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Quick Guide
For Clinicians

Based on TIP 7
Screening and Assessment
for Alcohol and Other Drug
Abuse Among Adults in the
Criminal Justice
System

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Contents
Why a Quick Guide?  . . . . . . . . . . . . . . . . . . . 2
What is a TIP?  . . . . . . . . . . . . . . . . . . . . . . . 3
Introduction  . . . . . . . . . . . . . . . . . . . . . . . . . 4
Criminal Justice and Assessment  . . . . . . . . 6
Screening, Assessment and Readiness 
for Treatment   . . . . . . . . . . . . . . . . . . . . . . 14
Treatment Planning and 
Treatment Progress  . . . . . . . . . . . . . . . . . . .23
Special Assessment Issues . . . . . . . . . . . . .30
Legal and Ethical Issues  . . . . . . . . . . . . . . 37
Glossary  . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

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Quick Guide
For Clinicians

This Quick Guide is based almost entirely on information con
tained in TIP 7 published in 1994 and based on information
updated through approximately 1992.  No additional research
has been conducted to update this topic since publication of
the original TIP.
Based on TIP 7
Screening and 
Assessment for Alcohol 
and Other Drug Abuse
Among Adults in the
Criminal Justice System

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2
Screening and Assessment for Alcohol and Other Drug Abuse
Among Adults in the Criminal Justice System

WHY A QUICK GUIDE?

This Quick Guide was developed to accompany
Screening and Assessment for Alcohol and Other
Drug Abuse Among Adults in the Criminal Justice
System, Number 7 in the Treatment Improvement
Protocol (TIP) Series published by the Center for
Substance Abuse Treatment (CSAT), Substance
Abuse and Mental Health Services Administration.
This Quick Guide is based entirely on TIP 7 and is
designed to meet the needs of the busy clinician
for concise, easily accessed "how-to" information.

The Guide is divided into seven sections, (see
Contents) to help readers quickly locate relevant
material.

Terms related to screening and assessment for
alcohol and other drug abuse among adults in the
criminal justice system are listed on page 39 in
the Glossary. These terms are included to enable
clinicians to talk knowledgeably with their clients
and other providers.

For more information on the topics in this Quick
Guide, readers are referred to TIP 7.

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What Is a TIP? 3

WHAT IS A TIP?

The TIP series has been in production since 1991.
This series provides the substance abuse treat
ment and related fields with consensus-based,
field-reviewed guidelines on substance abuse
treatment topics of vital current interest.

TIP 7, Screening and Assessment for Alcohol and
Other Drug Abuse Among Adults in the Criminal
Justice System

 Addresses concerns of a broad range of readers
including clinicians, social workers, medical per
sonnel, mental health workers, program admin
istrators, and policymakers
 Includes extensive research
 Is a comprehensive reference for clinicians on
screening and assessment for alcohol and other
drug abuse among adults in the criminal justice
system
See the inside back cover for information on how
to order TIPs and other related products.

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4
Screening and Assessment for Alcohol and Other Drug Abuse
Among Adults in the Criminal Justice System

INTRODUCTION

Practical screening, assessment, and treatment
planning can help to improve care and treatment
outcomes. The goal of this Quick Guide is to pro
vide guidelines that can be easily used by clini
cians in order to

 Identify substance abuse screening and assess
ment services that need to be provided to
offenders with various levels of substance
abuse problems and concurrent needs for cor
rectional supervision
 Identify specific screening and assessment
tools that appear to be particularly appropriate
for offender populations and help to facilitate
treatment planning
 Assist criminal justice agencies in the use of
screening and assessment tools to enhance
treatment outcomes
It is important to understand that this Quick Guide
prescribes no particular screening or assessment
tool. It is only a starting point for better coordina
tion between substance abuse service providers
and other providers at various points in the crimi
nal justice process. 

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Introduction 5

The three basic principles that should guide a
counselor's efforts are to assure that

 Adult offenders should have effective and
appropriate care
 Adult offenders have a right to privacy and to
confidential handling of any and all information
they provide
 Cultural, racial, ethnic, and gender concerns
must be considered in all aspects of the screen
ing and assessment process
For more detailed information, see TIP 7, pp. 13.

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6
Screening and Assessment for Alcohol and Other Drug Abuse
Among Adults in the Criminal Justice System

CRIMINAL JUSTICE AND ASSESSMENT

Classification, Screening, and Clinical Assessment

Classification
The criminal justice system relies on the classifi
cation process to determine the social service
needs of the offender and assess his potential
security risk. Ideally, the system should fit the
rehabilitation and security programs of the institu
tion to the requirements of the individual.

Clinical Screening 
With limited funding for clinical assessment, the
clinical screening process is imperative to deter
mine if an individual has a substance abuse prob
lem and whether he can benefit from treatment.
Medical, legal, and psychological problems are fil
tered out at this point and will need to be
addressed before treatment begins.

Questions during the screening process should be
designed to

 Identify the existence of a substance use prob
lem
 Identify individuals with a history of violent
offenses or severe medical or psychiatric prob
lems
 Identify individuals with mental retardation

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Criminal Justice and Assessmment 7

 Identify individuals who would not be eligible for
release to treatment or accepted by a treatment
program
Clinical Assessment
Clinical assessment is a more detailed gathering
of information on the client's substance abuse
patterns and history. This includes data on the
individual's emotional, psychological, and physical
health so that an appropriate treatment regimen
can be prescribed. 

If the client is actively engaged in the assessment
process, the treatment process can be initiated.
This assessment requires the client to confront
the consequences of his substance abuse and to
understand that continuance of this behavior is a
personal choice. If the client desires change, he
will work with the clinician to decide upon treat
ment.

Elements of Clinical Assessment
For multidimensional information gathering, these
three domains are used for clinical assessment:

Sociobehavioral Domain
 History of substance abuse
 Involvement in the criminal justice system

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8
Screening and Assessment for Alcohol and Other Drug Abuse
Among Adults in the Criminal Justice System

 Social support and social roles (family members
and friends, the individual's care-giving respon
sibilities)
 Educational and vocational needs (education
level and marketable skills for employment)
 Spirituality; can help match the client with the
appropriate services
Psychological Domain
To benefit from treatment, the client's emotional
disorders must be treated. An interview should
assess

 Levels of anxiety and depression
 Personality disorders
 Locus of control
 Level of psychological development
 Organic brain syndromes
 Central nervous system function and impair
ment
 History of sexual, emotional, and/or physical
abuse
 History of violent behavior
Biomedical Domain 
 Medical/dental health
 Medical problems 

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Criminal Justice and Assessmment 9
The training for all portions of the clinical and
medical assessments includes
 The ability to establish rapport
 The ability to conduct nonjudgmental, nonthreat
ening interviews
 The ability to document information throughout
the assessment
 Cultural competence
 Nutritional deprivation 
 Infectious and contagious diseases
Qualifications for Individuals Conducting
Screening and Assessment 
 Any professional staff member of a treatment or
criminal justice program can be trained to con
duct the initial clinical screening.
 In-depth clinical assessments require the indi
vidual to have training, professional experience
working with substance abusers, and an ability
to engage the client's active participation.
 Psychological and sociobehavioral portions of
the assessment must be done by appropriate
professionals for the task, including psycholo
gists, social workers, certified substance abuse
counselors, and clinical nurse specialists.
 The biomedical assessment must be conducted
by a physician, physician's assistant, nurse prac
titioner, or nurse clinical specialist.

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10
Screening and Assessment for Alcohol and Other Drug Abuse
Among Adults in the Criminal Justice System

For consistency, programs should utilize standard
ized, culturally appropriate assessment instru
ments, to be used in combination with the inter-
viewer's structured, clinical, and intuitive assess
ment of the client. All assessments should be
valid, reliable, and widely recognized.

Coordinating Treatment and Criminal Justice
Programs 
Assessment and treatment programs are more
effective with coordination between the two sys
tems, as it puts scarce treatment resources to the
best possible use. A formal agreement to collabo
rate is not enough; cross-training is essential to
maximize efforts and minimize duplication.

At the institutional level...

Who should be involved in the team 
managing coordination between the two sys
tems? 
 The director of probation or prison director
 Judges, prosecutors, representatives of the
defense bar where appropriate
 The treatment director
The two systems should develop working policies
that specify principles and rationales guiding col
laboration. Detailed documents should include

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Criminal Justice and Assessmment 11

 Needs and goals of each institution
 Means by which the goals will be met (including
time frames)
 Guidelines for sharing information at various
points in the assessment and treatment
process
 Guidelines for providing a continuum of care
Case Management 
The client's case management team must include
representatives from each institution involved and
at every stage of the treatment process. A formal
agreement should be reached by the team on the
following questions: 

 What are the goals and time frame for treat
ment?
 What are the guidelines for sharing information?
 What process will be followed to reach decisions
concerning whether pretrial release, probation,
or parole should be revoked; when treatment
should be considered a failure; and how person
nel in both systems will respond in the event of
specific treatment problems?

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12
Screening and Assessment for Alcohol and Other Drug Abuse
Among Adults in the Criminal Justice System

Special Issues in Assessment 
A broad range of sociocultural characteristics that
play a large role in assessment include

 Literacy and communication skills cannot be
presupposed based on the client's social class,
race, or ethnicity. The client should still be able
to take an active part in the assessment despite
an inability to read or write.
 Language (the individual's primary, lay, or street
language) is essential to make a true connec
tion with the individual. Avoid clinical jargon.
 A client's cultural identity and ethnicity must
be addressed by a culturally and linguistically
competent staff. The assessor should under
stand the client's own cultural perspective.
 Treatment programs must address gender
issues and guard against sexism. Treatment
tools need to be separately tailored for men and
women based on the differences that the abuse
of substances is manifested in each gender.
 Assessing the client's sexual orientation and
her attitude towards it will help place her in the
appropriate treatment program.
 People with a lower socioeconomic status may
require more intensive services due to biases
that have denied them adequate food, shelter,
or medical treatment. 

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Criminal Justice and Assessmment 13

 Assessors must respect and be familiar with all
religious affiliations and the nonreligious
clients in the community. 
 Clients with physical disabilities must be
screened and placed in a treatment program
that is physically accessible. 
 The risk factors for HIV infection should be
assessed, including
 Frequency of drug injections
 Sharing of drugs and injection equipment
 Use of bleach to sterilize needles
 Number of sexual partners
 Patterns of condom use
 Sex-for-drug exchanges
 History of sexually transmitted diseases
For more detailed information, see TIP 7, 
pp. 511.

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14

Eight percent of street crime in the U.S. involves
substance use. By screening and treating an
increasing number of substance abusers, there is
a potential to reduce associated crimes, deaths,
and accidents.
Screening and Assessment for Alcohol and Other Drug Abuse
Among Adults in the Criminal Justice System

SCREENING, ASSESSMENT, AND
READINESS FOR TREATMENT

Why Screen? 
Screening offenders for substance abuse helps to
identify potential candidates for treatment inter
vention at the early stages of their criminal justice
processing. Addressing the problem early may
also curb the cycles of addiction and crime.

Officials in the criminal justice system should be
taught basic screening techniques and apply them
as the offender moves through the system (lock
up, arraignment, pretrial investigation, etc.).

Considerations 
Substance abuse is not always apparent during
the initial screening interview. Officers must learn
to look for signs of substance use, to trust their
instincts and intuition, and to pass these impres
sions on to the next official handling the case.

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Screening, Assessment, and Readiness for Treatment 15

Components 
When a client acknowledges and recognizes the
extent of a personal substance abuse problem,
the screening process ends and further assess
ment begins. If the individual denies problems,
the screener should try to seek evidence in major
life areas by investigating certain aspects of the
client's life, such as

 Relationship of the current charge to substance
use
 Recent or current substance use
 Past treatment history
 Health problems (HIV, TB, hepatitis B)
 Criminal justice system history
 History or evidence of mental illness
 Results of urine, breath, or blood testing
 Family problems, employment, housing or finan
cial instability
Screening Instruments 
Screening instruments provide uniformity, quality
control, and structure to the process. This
includes Breathalyzer, blood-alcohol, and urine
tests as well as the other commonly used instru
ments listed below. 

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16
Screening and Assessment for Alcohol and Other Drug Abuse
Among Adults in the Criminal Justice System

The CAGE Questionnaire 
This is a simple, four-question test designed to
screen for alcohol abuse and can correctly identify
75 percent of alcoholics:

 Have you ever felt the need to Cut down on your
drinking?
 Do you feel Annoyed by people complaining
about your drinking?
 Do you ever feel Guilty about your drinking?
 Do you ever drink an Eye-opener in the morning
to relieve the shakes?
Studies show that two or more "yes" answers to
the CAGE questionnaire will correctly identify 75
percent of the alcoholics who so respond and
eliminate 96 percent of nonalcoholics.

The questionnaire can be modified for drug use by
substituting "drug use" for "drinking" and replacing
the fourth question with "Do you ever use drugs
first thing in the morning to 'take the edge off'?"

The Michigan Alcoholism Screening Test
(MAST)
This is a 25-question test. It can be used as an
indicator of alcoholism and is used during longer
interviews or in holding and confinement situa
tions. (See TIP 7, p. 57.)

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Screening, Assessment, and Readiness for Treatment 17

The Offender Profile Index (OPI) 
The OPI measures the client's drug use severity
and uses a grading guide to interpret the serious
ness of the problem. It must be administered by
an experienced probation officer, counselor, or
other trained clinician. (See TIP 7, pp. 6176.)

Assessment 
Assessment identifies the client's individual
strengths, weaknesses, and readiness for treat
ment. It also recommends appropriate treatment
based on the client's problems.

An assessment should be conducted by qualified
human services professionals with a demonstrat
ed competence in treatment programs (addiction
counselor, licensed social worker). In addition, a
credentialed and/or certified alcoholism, sub
stance abuse, or chemical dependency counselor
should be available. 

Components of Assessment 
A variety of components will yield the most com
prehensive evaluation of the client and will recom
mend the most appropriate treatment.

 Archival data on the client (prior arrests, previ
ous assessment and treatment records, etc.)

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18
Screening and Assessment for Alcohol and Other Drug Abuse
Among Adults in the Criminal Justice System

 Patterns of substance abuse (tolerance,
attempts to hide use, history of withdrawal
symptoms)
 Impact of substance abuse on major life areas
such as marriage, family, employment record,
and self-concept
 Risk factors for continued substance abuse
 Available health and medical findings
 Psychological test findings
 Educational and vocational background
 Suicide, health, or other risk appraisal
 Client motivation and readiness for treatment
 Client attitudes and behavior during assess
ment
Assessment Instruments 
In conjunction with the client's personal history,
assessment instruments can provide another data
source for evaluating the individual. The following
instruments can provide valuable information.

 The Addiction Severity Index (ASI): Evaluates
addiction based on the problems that resulted
from the substance use. Measures the client's
level of discomfort in: alcohol use, medical con
dition, drug use, employment, financial support,

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Screening, Assessment, and Readiness for Treatment 19

illegal activity, family and social relations, and
psychiatric problems.
 Biological Testing: The use of urinalysis,
Breathalyzer tests, blood tests, and all other
available physical tests when substance use is
denied by the client or he is unclear about what
drug or drugs have been used. If possible, self
reports should be corroborated by biological
testing. 
Presenting Findings of Screening and
Assessment
Assessment results contain data that will be rele
vant in treatment. The client should not be
reduced to a number or a label in this assess
ment. 

The language of the data should not be difficult
for any personnel or the client to understand. All
acronyms should be explained. The client and
client's attorney are entitled to review the assess
ment findings, and they should be able to read
and fully understand the document.

A narrative document based on the data gathered
from the screening and assessment tool and the
client's clinical interview should be created, having
three sections:

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20
Screening and Assessment for Alcohol and Other Drug Abuse
Among Adults in the Criminal Justice System

 An introduction explaining how the assessment
came to be, who ordered it, and why
 A section on methodology, explaining how the
data were collected, what tests were used, and
how the results were interpreted
 A presentation of the data relating to the com
ponents of assessment and followed by clinical
impressions and recommendations
Confidentiality and Client Consent 
In many cases, results of the assessment cannot
be released without the signed consent of the
client. The client should fully understand the rea
son for the release, including the recommenda
tions made in the assessment report. The client
has a right to disagree with the report, and any
ruling officer (such as a judge) should be made
aware of such disagreement.

Quality Assurance and Improvement 
This is designed to evaluate, and possibly
improve, the quality of client care services. The
external reviews should consist of intermittent or
annual evaluations done by an outside source.
Internal reviews should be an ongoing process
done by both peer and supervisory personnel,
helping to improve the assessment process for
that agency.

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Screening, Assessment, and Readiness for Treatment 21

Readiness for Treatment 
This is based on

 The client's insight into his own condition
 A willingness to effect change
 The understanding that prior attempts at effect
ing change have not consistently yielded desir
able results
Increasing a client's readiness for treatment
begins with the assessment process and can be
prompted in two different ways:

 Circumstances or pressures relating to loss (job,
family support, money)
 Fear (of incarceration, violence, health risks)
Assessing Readiness 
Clients whose perception includes an acknowl
edged substance abuse problem and the need for
assistance are ready for treatment. Nonvoluntary
participants can become aware of measures that
can be employed to create a motivational crisis
that makes them amenable to treatment. Clients
need to understand the severity of the substance
abuse and the available treatment options.

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22

The "Unready" Client

Research has shown that coerced treatment is as
effective as voluntary treatment, suggesting the
importance of connecting all substance abuse-
involved offenders with assessment and treat
ment resources.

For more detailed information, see TIP 7, 
pp. 1319.
Screening and Assessment for Alcohol and Other Drug Abuse
Among Adults in the Criminal Justice System

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Treatment Planning and Treatment Progress 23

TREATMENT PLANNING AND 
TREATMENT PROGRESS

The Treatment Plan 
The treatment plan is the overall management
strategy for treating people with substance abuse
problems and is based on the client's needs, prob
lems, and resources. The plan should develop
from the assessment process, be individualized,
have clearly-stated goals and objectives, and
include documented participation by the client. 

What is a Good Treatment Plan? 
 A set of tools that identifies the client's
strengths and problems
 An approach for sequencing resources and
activities, and identifying benchmarks of
progress to help guide evaluation
 A plan that addresses the need for rehabilita
tion as well as habilitation (the client's initial
socialization into a productive way of life)
 A plan that is designed to address three types
of potential problems: 
 Attrition
 Noncompliance
 Inadequate progress

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24
Screening and Assessment for Alcohol and Other Drug Abuse
Among Adults in the Criminal Justice System

Components of the Treatment Plan
 The plan should be individualized; that is, the
plan should address the client's specific prob
lems and needs, but should not be over-influ
enced by the counselor's values.
 The plan should be participatory; that is, the
plan should be a shared effort between the
client and counselor working toward a common
goal.
Treatment Planning Goals and Objectives
These goals should be specific, measurable,
quantitative, and have realistic end points.

 The plan should help the client establish a posi
tive sense of self and self-esteem.
 Although abstinence-based goals are custom
ary, the plan should have some flexibility to
accommodate relapses or slips during treat
ment.
 Early goals can be set so they can be realistical
ly met ("Fewer dirty urines a month for the next
3 months").
Client Accountability 
Clients must be accountable for the rules of the
treatment program and should understand the
penalties for breaking them. These rules must be
specifically spelled out for the client, leaving no
doubt about the consequences of infractions.

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Treatment Planning and Treatment Progress 25

The Treatment Team 
Ideally, this should consist of whatever specialists
are necessary to address the client's problems,
including

 Drug and alcohol counselor
 Clinical director
 Licensed social worker
 Medical personnel to address diagnosed 
illnesses
 Registered nurse

At a minimum, the treatment teams need a case
manager and counselor who are certified and
experienced in providing substance abuse 
treatment.

Potential Conflicts Between Treatment and
Criminal Justice Agencies 
Problems can be avoided if certain points are clar
ified in a memorandum of understanding (MOU)
before the treatment process begins. This formal
agreement should contain

 Specific actions of the client that can result in a
dismissal from the treatment program
 Clearly defined expectations
 Definition of terms 

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26
Screening and Assessment for Alcohol and Other Drug Abuse
Among Adults in the Criminal Justice System

 Methods of communication 
 Deliverables, roles, grievance procedures, and
crisis management
(For more information on the MOU, see TIP 7, 
p. 23.)

Assessment of Treatment Progress 
The process of assessment does not end once a
client has been classified, assessed, and
assigned to a treatment program. Assessment is
part of the ongoing treatment process, an essen
tial tool that can determine

 The value of the course of treatment chosen
 How that course should be adjusted
 How realistic are the goals that have been set
 What linkages need to be made to other agen
cies to obtain services for the client
 When maximum benefit of the intervention has
been achieved
 The plan for further intervention
Criteria for Measuring Treatment Progress 
Treatment plans are reviewed, assessed, updated,
and revised throughout the course of treatment
and become the basis for a discharge plan.
Individualized plans will have addressed specific
substantive issues such as

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Treatment Planning and Treatment Progress 27

 Employment, vocational, and educational needs
 Housing environment that is free from abusable
substances
 Medical and psychological concerns
 Recovery support
 Self-esteem development
 Relapse prevention
 Stress management
 Abstinence or reduced substance use
These and other issues should be addressed at
different points of assessment and are used to
help clients make changes in the way they view
the world and themselves.

Sources of Information
To avoid misinformation when assessing a client
(who may only be saying what he thinks the clini
cian wants to hear), the assessor should try to
gather information from the individual based on

 Current events in the client's life (living arrange
ments, etc.)
 Input from family members and significant 
others

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28

All information should be written whenever possi
ble, but oral verifications from the client are also
acceptable in certain circumstances. Clients who
attend self-help meetings should be able to
describe the meeting format, their reactions to the
meetings, and the issues addressed.
Screening and Assessment for Alcohol and Other Drug Abuse
Among Adults in the Criminal Justice System

 What the client has learned throughout the
treatment process (do not just assume the
client has learned something)
 Observation of appearance (if the client is
unemployed but wears expensive clothes and
jewelry, drug dealing is suspect)
 The impact treatment has had on the client (is
he no longer associating with drug users?)
 Information from sources in the criminal justice
system (who can also verify information from
other sources, such as a social services agency)

Potential Conflict Between Systems 
With the same clients passing through both sys
tems, coordination is imperative between treat
ment and criminal justice. Information must be
shared and kept up to date in order to address
new client problems (arrests, parole violation, con
tinued substance use). This will help allocate
resources where they are most needed and avoid

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Treatment Planning and Treatment Progress 29

duplication of effort when handling such concerns
as Social Security and Medicaid eligibility.

Attrition and Non-Compliance Issues 
These problems should be anticipated early in
treatment so that a criminal justice representative
is aware and the problems may be prevented.

There will always be certain nonnegotiable rules
for a client in treatment, and the client must fully
understand these rules and the consequences for
violations.

For more detailed information, see TIP 7, 
pp. 2126.

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30
Screening and Assessment for Alcohol and Other Drug Abuse
Among Adults in the Criminal Justice System

SPECIAL ASSESSMENT ISSUES 

Guidelines to Use When Conducting
Assessments
 Determine who should do the assessment (see
p. 9 for details)
 Lay the groundwork for assessment first by
providing the client with enough clear informa
tion to motivate a participation in the assess
ment process. Include information on the
effects of substance abuse on society in a gen
eral way (don't direct it towards the client) 
- The impact of substance abuse on relation
ships with significant others
- Empowerment issues: How addiction and 
abuse diminish an individual's self-determi-
nation
- HIV/AIDS, other sexually transmitted 
diseases, tuberculosis
(If preassessment education is unavailable, gather
information on the client's sense of self that can
help with successful treatment.)

- The belief system or world view of the client; 
whether he sees himself as a victim of cir
cumstances or as an agent of his own fate

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Special Assessment Issues 31

- Whether the client has a relationship with a 
higher spiritual power
- The client's sense of self-esteem
 Address the client's basic needs:
Some concerns may be related to
- The trial date and what is expected in court
- Fear of sexual victimization in jail or prison
- Basic survival issues (homelessness, hunger,
lack of employment)
- Health issues (pregnancy, HIV, other STDs)
- Withdrawal symptoms
- Physical disability
 Test the client's literacy level and English
competence: Miscommunication can compro
mise assessment if the client's native language
and/or English skills are not properly assessed. 
 A two-way dialog between an equally motivated
assessor and client must take place in order to
build a trusting relationship. 
- The assessor must communicate an attitude
of sincerity, empathy, and understanding to 
the client.
- Help elicit the client's "story," write it down, 
and ask the client to modify it, thereby taking
responsibility for his role in the substance 

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32
Screening and Assessment for Alcohol and Other Drug Abuse
Among Adults in the Criminal Justice System

abuse and involvement in the criminal jus
tice system.
 Ethnicity and Culture: The assessor must be
familiar with cultures other than her own and
have a knowledge of the substance abuse pat
terns in these specific cultures. The assessor
must be able to handle issues related to ethnic
and class bias, gender and sexual bias, sexual
harassment, and cultural and linguistic sensitivi
ty, competency, and diversity. 
 Gender: Understand the differences between
the genders, especially the roles in which they
view themselves, and address them accordingly.
Many incarcerated men feel a loss of identity in
the traditional rolesas men, as fathers, hus
bands, providers. Their loss of freedom and
access to alcohol and drugs leads to feelings of
vulnerability and powerlessness. 

Women may also feel levels of incompetency (as
mothers, working women, wives). An assessment
of parenting skills and responsibility for child care
should be included in the assessment of all
women clients. Other issues to consider during
assessment are

- Whether the woman is in substance abuse 
withdrawal
- History of violence or rape

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Special Assessment Issues 33

- Underemployment, poor and hazardous 
working patterns (prostitute, drug dealer)
- Poor health care, inadequate birth control
- Limited educational opportunities
- Inadequate support for aging and single 
parents
- Guilt associated with concept of a "bad 
mother"
 Age: Factors vary when substance abuse begins
at different ages. Rehabilitation may be more
difficult for those who began substance use at
an early age. 
 Spirituality: Treatment can be enhanced by a
client's spirituality, and although spiritual and
creative development can't be assessed, it is
possible to determine a client's external value
system and incorporate that into assessment.
 Health issues have an impact on recovery from
substance abuse. The following are health
areas requiring special assessment: 
- Nutrition, weight, and eating disorders
- Dental hygiene
- HIV/AIDS and other STDs
- Endocrine disorders (diabetes)
- Sleep disorders

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34
Screening and Assessment for Alcohol and Other Drug Abuse
Among Adults in the Criminal Justice System

- Cardiovascular disorders
- Mental status (depression, withdrawal, etc.)
 A history of physical or sexual abuse should be
taken and the treatment plan individualized
based on the client's situation. It is recommend
ed that the assessor be from outside the facility
to ensure confidentiality and objectivity. 
 Risk for HIV and STDs: (See TIP 7, p. 33 for
questionnaire to gather information for assess
ment of risk.)
 There is a close relationship between mental
health issues and substance abuse. The men
tal health assessment, conducted by a trained
mental health clinician, should look for the fol
lowing:
- Signs and symptoms of depression
- Sleeping disorders
- Recurrent dreams and nightmares
- Symptoms of psychotic disorders, such as 
hallucinations
- Symptoms of dissociative disorders, such as 
"losing time"
- Self-mutilation and thoughts of self-injury
- Suicidal thoughts

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Special Assessment Issues 35

 The individual safety of the client has direct
bearing on the client's chance for relapse. This
includes while she is incarcerated (sexual
abuse, gangs) and when she is released (going
to a drug-free environment). 
 The potential for relapse in substance users is
largely dependent upon three factors: 
- Duration of treatment (the longer, the better)
- Duration of time before relapse (the longer 
the client stays abstinent, the better the 
chance for continued abstinence
- Duration of substance use following relapse 
(if the client seeks treatment immediately 
after relapsing, the greater the chance for 
success)
The potential triggers for relapse are
 Availability of alcohol and drugs in home and
neighborhood
 Anger or stress
 Situations that repeat past traumas
 Sexual partners who are substance users
 Reactions to anniversaries or holidays
 Fears of failure or actual failure in critical life
experiences
 Newfound freedom to have choices

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36
Screening and Assessment for Alcohol and Other Drug Abuse
Among Adults in the Criminal Justice System

 Having money for the first time in a long while
For more detailed information, see TIP 7, 
pp. 2735.

-----------------------------------------------
Legal and Ethical Issues 37

LEGAL AND ETHICAL ISSUES 

It is the responsibility of the courts, correctional
systems, and treatment programs to make screen
ing, assessment, and treatment choices available
to people with substance abuse problems.
Coordination among these systems raises legal
and ethical issues including

 The responsibility of the systems to advocate for
more substance abuse treatment services
 The guidelines used to allocate treatment slots
 The need to avoid overzealous participation by
law enforcement in the "recruitment" of poten
tial clients for treatment
 The courts' responsibility to determine the effec
tiveness of mandated treatment
 The need to protect the confidentiality rights
and other rights of criminal justice clients in
treatment
Priorities for Use of Scarce Resources 
Criminal justice clients can be grouped into four
categories when setting resource priorities:

1. Young people who have been abusing alcohol
and drugs for a brief period of time and have
not experienced serious negative consequences
of substance abuse.

-----------------------------------------------

38

Confidentiality: Protecting the Rights of Clients 
There are many legal and ethical issues that the
staff of substance abuse treatment programs
need to know. For a complete description of the
client's privacy rights and the rules staff must fol
low, see TIP 7, pp. 3845. 
Screening and Assessment for Alcohol and Other Drug Abuse
Among Adults in the Criminal Justice System

2. Individuals whose substance abuse has caused
a personal crisis that could motivate them to
participate in treatment.
3. Individuals who have had substance abuse
problems for 5 or more years and have experi
enced negative consequences, but have not yet
"hit bottom."
4. Career criminals with substance abuse prob
lems.
The first two categories are the early stages of
substance-abusing careers. They are primary tar
gets for assessment and services.

Exceptions to the Federal 
Confidentiality Rule 
Federal regulations permit the disclosure of infor
mation that identifies someone as a substance
abuser without consent in the following circum
stances:

-----------------------------------------------
Legal and Ethical Issues 39

1. Communications that do not disclose patient-
identifying information.
2. Court-ordered disclosures: State or Federal
court may issue an order for a program to dis
close information about an offender that would
otherwise be forbidden. The court must find
"good cause" for doing so.
3. Medical emergencies: Disclosures to medical
personnel for the purpose of treating a condi
tion which poses an immediate threat to the
health of the offender or any other individual.
The following information must be documented
in the offender's records. 
 The name and affiliation of the recipient of 
the information
 The name of the individual making the 
disclosure
 The date and time of the disclosure
 The nature of the emergency
4. Crimes on program premises or against pro
gram personnel: Regulations permit the pro
gram to report the crime to a law enforcement
agency.
5. Sharing information with an agency that pro
vides services to the program: If a program
needs to do this, it can enter into a qualified

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40
Screening and Assessment for Alcohol and Other Drug Abuse
Among Adults in the Criminal Justice System

service organization agreement (QSOA). This
acknowledges that 
 In receiving, storing, processing, or otherwise
dealing with any patient records from the 
program, he or she is fully bound by the 
Federal confidentiality regulations.
 The agency promises that, if necessary, it will
resist in judicial proceedings any efforts to 
obtain access to patient records except as 
permitted by these regulations.
6.Internal program communications: some infor
mation is permitted to be disclosed within the
same program. 
7. Reporting child abuse and neglect: If there is
reasonable cause, the agency is required to
report it. This includes educators and social
workers as well as physicians.
8.Research, audit, or evaluation: Providing certain
safeguards are met, information may be dis
closed without patient consent. 
For more detailed information, see TIP 7, 
pp. 3738; pp. 4649.

-----------------------------------------------
Glossary 41

GLOSSARY
Arrest: Holding in legal custody, either at the
scene of a crime or as a result of investigations.

Assessment: Evaluation or appraisal of a candi
date's suitability for substance abuse treatment
and placement in a specific treatment
modality/setting. 

Day reporting center: Place where offenders
must report while on probation or parole to
receive supervision. Day reporting centers may
include educational services, vocational training,
treatment, and other service deliveries.

Drug testing: Technical examination of urine sam
ples to determine the presence or absence of
specified drugs or their metabolized traces.

Infectious disease risk assessment: Evaluation
of a substance abuser's risk for sexually transmit
ted diseases, tuberculosis, HIV/AIDS, and other
infectious diseases, including information regard
ing current and past history, screening, and treat
ment of such diseases. Testing and referral for
treatment are recommended for the substance
abuser assessed as at high risk for such diseases.
The substance abuser assessed as at low risk
should be reassessed intermittently.

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42
Screening and Assessment for Alcohol and Other Drug Abuse
Among Adults in the Criminal Justice System

Jail: To hold a person in lawful custody, usually
while he or she is awaiting trial. In some jurisdic
tions, jails are used punitively for offenders serv
ing short-term sentences or sentences to work
release or weekends in jail.

Parole: Process of being released from prison
before the completion of a sentence. Parole
involves supervision and other stipulations and
prohibitions on certain activities imposed by a
board of parole.

Prison: Secure institution in which offenders are
confined after sentencing for crimes. Prisons are
classified as minimum, medium, or maximum
security facilities, based on the need for internal
institutional fortification.

Probation: Sentence of community-based supervi
sion. Probation includes stipulations and prohibi
tions on certain activities and often includes fines
imposed by the court at the time of sentencing.

Relapse prevention: Strategy to train substance
abusers to cope more effectively and to overcome
the stressors/triggers in their environments that
may lead them back into drug use and dependency.

Treatment: Any intervention that many change
behavior. Substance abuse treatment involves
planned, therapeutic intervention, with the ulti-

-----------------------------------------------
Glossary 43

mate goal of the client discontinuing the sub
stance use or abuse. Substance abuse treatment
generally consists of specific modalities designed
to meet a client's need for structure.

For more detailed information, see TIP 7, Criminal
Justice Treatment Planning Chart foldout.

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44
Screening and Assessment for Alcohol and Other Drug Abuse
Among Adults in the Criminal Justice System

-----------------------------------------------
Ordering Information
    TIP 7 Screening and 
 Assessment for Alcohol and 
Other Drug Abuse Among Adults 
in the Criminal Justice System

TIP 7-Related Products
KAP Keys for Clinicians
based on TIP 7

Do not reproduce or distribute this publication for a fee without spe
cific, written authorization from the Office of Communications,
Substance Abuse and Mental Health Services Administration, U.S.
Department of Health and Human Services.

Easy Ways to Obtain Free Copies 
of All TIP Products
1. Call SAMHSA's National Clearinghouse for Alcohol
and Drug Information (NCADI) at 800-729-6686, 
TDD (hearing impaired) 800-487-4889
2. Visit CSAT's Website at www.csat.samhsa.gov

-----------------------------------------------
Other Treatment Improvement
Protocols (TIPs) that are relevant to
this Quick Guide:

DHHS Publication No. (SMA) 01-3555
Printed 2001
TIP 12, Combining Substance Abuse Treatment
With Intermediate Sanctions for Adults in the
Criminal Justice System (1994) BKD144
TIP 17, Planning for Alcohol and Other Drug
Abuse Treatment for Adults in the Criminal
Justice System (1995) BKD165
TIP 21, Combining Alcohol and Other Drug Abuse
Treatment With Diversion for Juveniles in the
Justice System (1995) BKD169
TIP 23, Treatment Drug Courts: Integrating
Substance Abuse Treatment With Legal Case
Processing (1996) BKD205
TIP 30, Continuity of Offender Treatment for
Substance Use Disorders (1998) BKD304