Ask Paul: Do you have an alcohol and/or drug problem?
October 18, 2017
RENO, Nev. — Sometimes when a person is referred to me, they have filled out a screening tool or questionnaire from their health care provider. This health care provider has noticed some possible mental or physical issues, which may have been a result of substance use.
Please note there are many different screening tools, and in no way does a screening tool or questionnaire substitute for your health care provider's care and expertise.
Maybe I can save you a trip to a doctor and have you take a couple screening tools yourself. If the results from your scores are not where you want them, please come in and see me. Our Behavioral Health Department has many experts in different life areas who are here to help you confidentially without judgment.
This first set of questions is very general. Remember one or two questions cannot tell a person's story.
First set of questions:
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Alcohol question: One alcohol drink is considered a 12oz beer, 5oz glass of wine or 1.5oz liquor (one shot)
- Men: How many times in the past year have you had 5 or more drinks in a day?
- Women: How many times in the past year have you had 4 or more drinks in a day?
Drugs question: Recreational drugs include methamphetamines (speed, crystal), marijuana (pot, edibles, dabs), inhalants (paint thinner, aerosol, glue), tranquilizers (valium), barbiturates, cocaine, ecstasy, hallucinogens (LSD, mushrooms), or narcotics (heroin).
- How many times in the past year have you (men or women) used a recreational drug or used a prescription medication for non-medical reasons?
Depending on your answers, we may move to a more thorough assessment. But wait, there's more! Let's look at your emotions.
Emotions questions: Answer Yes or No.
- During the past two weeks, have you been bothered by little interest or pleasure in doing things?
- During the past two weeks, have you been bothered by feeling down, depressed or hopeless?
An answer of "Yes" to either of these will tell us to move to a more thorough second set of questions which will narrow our focus to offer help.
Second set of questions for alcohol:
This questionnaire has 10 questions about alcohol use and the answers have points assigned to them. Never = 0 points, Monthly or less = 1 point, 2-4 times a month = 2 points, 2-3 times a week = 3 points, 4 or more times a week = 4 points. After answering the questions, add up your points and I'll tell you what the scores mean.
- How often do you have a drink containing alcohol?
- How many drinks containing alcohol do you have on a typical day when you are drinking?
- How often do you have four or more drinks on one occasion?
- How often during the last year have you found that you were not able to stop drinking once you had started?
- How often during the last year have you failed to do what was normally expected of you because of your drinking?
- How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?
- How often last year have you had a feeling of guilt or remorse after drinking?
- How often during the last year have you been unable to remember what happened the night before because of your drinking?
- Have you or someone else been injured because of your drinking?
- Has a relative, friend, doctor, or other health care provider been concerned about your drinking or suggested you cut down?
If you are a woman: A score of 0-3 indicates a low risk of health problems related to alcohol, 4-12 indicates risky use of alcohol and an increased risk of health-related problems due to alcohol, 13-19 indicates harmful alcohol use, and 20+ is severe.
If you are a man: A score of 0-4 indicates a low risk, 5-14 indicates an increased risk, 15-19 indicates harmful alcohol use, and 20+ is severe.
Low risk means basic education on alcohol would be appropriate. Risky scores indicate concentrating on behavioral changes until getting to a low risk. Harmful and severe use would be a referral to engage in more in depth examination to determine the appropriate level of care.
Second set of questions for drugs:
If you answered "Yes" to the Drugs question, here is a Drug Screening Questionnaire (DAST):
- Have you used drugs other than those required for medical reasons?
- Do you use more than one drug at a time?
- Are you unable to stop using drugs when you want to?
- Have you ever had blackouts or flashbacks as a result of drug use?
- Do you ever feel bad or guilty about your drug use?
- Does your spouse (or parents) ever complain about your involvement with drugs?
- Have you neglected your family because of your use of drugs?
- Have you engaged in illegal activities in order to obtain drugs?
- Have you ever experienced withdrawal symptoms (felt sick) when you stopped taking drugs?
- Have you had medical problems as a result of your drug use (e.g. memory loss, hepatitis, convulsions, bleedings)?
DAST scoring is as follows:
- 0 = Healthy.
- 1-2 = Risky: Education and continue to monitor.
- 3-5 = Harmful: Brief Intervention or referral to specialist.
- 6+ = Severe: Refer to specialist 2.
What to do next?
Don't worry — these questionnaires don't tell the person's whole life story. Each individual has his or her own road and journey. Each individual has his or her own pain and stress in life, and each individual seeks relief in different ways.
These questionnaires are simply used as tools to see if a person's substance use is causing problems in their life. The idea is to be a warrior — one who is as smart, strong and fast as he/she can be to protect those who are not as smart, strong or fast as they are. It's very challenging to be this kind of warrior if the person is slowed down by substance use.
Also, the answers to these questions are not to be used to label a person, but as a starting point or baseline to begin offering suggestions for healing. The idea is to move forward and progress. Labels tend to stagnate a person, and sometimes the person even uses them as an excuse to use alcohol or substances.
For example, have you ever heard anyone say, "It's just the way I am," or, "I just drink, it's what I do," or, "I drive and function better when I'm using"?
The person saying these things is right (except for the last one). They are defining who they are. What if this person changed his/her thought process from, "it's just the way I am," to, "it's the way I used to be"?
I don't tell people what to do or force any change on them. I share different options to using substances and ask them to honestly look at all of the options to decide which would be the most beneficial way to live their life, consistent with their core beliefs and values.
The person who I'm serving makes all of the decisions for their life. Many times after people experiment without substances in their life, they tell me their life is more fulfilled spiritually, emotionally, mentally and physically.
Also, these people tell me they feel more like a true warrior by striving to be the best they can be to protect and serve their family and community.
If you think you or someone you know needs help, reach out to me. These services at Reno Sparks Tribal Health Center are free and confidential to tribal members.
"Ask Paul" is a health column by Paul Snyder, MA, LADC-S, a Substance Use Counselor at the Reno-Sparks Tribal Health Center. It publishes each month in The Camp News, the monthly newsletter for the Reno-Sparks Indian Colony community. Have a question for Paul? Email him at firstname.lastname@example.org.
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