Establishing a systematic approach to screen and assess for alcohol and other drug problems and mental health problems is imperative. Despite the high prevalence of co-occurring disorders among justice-involved individuals, these disorders are not always detected. Screening and assessment for mental health and substance use disorders should be conducted at the same time and as early as possible upon the individual’s initial involvement with the justice system. Until it is determined how the mental health and substance abuse disorders relate to one another, diagnosis may be difficult. However, if a co-occurring disorder is undetected, many individuals will not receive appropriate treatment and planning for release strategies will be ineffective.
No single instrument can adequately screen for all mental health and substance use disorders, particularly given the constraints of length, cost, and required training but a combination of evidence-based instruments can be useful (Peters and Hills, 1999). Choosing the most effective screening and assessment instruments requires consideration of a number of factors that can influence the effectiveness of the instrument, such as the amount of time required to administer, cost, mode of administration, staff training required, and contextual factors, including:
- Client characteristics: Age, Gender, Education and Ethnicity
- Environmental factors, such as the setting within the judiciary (i.e. juvenile justice system, family court, criminal justice system, problem-solving courts).
Screening for substance use and mental health problems is usually administered separately because there are few valid screening tools to screen for both problems simultaneously. Research shows the TCUDS, SSI, or ADS in combination with ASI-Drug Screen are equally effective in detecting alcohol and other drug problems among prisoners (Peters et al., 2000). There are many screening instruments for mental health disorders. The GSS, MINI-M, and MHSF are all standardized and commonly used screening instruments for mental health problems, and have been validated for use in prison substance-abuse settings (Sacks et al., 2007).
NIDA’s CJ-DATS project developed the Co-Occurring Disorders Screening Instrument (CODSI), a short screening instrument, to identify both alcohol and other drug and mental health disorders in a variety of justice settings. Initial research shows that CODSI in combination with TCUDS are effective screening tools for co-occurring mental and alcohol and other drug problems in prison treatment programs. (Sacks et al., 2007).
Part of the problem in the treatment of co-occurring disorders is that many people performing the assessments are not adequately trained in addiction medicine or in treating other mental and physical health conditions that frequently co-occur, particularly in those involved in the justice system. Assessments of individuals who screen positive for co-occurring disorders should be performed by a medical professional specially trained in addiction and psychiatric disorders. This will assure a more comprehensive clinical assessment is performed and appropriate medical intervention. After the assessment is complete, a treatment plan can be developed incorporating a broader network of health professionals to manage treatment.
Examples of brief screening instruments to detect mental health or alcohol and other drug problems in the justice system:
- Alcohol Dependence Scale (ADS)
- Alcohol Severity Index-Drug Use Subscale (ASI-Drug)
- Global Appraisal of Individual Needs Short Screener (GSS)
- Mental Health Screening Form (MHSF)
- Mini-International Neuropsychiatric Interview-Modified (MINI-M)
- Simple Screening Instrument for Substance Abuse (SSI-SA)
- Texas Christian University Drug Screen (TCUDS)
