instrument for Parents (POSIP) is the parental version of the POSIT, asking similar questions from the caregiver's perspective. The Teen Addiction Severity Index (T-ASI) is a semi-structured interview that assesses the adolescent's functioning across 7 domains: substance use, school, vocation, family, legal status, peer relationships, and mental health status. Each domain is rated from 1 to 5 in terms of both perceptions of impairment and need for treatment. The Global Appraisal of Individual Needs Initial (GAIN-I) is a semi-structured diagnostic interview that can help diagnose substance use disorder and can be used to inform treatment placement and planning along with outcome monitoring. The GAIN-I focuses on the same four sub-scales as the GAIN-SS: substance problems, internal mental distress, behavior complexity, and crime/violence. If a clinician specifically wants to know more about an adolescent's alcohol related problem behavior, the The Rutgers Alcohol Problems Index (RAPI) is an 18 item questionnaire that asks about the frequency of issues like going to school drunk, avoiding responsibilities, and blacking out. Similarly, the 23 item Marijuana Adolescent Problem Inventory (MAPI) assesses problem behavior related specifically to cannabis use.

In addition to the assessing severity of use and problems functioning, learning about the adolescent's context of substance use, motives for substance use, and readiness to change their behavior can help inform treatment planning and assess ongoing treatment (CHUNG). The Time Line Follow-Back (TLFB) is a calendar-based method of reporting substance use in the past month. This assessment not only gives information on the frequency and severity of use but can also highlight the contexts in which the adolescent tend to use the substance and illuminate patterns of their use. The Drinking Motives Questionnaire Revised (DMQ-R) and Comprehensive Marijuana Motives Questionnaire (CMMQ) assess the adolescent's reasons for substance use. The DMQ-R looks at four main motives for alcohol use: drinking to be social, drinking to cope, drinking to enhance postive emotions, and drinking to confirm with peers. The CMMQ looks at 12 main motives for cannabis use: enjoyment, conformity, coping, experimentation, boredom, alcohol, celebration, altered perception, social anxiety, relative low risk, sleep/rest, and availability. In both measures, using to cope was associated with more negative consequences, as was using to sleep/rest for the CMMQ. To assess motivation to change substance use behavior at the onset or during treatment, clinicians can use the Contemplation Ladder or Readiness Ruler. The Contemplation Ladder has 11 "rungs" that range from statements of no desire to change, to ambivalence, to taking action The Readiness Ruler is a visual scale from 1-10 with similar markers along the continuum of change. These tools can help the clinician gage the adolescent's feelings about treatment and desire/resistance to changing their substance use.

-Delete Casi? (Discuss with group at meeting) -

In addition to self-report and interview assessments, toxicological tests of urine, blood, or hair are recommended to detect substance use at the onset and throughout treatment. However, a negative test does not necessarily mean the adolescent is not using drugs, as drugs only temporarily remain in urine and results can vary based on the type of substance and frequency of use. While some studies have found self-report measures to be highly correlated with urine tests, others have found self-report measures to be inconsistent with urine tests, with some adolescents who report substance use having negative urinalysis and other adolescents who deny substance use having positive urinalysis. Therefore, the results from multiple types of assessments should be considered by the clinician. Adolescents may under-report or deny use in a clinical setting due to fear of consequences like legal repercussions or their parents finding out. In addition to cross-referencing self-reports with parental-reports and biological testing, validity of adolescent self-report can also be improved by building rapport with motivational interviewing techniques and by discussing confidentiality guidelines and limits before assessment.

Comprehensive Assessments

---CASI

Toxicology assessments

---Urine/Saliva Drug Screen

Challenges with assessment

--importance of rapport and motivational interviewing with assessment

--Importance of confidentiality/legal rules around it

As substance use still has a perceived stigma in culture, as well as potential legal ramifications for the use of particular substances, the approach to assessing the presence of SUD in a patient must be handled with care. Particularly because the topic is so personal and because specific answers are often expected (usually in the negative in relation to usage), the approach to assessment must be finely tuned to the situation and patient.

Other lengthier but more comprehensive screening options include Personal Experience Screening Questionnaire (PESQ) which screens for the need for further drug use assessment, Drug Use Screening Inventory - Adolescent (DUSI-A) which screens for severity of involvement with and consequences of drug use, and Problem Oriented Screening Instrument for Teenagers (POSIT) which looks at problems and needs in multiple areas, including substance use. Likewise, McNeely et al. developed the TAPS Tool to help assess, accurately, the recent usage and current risk level of developing specific substance abuse disorders. More recently, evidence shows validity in differentiating clinically important adolescent substance use for an electronic assessment of annual use frequency for eight commonly-abused substances.

Beyond screening, assessment should quantify substance use, effects on functioning, and decide if criteria for a DSM disorder is met. This requires information gathered from multiple sources (i.e. teachers, parents, physicians, social workers), since the adolescent is unlikely to be forthcoming about substance abuse. Severity ratings such as Adolescent Drug Abuse Diagnosis (ADAD), Adolescent Problem Severity Index (APSI), Teen Addiction Severity Index (T-ASI), and Comprehensive Addiction Severity Index - Adolescents (CASI-A) are empirically supported, as are structured interviews like Adolescent Diagnostic Interview (ADI). The Addiction Severity Index (ASI), renowned as the one of the most popularly used substance abuse assessment tools today, in both clinical and research settings, involves semi-structured interviewing to learn about the patient in multiple areas, and thus is one assessment method which should not be overlooked. For SUD in particular, best practice is to conduct toxicology reports pre, throughout, and post treatment, which allows for tracking progress and confirming self-reports.

In regard to opioid misuse specifically, a series of assessments have been developed to help identify chronic pain patients who may be at risk of developing an opioid addiction. These assessments were constructed to help physicians consistently abide by the operational definition of opioid misuse, a definition that is often mistaken to include physical dependency and tolerance. The Pain Medication Questionnaire (PMQ) is one example of an assessment designed to analyze possible opioid misuse. The PMQ is a 26-item self-report questionnaire designed to test the correlation between abnormal attitudes/ behaviors regarding pain medication use and opioid medication misuse. In a single measure study, subjects with higher PMQ scores were found to have a history of substance abuse and higher levels of psychosocial distress. Another example of an opioid misuse assessment is the Prescription Opioid Misuse Index (POMI): a questionnaire constructed specifically to gauge the extent of OxyContin (oxycodone) abuse in pain patients. In a single measure study, subjects who fit the criteria for at least two of the six items in the POMI were correctly identified as being vulnerable to opioid misuse.

All individuals should continue to be reassessed over time to ensure the correct treatment plan is still being provided. Overall, the best assessment plan has been found to combine multiple techniques together. Individual self-report typically finds the framework, where other tools can be used to create the diagnosis and treatment plan A more unique assessment tool has been a combination of natural language processing (NLP) and computer-assisted manual review in electronic health records (EHRs). These methods could successfully detect individuals with opioid misuse problems from the EHRs

Evidence-Based Treatment
Determining the optimal treatment for an adolescent substance use disorder requires careful consideration of multiple factors. According to the American Society of Addiction Medicine (ASAM) criteria, clinicians should consider the patient on six dimensions to approach their treatment planning from a holistic perspective. These include the individual's addiction history/severity and withdrawal potential, their physical health/medical conditions (including STIs/HIV and pain), their mental health, their readiness to change, their risk of relapse, and their recovery situation/support. With these factors in mind, the clinician can determine the best intensity of treatment for the patient on the continuum of care options, ranging from brief intervention, to outpatient services, to intensive outpatient services, to residential/inpatient services, to medically managed intensive inpatient services. Adolescents should be treated in the least restrictive care setting that still provides necessary care and a safe environment. While more intensive residential programs may be needed in more serious cases, outpatient therapy is the most common treatment for adolescents and can foster generalization of treatment gains. There is not a "one-size fits all" treatment for adolescent substance disorders, and the best treatment varies based upon the type of substance and the adolescent's particular needs and problems. These needs will likely change over time and treatment should be continually assessed and adapted through a continuing care approach.

The least intensive of the ASAM criteria levels of care is early intervention. This is often implemented through a brief intervention delivered by a primary care provider or other medical professional. This brief intervention is a short conversation between the provider and patient that is tailored to the severity of substance use that the patient disclosed on a screener assessment. The focus should be on preventing, reducing, or stopping substance use, with the provider giving clear advice to abstain from the substance, information on negative effects of usage, and a discussion about a plan to stop usage, including a discussion of individual strengths and positive behaviors of the patient that will help them abstain. Specific training guidelines by the American Academy of Pediatrics for primary care providers on how to deliver a brief intervention for adolescent substance misuse can be found here.

For adolescents who need more treatment than a brief intervention, the next level of care according to ASAM criteria is outpatient therapy. This treatment may consist of many different elements and forms of therapy in order to address the multiple needs of the adolescent around their substance usage including family therapy, individual behavioral therapy, support groups, medication, and legal services. Given high comorbidity rates in adolescent SUD, co-occurring disorders should be screened for in all SUD treatment settings. These disorders must be appropriately addressed as well with evidence-based methods in order for the adolescent to return to developmentally-appropriate functioning. Throughout treatment, drug usage should be continuously monitored as relapse is common and recovery is a long term process. The treatment should be abstinence-based with a focus on motivation, family engagement/support, skills-building and relapse prevention, co-occurring disorder treatment, multisystem intervention, and completion of treatment and follow-up. Ensuring that services that are developmentally, culturally, and gender-appropriate is also necessary when determining treatment for adolescent substance use.

In general, the most efficacious therapies for adolescent substance use disorders are family-based ecological treatment, cognitive behavioral therapy (individual, group, and family), motivational enhancement treatment with CBT, or some combination of all three therapies. Family therapy is important as family relationships and context are important risk factors for adolescent SUD and families can institute important environmental changes. Cognitive behavioral therapy helps the adolescent anticipate their problems and enhance their self-control. They work on creating adaptive coping, recognizing cravings and situations that are high-risk for their substance use and developing strategies to avoid them. However, developing buy-in to therapy is crucial to treatment completion and relapse prevention, especially since adolescents rarely self-refer and are typically pressured or forced into treatment by a caregiver. Motivational Enhancement Treatment can help drive treatment compliance and retention in adolescents with SUD by helping them increase their motivation for recovery and build a plan for change. In addition to these therapies, twelve-step groups such as AA or NA have been shown to be a beneficial as supplemental or continuing treatment. Similarly, building peer support systems of non-users can be a driver of sustained behavior change and can help prevent relapse.

There are many forms of evidence-based family therapy for adolescent substance use disorder. Family Behavior Therapy focuses on the substance use issues along with other simultaneous problems including conduct disorders, depression, mistreatment, and family conflict. The therapist meets with the adolescent and one of their caregivers and helps them create behavioral goals for substance abstinence and build new skills to deal with co-occuring problems. The therapy also utilizes contingency management and allows the patients to contribute to the treatment planning. Brief Strategic Family Therapy focuses on identifying and changing family patterns that are thought to continue or worsen adolescent substance abuse and conduct problems. The approach of BSFT is flexible and can be adapted to many settings and modalities of treatment from outpatient therapy to being a part of a residential program or continual care plan.

Other forms of family therapy are more comprehensive and community based, also addressing the influence of school, peers, and community in the treatment. Since family, school and peer systems shape adolescent behavior significantly and exert considerable structure and control on their lives, aligning these systems with recovery-focused goals can be highly influential, helping to decrease instances of relapse and to address and overcome trauma that might be a root cause of the substance abuse. One of these types of comprehensive substance abuse treatments that works with the adolescent and their family is Multisystemic Therapy (MST). MST is especially helpful for adolescents who display antisocial behavior along with their substance use. The intensive treatment occurs in natural environments in patient's home, school, and/or community and addresses individual factors, family conflict, peer influence, school issues, and neighborhood cultural influences on drug use. MST has high retention rates and has been found to significantly reduce substance use for at least 6 months after treatment. Multidimensional Family Therapy (MDFT) considers adolescent drug use through the lens of multiple interconnected networks of the individual, family, peer group, and community. The therapist works with the individual to build important developmental skills for problem solving, decision making, and communication along with vocational skills. They work to increase desirable behavior and decrease drug use and other problem behaviors across many different settings and with multiple strategies. Parallel sessions with the caregiver focuses on examining parenting styles and negotiating developmentally appropriate levels of control and influence.

While pharmacological treatment is often a significant component of treatment for adult substance use disorders, there are limited addiction medications that are approved by the FDA for people under 18. Currently, over-the-counter nicotine chewing gum, lozenges, and skin patches are the only FDA approved medication for adolescent substance users and they should only be used with physician consultation. Recent research suggests that buprenorphine, a prescription medication for treating opioid addiction, may be effective for adolescents 16 and older, but the medication has not yet been approved by the FDA. Other medications for treating opioid, nicotine, and alcohol substance use disorders are currently being researched to determine their safety for adolescent populations.

MORE INTENSIVE TREATMENTS