Based on TIP 7

Screening and Assessment

for Alcohol and Other Drug

Abuse Among

Adults in the

Criminal 

Justice System

KAP Keys

For Clinicians

CSAT’s

Knowledge Application Program

KAP KEYS Based on TIP 7

Screening and Assessment for Alcohol and

Other Drug Abuse Among Adults in the

Criminal Justice System

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Treatment

www.samhsa.gov
KAP KEYS Based on TIP 7

Screening and Assessment for Alcohol and Other Drug Abuse

Among Adults in the Criminal Justice System

These KAP Keys were developed to accompany the Treatment

Improvement Protocol (TIP) Series published by the Center for

Substance Abuse Treatment (CSAT), Substance Abuse and

Mental Health Services Administration. These KAP Keys are

based entirely on TIP 7 and are designed to meet the needs of

the busy clinician for concise, easily accessed "how-to" information.

For more information on the topics in these KAP Keys, readers

are referred to TIP 7.

Introduction

TIP 25, Substance Abuse Treatment and Domestic Violence

(1997) BKD139

TIP 26, Substance Abuse Among Older Adults (1998) BKD250

TIP 29, Substance Use Disorder Treatment for People with

Physical and Cognitive Disabilities (1998) BKD288

TIP 32, Treatment of Adolescents With Substance Use

Disorders (1999) BKD307

TIP 35, Enhancing Motivation for Change in Substance Abuse

Treatment (1999) BKD342

Other Treatment Improvement Protocols (TIPs)

that are relevant to these KAP Keys:
KAP KEYS Based on TIP 7

Screening and Assessment for Alcohol and Other Drug Abuse

Among Adults in the Criminal Justice System 

1. Do you feel that you are a normal drinker? (By "normal" we mean that you drink less than or as much as

most other people.)

2. Does your wife, husband, a parent, or other near relative ever worry or complain about your drinking?

3. Do you ever feel guilty about your drinking?

4. Do friends or relatives think you are a normal drinker?

5. Are you able to stop drinking when you want to?

6. Have you ever attended a meeting of Alcoholics

Anonymous?

7. Has drinking ever created a problem between you and

your wife, husband, parent, or other near relatives?

8. Have you ever gotten into trouble at work because of

your drinking?

9. Have you ever neglected your obligations, your family,

or your work for two or more days in a row because

you were drinking?

10. Have you ever gone to anyone for help about your

drinking?

11. Have you ever been in a hospital because of drinking?

12.Have you ever been arrested for driving under the

influence of alcoholic beverages?

13. Have you ever been arrested, even for a few hours,

because of other drunken behavior?

Short Michigan Alcohol

Screening Test 

1

Answer Yes or No

Continued on Back
KAP KEYS Based on TIP 7

Screening and Assessment for Alcohol and Other Drug Abuse

Among Adults in the Criminal Justice System

Scoring

Each "yes" answer equals one (1) point. A score of 1 or 2 indicates there is no alcohol problem. A score of 3 indicates a borderline alcohol problem. A score of 4 or more indicates an

alcohol problem.
KAP KEYS Based on TIP 7

Screening and Assessment for Alcohol and Other Drug Abuse

Among Adults in the Criminal Justice System

I, _____________________ , hereby consent to communication (Name of defendant)

between _________________________________________ and 

(Treatment program)

____________________________________________________ (Court, probation, parole, and/or other referring agency)

the following information: ______________________________ 

____________________________________________________ (Nature of the information, as limited as possible)

The purpose of and need for the disclosure is to inform the

criminal justice agency(ies) listed above of my attendance and

progress in treatment. The extent of information to be disclosed is my diagnosis, information about my attendance or

lack of attendance at treatment sessions, my cooperation with

the treatment program, prognosis, and ___________________

____________________________________________________

____________________________________________________

I understand that this consent will remain in effect and cannot

be revoked by me until:

_____ There has been a formal and effective termination or 

revocation of my release from confinement, probation, 

or parole, or other proceeding under which I was 

mandated into treatment, or

_____ _____________________________________________ (Other time when consent can be revoked and/or expires)

I also understand that any disclosure made is bound by Part 2

of Title 42 of the Code of Federal Regulations governing confidentiality of substance abuse patient records and that recipients of this information may redisclose it only in connection

with their official duties.

____________ ______________________________________

(Date) (Signature of defendant/patient) 

Consent for the Release of Confidential

Information: Criminal Justice System Referral 

2

Prohibition on Redisclosing Information Concerning 

Substance Abuse Treatment Patients 

Once the consent form has been properly completed, there

remains one last formal requirement. Any disclosure made with

written patient consent must be accompanied by a written

statement that the information being disclosed is protected by

Federal law and that the person recieving the information canContinued on Back
KAP KEYS Based on TIP 7

Screening and Assessment for Alcohol and Other Drug Abuse

Among Adults in the Criminal Justice System

not make any further disclosure of such information unless

permitted by the regulations. This statement, not the consent

form itself, should be delivered and explained to the recipient

at the time of disclosure or earlier.

The prohibition on redisclosure is clear and strict. Those who

recieve the notice are prohibited from rereleasing information

except as permitted by the regulations. (Of course, an offender

may sign a consent form authorizing such a redisclosure.)

See below for suggested statement language.

This notice accompanies a disclosure of information concerning a client in alcohol/drug abuse treatment, made to

you with the consent of such client. This information has

been disclosed to you from records protected by Federal

confidentiality rules (42 CFR Part 2). The Federal rules prohibit you from making any further disclosure of this information unless further disclosure is expressly permitted by the

written consent of the person to whom it pertains or as otherwise permitted by 42 CFR Part 2. A general authorization

for the release of medical or other information is NOT sufficient for this purpose. The Federal rules restrict any use of

the information to criminally investigate or prosecute any

alcohol or drug abuse patient.
KAP KEYS Based on TIP 7

Screening and Assessment for Alcohol and Other Drug Abuse

Among Adults in the Criminal Justice System

Qualified Service Organization

Agreement

3

XYZ Service Center ("the Center") and the _________________ 

_____________________________________________________ (Name of the program)

("the Program") hereby enter into a qualified service organization agreement, whereby the Center agrees to provide the 

following:

_____________________________________________________

_____________________________________________________

(Nature of services to be provided)

Furthermore, the Center:

1. Acknowledges that in receiving, storing, processing, or otherwise dealing with any information from the Program about the

patients in the Program, it is fully bound by the provisions of

the Federal regulations governing Confidentiality of Substance

Abuse Patient Records, 42 CFR Part 2: and

2. Undertakes to resist in judicial proceedings any effort to

obtain access to information pertaining to patients otherwise

than as expressly provided for in the Federal confidentiality

regulations, 42 CFR Part 2.

Executed this ________ day of ________ , 200___

___________________ ___________________

President Program Director

XYZ Service Center (Name of Program)

(Address) (Address)
KAP KEYS Based on TIP 7

Screening and Assessment for Alcohol and Other Drug Abuse

Among Adults in the Criminal Justice System

Glossary 4

Assessment: Evaluation or appraisal of a candidate's suitability for substance abuse treatment modality/setting. This evaluation includes information regarding current and past

use/abuse of drugs; justice system involvement; medical,

familial, social, educational, military, employment, and treatment histories; and risk for infectious diseases (e.g., sexually

transmitted diseases, tuberculosis, HIV/AIDS, and hepatitis).

Jail: To hold a person in lawful custody, usually while he or she

is awaiting trial. In some jurisdictions, jails are used punitively for offenders serving short-term sentences or sentences to

work release or weekends in jail. Jails range in size from

rural jails having a dozen cells to urban jails having thousands of cells.

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.

Pre-release assessment: Infectious diseases risk assessment

recommended for all potential parolees. This information

should be available to the judge, prosecutor, and other participants at the time of the pre-sentence hearing or trial/sentencing. If the individual is paroled, this information should

be conveyed to the parole officer for followup and evaluation.

Recommendations for referral for treatment can be made at

this time.

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. Inmates are similarly

classified, by severity of offense and/or other behavior, and

are usually assigned to prisons having a corresponding level

of security.

Probation: Sentence of community-based supervision.

Probation includes stipulations and prohibitions on certain

activities and often includes fines imposed by the court at

the time of sentencing.

Risk/needs assessment: Comprehensive report that includes

the client's social, criminal, and other history. The report usually includes a recommendation for sentencing if the client is

found guilty.
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

Do not reproduce or distribute this publication for a fee without specific, written authorization from the Office of

Communications, Substance Abuse and Mental Health

Services Administration, U.S. Department of Health and

Human Services.

DHHS Publication No. (SMA) 01-3556

Printed 2001

Ordering Information

TIP 7

Screening and Assessment for Alcohol 

and Other Drug Abuse Among Adults in 

The Criminal Justice System