Substance use screening

A screen is a quick net, not a verdict. Substance-use screening tools are brief, sensitive instruments designed to flag who needs a closer look — they never, by themselves, diagnose a substance use disorder. Examiners test whether you can name the classic tools and hold that screening-versus-diagnosis line.

Meet the big three. CAGE is the fastest — four yes/no questions built around an acronym you must know: Cut down (ever felt you should?), Annoyed (by others criticizing your drinking?), Guilty (about drinking?), and Eye-opener (a morning drink to steady nerves or cure a hangover?). Two or more "yes" answers is the classic cut-off suggesting a problem worth further assessment. AUDIT — the Alcohol Use Disorders Identification Test — is a 10-item instrument developed by the World Health Organization; it's more sensitive than CAGE, covers consumption, dependence, and harm, and is validated across cultures. The SASSI — Substance Abuse Subtle Screening Inventory — is cleverly designed to detect substance problems even in clients who are defensive or in denial, because many of its items don't obviously reference substances ("subtle" is in the name).

Here's the boundary that matters: these tools screen; they do not diagnose. A positive screen is an indication to assess further, not a diagnosis. The actual diagnostic criteria for a substance use disorder live in the DSM-5-TR (an 11-criterion checklist rated mild/moderate/severe) — covered in a separate topic, not here.

Clinical Pearl: Keep screening and diagnosis in separate boxes. CAGE (4 items, 2+ = concern), AUDIT (10 items, WHO), and SASSI (catches denial/defensiveness) are SCREENING tools — they flag risk, not diagnose. If a stem says a positive result diagnoses a disorder, it's wrong; screens only signal the need for full assessment.