Clinical issues in the assessment of adolescent alcohol and other drug useIntroductionHeuristic assessment modelOverviewAssessment methodsSelf-reportLaboratoryContent domainsInstrument SelectionSelecting instruments for use in clinical settingsGeneral principlesScreening toolsMulti-scale questionnairesAOD diagnostic interviewsOverview of clinical assessment toolsScreening instrumentsAdolescent alcohol involvement scale (AAIS)Adolescent drinking index (ADi)Adolescent drug involvement scale (ADIS)Drug abuse screening test for adolescents (DAST-A)Drug use screening inventory-revised (DUSI-R)Personal experience screening questionnaire (PESQ)Problem oriented screening instrument for teenagers (POSIT)Rutgers alcohol problem index (RAPI)Substance abuse subtle screening inventory (SASSI)AOD diagnostic interviewsAdolescent diagnostic interview (ADI)Customary drinking and drug use record (CDDR)Other specialized interviewsAdolescent drug abuse diagnosis (ADAD)Comprehensive addiction severity index for adolescents (CASI-A)Teen severity index (T-ASI)Paper-and-pencil questionnairesAdolescent self-assessment profile (ASAP)Hilson adolescent profile (HAP)Juvenile automated substance abuse evaluation (JASAE)Personal experience inventory (PEI)Summary and future directionsAcknowledgementsReferencesBehaviour Research and Therapy 40 (2002) 1443–1456www.elsevier.com/locate/bratClinical issues in the assessment of adolescent alcohol andother drug useK.C. Wintersa,∗, W.W. Latimerb, R. StinchfieldaaDepartment of Psychiatry, University of Minnesota, F282/2A West, 2450 Riverside Avenue, Minneapolis,MN 55454, USAbDepartment of Mental Hygiene, Johns Hopkins University of School of Hygiene and Public Health, USA.Accepted 14 March 2002AbstractClinicians working with adolescents are routinely faced with the issue that alcohol and other drug (AOD)involvement may be part of the clinical picture either as a primary problem or a contributing factor toother problems or disorders. Fortunately, assessment research in this area has produced several behaviorallyoriented and psychometrically sound tools from which to choose for problem identification, referral andtreatment of youth suspected of AOD abuse. The aim of this paper is to provide an overview of severalissues related to the clinical utility of such assessment tools. 2002 Elsevier Science Ltd. All rights reserved.Keywords: Adolescents; Substance abuse; Assessment1. IntroductionAlcohol and other drug (AOD) use by teenagers continues to be a significant public healthproblem in this country. Despite some reductions or leveling-off of use for some drugs, Americanteenagers are showing a general increase in use of AOD since 1992 (Johnston, O’Malley, &Bachman, 1999). Regional epidemiologic studies suggest that between 4% and 16% of youthmeet diagnostic criteria for at least one substance use disorder (Harrison, Fulkerson, & Beebe,1998; Cohen et al., 1993). From a public health standpoint, adolescent drug abuse has far-reachingsocial and economic ramifications (Children’s Defense Fund, 1991; Johnston, O’Malley, & Bach-man, 1992), particularly when its onset is early and when the disorder does not remit. Adverse∗Corresponding author. Tel.: +1-612-273-9815; fax: +1-612-273-9779.E-mail address: [email protected] (K.C. Winters).0005-7967/02/$ - see front matter  2002 Elsevier Science Ltd. All rights reserved.PII: S0005-7967(02)00041-41444 K.C. Winters et al. / Behaviour Research and Therapy 40 (2002) 1443–1456consequences associated with AOD involvement by young people include psychiatric comorbidityand suicidality (Kaminer, 1994; Shedler & Block, 1990), mortality from drug-related trafficcrashes (Kokotailo, 1995), risky sexual practices (Mackenzie, 1993), and substantial direct healthcare costs (DAWN, 1996).Fortunately, since the mid-1980s, prevention and treatment services that address adolescentAOD involvement have benefited from the development of several behavioral-based screeningand comprehensive assessment tools (Lecesse & Waldron, 1994; Winters, in press). These effortshave introduced greater standardization to the field and permitted a wide network of professionalswith diverse training and background to more objectively measured AOD variables in researchand clinical settings. Further, these tools have permitted many youth-serving programs toefficiently and accurately identify AOD and related problems (Center for Substance Abuse Treat-ment, 1999).This paper is divided into three sections. The first section provides a description of an heuristicAOD assessment model for problem identification, referral and treatment planning that identifiesmethods and content domains as a function of the assessment goal (screening or in-depthevaluation). The second section of the paper discusses several issues when choosing assessmentinstruments, and the final section provides a summary of several well-known and psychometricallytested adolescent AOD assessment instruments.2. Heuristic assessment model2.1. OverviewTable 1 provides an overview of an assessment model intended as a guide for clinicians whenfaced with the task of assessing an adolescent suspected of AOD involvement. The model disting-Table 1Model of assessing adolescent alcohol and other drug abuseLevel Content MethodsScreening AOD use problem severity Self-report: short questionnaire andSuicidality brief interviewPhysical/sexual abuseLiving situationComprehensive assessment AOD use problem severity Self-report: standardized questionnaireFamily life and detailed interviewLiving situationDelinquency/legal statusPeer functioning Laboratory testMedical statusSchool functioning Direct observationPsychiatric statusPhysical/sexual abuse Other-reportSexual behaviorLeisure and recreation1445K.C. Winters et al. / Behaviour Research and Therapy 40 (2002) 1443–1456uishes methods of collecting information and candidate content domains for the two basic assess-ment goals typically practiced in clinical settings—screening and comprehensive assessment. Theapplication of the model recognizes that the screening process primarily addresses drug use prob-lem severity and targets a very limited set of underlying precipitating and predisposing biopsycho-social factors. Further, the screening process necessitates that clinicians use short questionnairesand brief interviews and rely heavily on the self-report method. On the other hand, the comprehen-sive assessment process dictates that multiple methods be employed to