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The alcohol evaluation process has been updated and the format changed as of late 2013. It is critical to understand the process as preparation can lead to a more realistic and ultimately fair diagnosis. Further, most Judges and Probation officers do not understand the changes in philosophy and may question a seemingly advantageous diagnosis so it is important to be well informed.
Prior to 1998, Washington State Assessments used a simply approach to diagnosing individuals following an alcohol and/or drug evaluation. There were only three possible outcomes, 1) No significant problem (8 hour ADIS class was required); 2) Significant Problem State I (One-year treatment); and 3) Significant Problem Stage II (Two-years of treatment).
In 1998 the model (DSM IV) changed and re-categorized the diagnosis in determining the level of care. The model still used the three possible outcomes but classified them differently. They were: 1) Insufficient Evidence of Substance Abuse/Dependent (ADIS or ADIS plus ASAM Level 0.5); 2) Substance Abuse (3-6 months of treatment); and 3) Substance Dependence (6-8 months of treatment). This model of care has now been replaced by the DSM 5 effective in 2013, although fundamental changes are occurring in 2014.
The new DSM model uses two general forms of diagnosis, namely no substance use disorder or a substance use disorder. If a substance use disorder is diagnosed the new DSM/ASAM model divides the level of recommended treatment into three sub-categories. Effective immediately an individual obtaining an alcohol evaluation for a DUI can expect one of the following results, depending on the outcome of the evaluation.
1) Insufficient Evidence of a Substance Use Disorder (ADIS or ADIS plus ASAM level 0.5);
2) Substance Use Disorder
i) Mild (3-6 months of treatment)
ii) Moderate (6-8 months of treatment)
iii) Severe (6-8 months of treatment or more)
The "New" Alcohol and Drug Evaluation
In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the revised chapter of “Substance-Related and Addictive Disorders” includes substantive changes to the disorders grouped there plus changes to the criteria of certain conditions.
Substance Use Disorder
Substance use disorder in DSM-5 combines the DSM-IV categories of substance abuse and substance dependence into a single disorder measured on a continuum from mild to severe. Each specific substance (other than caffeine, which cannot be diagnosed as a substance use disorder) is addressed as a separate use disorder (e.g., alcohol use disorder, stimulant use disorder, etc.), but nearly all substances are diagnosed based on the same overarching criteria. In this overarching disorder, the criteria have not only been combined, but strengthened. Whereas a diagnosis of substance abuse previously required only one symptom, mild substance use disorder in DSM-5 requires two to three symptoms from a list of 11. Drug craving will be added to the list, and problems with law enforcement will be eliminated because of cultural considerations that make the criteria difficult to apply internationally.
In DSM-IV, the distinction between abuse and dependence was based on the concept of abuse as a mild or early phase and dependence as the more severe manifestation. In practice, the abuse criteria were sometimes quite severe. The revised substance use disorder, a single diagnosis, will better match the symptoms that patients experience.
Additionally, the diagnosis of dependence caused much confusion. Most people link dependence with “addiction” when in fact dependence can be a normal body response to a substance.
The chapter also includes gambling disorder as the sole condition in a new category on behavioral addictions. DSM-IV listed pathological gambling but in a different chapter. This new term and its location in the new manual reflect research findings that gambling disorder is similar to substance-related disorders in clinical expression, brain origin, comorbidity, physiology, and treatment.
Recognition of these commonalities will help people with gambling disorder get the treatment and services they need, and others may better understand the challenges that individuals face in overcoming this disorder.
While gambling disorder is the only addictive disorder included in DSM-5 as a diagnosable condition, Internet gaming disorder will be included in Section III of the manual. Disorders listed there require further research before their consideration as formal disorders. This condition is included to reflect the scientific literature on persistent and recurrent use of Internet games, and a preoccupation with them, can result in clinically significant impairment or distress. Much of this literature comes from studies in Asian countries. The condition criteria do not include general use of the Internet, gambling, or social media at this time.
Substance Use Disorder
The newest version of the DSM: DSM-5 was released in May 2013. In this version of the DSM Substance Use Disorder is the singular diagnosis which combines Substance Abuse and Substance Dependence.
In order to be diagnosed with Substance Use Disorder the patient must meet at least 2 of the 11 criteria for the diagnosis. the criteria are very similar to those outlined in DSM-IV for abuse and dependence combined. A patient meeting 2-3 if the criteria indicates mild substance use disorder, meeting 4-5 criteria indicates moderate, and 6-7 indicates severe (APA, 2013).
Substance Use Disorders
The following is a list of 11 criteria used to diagnose an individual as having a substance use disorder. It's important to understand the information needed to diagnose you with such a disorder prior to any evaluation. This is particularly true in the DUI field as such a diagnosis will have collateral consequences in court including, but certainly not limited to, additional probation and more court costs.
A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by 2 (or more) of the following, occurring within a 12-month period:
1. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household)
2. Recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)
3. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights)
4. Tolerance, as defined by either of the following:
a. a need for markedly increased amounts of the substance to achieve intoxication or desired effect
b. markedly diminished effect with continued use of the same amount of the substance (Note: Tolerance is not counted for those taking medications under medical supervision such as analgesics, antidepressants, ant-anxiety medications or beta-blockers.)
5. Withdrawal, as manifested by either of the following:
a. the characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria sets for Withdrawal from the specific substances)
b. the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms (Note: Withdrawal is not counted for those taking medications under medical supervision such as analgesics, antidepressants, anti-anxiety medications or beta-blockers.)
6. The substance is often taken in larger amounts or over a longer period than was intended
7. There is a persistent desire or unsuccessful efforts to cut down or control substance use
8. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects
9. Important social, occupational, or recreational activities are given up or reduced because of substance use
10. The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance
11. Craving or a strong desire or urge to use a specific substance.
In the context of driving under the influence, alcohol and drug use is front and center. An alcohol and drug evaluation must be undertaken and the individual must complete the recommended follow up which may included alcohol drug information school (ADIS), a series of classes or even intense treatment. It is imperative that the individual start preparing for the evaluation immediately following the DUI arrest and get the evaluation as soon as possible once the case is filed in court.
Regardless of whether the evaluation is court ordered or if you do it on your own you must be evaluated by a certified counselor in an alcohol program approved by the department of social and health sciences. The evaluation is typically two hours in length and involves your participation in the self reporting questionnaires (MAST and DAST), an interview with the alcohol/drug counselor and a UA test to detect recent drug or alcohol use. The face to face interview may involve the counselor asking you follow up questions from the questionnaires or alternatively asking you questions about your family history (regarding relatives you may have had substance abuse problems) and your general drinking (or drug use) patterns.
The most important advise we can provide prior to having your alcohol | drug evaluation is to abstain from alcohol and drugs (abstain from marijuana for no less than 30 days prior to the evaluation) and seek advice from your attorney. We provide all our clients with detailed advice on how to get through the alcohol | drug evaluation with the best result and least impact.
The evaluation will typically diagnose the individual has having no significant problem (NSP), the potential to develop an alcohol/drug problem of with an alcohol/drug problem. For those diagnosed as NSP the alcohol drug information school (ADIS)will be recommended. For those diagnosed with the potential to develop a problem early intervention will be recommended. And finally, for those diagnosed with a dependency issue treatment will be recommended.
Michigan Alcohol Screening Test (MAST)
Developed in 1971, the Michigan Alcohol Screening Test (MAST) is one of the oldest and, according to "experts," most accurate alcohol screening tests available, effective in identifying dependent drinkers with up to 98 percent accuracy.
Questions on the MAST test relate to the patient's self-appraisal of social, vocational, and family problems frequently associated with heavy drinking. The test was developed to screen for alcohol problems in the general population. The following is the 22-question, self-administered MAST.
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You may receive a few preliminary questions about your family history and whether any family member, related by blood, has had any alcohol/drug dependency issues. It is believed by some that alcoholism is hereditary and if someone in your family was an alcoholic/drug dependent then you are likely to be predisposed to the same condition.
These questions will be regarding your general alcohol/drug consumption. You will be asked what age you started drinking and how much you consumed at that age. It seems like the age of 15 is key – if you started consuming alcohol at or before that age you are more likely to have a substance abuse problem. The majority of questions, however, will focus on your drinking habits during the last 12 months and also since the incident (be sure you don’t consume alcohol after your arrest). What will get you in trouble is the following: 1) Admitting that you consume alcohol on a daily basis; or 2) admitting that periodically (ie. monthly/weekly) you drink to excess (ie. 4+ drinks).
Affect of Alcohol and your life
Questions in this area pertain to how alcohol consumption may affect your family, your work, or your own life. The more significant effect the more likely it is you have a substance abuse problem.
These questions will focus on how many drinks it takes you to feel affected by alcohol. Further, the questions are designed to determine if you need to drink more now than you once did in order to feel affected. The higher your tolerance, the more likely you have a substance abuse problem.
You cannot hide the obvious, you’re getting evaluated because you have legal problems. However, the concern is if you have prior DUI or alcohol/drug related charges. If you do, you can assume that some level of alcohol dependency will be diagnosed and you’ll be required to do some level of treatment.
You cannot control this, but the belief is a BAC reading below 0.15 is not a concern (1st offense) while a BAC reading above 0.15 is cause for concern (the default belief is need of some treatment). Some believe a “refusal” is a concern too, so be certain to explain why you refused (if this applies to your situation).
You will be tested for alcohol or drugs in your system. This should be obvious, but do not consume alcohol within 24 hours of your evaluation and do not smoke marijuana within 30 days of your evaluation.
Readiness to Change
The treatment provider is interested in knowing if you have learned from this experience. If you have changed your habits then this is viewed as positive and there may be no need to further educate. Be sure to inform the treatment provider that you have learned from the experience and have made changes in your life.
You will be diagnosed with one of the following: 1) No Significant Problem (NSP) (ADIS); 2) Early Intervention (ADIS plus 12 hours of classes); Level I-Outpatient (1 treatment session per week for 5/6 months); Level II –Intensive Outpatient (3 treatment sessions per week for several months followed up by after care for several more months).
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Obtaining an alcohol drug evaluation will be mandatory if you are arrested for DUI in Washington State. If you are convicted of DUI or if the DUI is amended to a less serious offense the Court will require you to go through the evaluation process. Additionally, if you lose your license through the Department of Licensing process you will need to complete an alcohol drug evaluation and the ADIS class in order to reinstate your driving privilege.
It is our objective as a law firm who represents the DUI defendant, to get our clients the most fair and objective alcohol evaluation. Hence, all clients will be counseled prior to the evaluation and provided with copies of the MAST and DAST self reporting questionnaire. Do not underestimate the value of a good (fair!) evaluation! Further, we will refer our clients to only a few individual treatment centers for evaluations as many treatment centers are more interested in the bottom line (money) than our client's welfare.
Please download our evaluation materials below in preparation for the best outcome possible.
* Please abstain from the use of alcohol & marijuana while your case is pending - you will be screened during the evaluation!
LAW FIRM OF DAVID N. JOLLY
The MAST Test is a simple, self-scoring test that helps assess if you have a drinking problem. Answer yes or no to the following questions:
1. Do you feel you are a normal drinker? ("normal" is defined as drinking as much or less than most other people)
2. Have you ever awakened the morning after drinking the night before and found that you could not remember a part of the evening?
3. Does any near relative or close friend ever worry or complain about your drinking?
4. Can you stop drinking without difficulty after one or two drinks?
5. Do you ever feel guilty about your drinking?
6. Have you ever attended a meeting of Alcoholics Anonymous (AA)?
7. Have you ever gotten into physical fights when drinking?
8. Has drinking ever created problems between you and a near relative or close friend?
9. Has any family member or close friend gone to anyone for help about your drinking?
10. Have you ever lost friends because of your drinking?
11. Have you ever gotten into trouble at work because of drinking?
12. Have you ever lost a job because of drinking?
13. Have you ever neglected your obligations, family, or work for two or more days in a row because you were drinking?
14. Do you drink before noon fairly often?
15. Have you ever been told you have liver trouble, such as cirrhosis?
16. After heavy drinking, have you ever had delirium tremens (DT), severe shaking, visual or auditory (hearing) hallucinations?
17. Have you ever gone to anyone for help about your drinking?
18. Have you ever been hospitalized because of drinking?
19. Has your drinking ever resulted in your being hospitalized in a psychiatric ward?
20. Have you ever gone to any doctor, social worker, clergyman, or mental health clinic for help with any emotional problem in which drinking was part of the problem?
21. Have you been arrested more than once for driving under the influence of alcohol?
22. Have you ever been arrested, or detained by an official for a few hours, because of other behavior while drinking?
SCORING THE MAST TEST
Score one point if you answered "no" to the following questions: 1 or 4. Score one point if you answered "yes" to the following questions: 2, 3, 5 through 22.A total score of six or more indicates hazardous drinking or alcohol dependence and further evaluation by a healthcare professional is recommended.
Alcohol Drug Information School
An individual diagnosed with no significant problem (NSP) will be recommended to attended the Alcoholand Drug Information School (ADIS). The ADIS is an 8 hour program designed to educate the participants about the dangers of alcohol and drugs. ADIS is typically recommended by a treatment provider for those who are deemed to have no significant problem (NSP) with alcohol or drugs.
ADIS includes the following topics:
•Expectations, Pre-test, Choice
•Blood Alcohol Concentration
•Long Term Affects of Alcohol & Drug Abuse
•Patterns of Use, Nonuse, Social Use, Misuse, Abuse and Addiction
•Underage Drinking and Driving
•Financial and Personal Losses
•Breaking the Family Cycle
•Exploring Values / Making Decisions
•Change Plans and Post-test
The Drug Abuse Screening Test (DAST) was developed in 1982 and is still an excellent screening tool. It is a 28-item self-report scale that consists of items that parallel those of the Michigan Alcoholism Screening Test (MAST). The DAST has “exhibited valid psychometric properties” and has been found to be “a sensitive screening instrument for the abuse of drugs other than alcohol.
Directions: The following questions concern information about your involvement with drugs. Drug abuse refers to (1) the use of prescribed or “over-the-counter” drugs in excess of the directions, and (2) any non-medical use of drugs. Consider the past year (12 months) and carefully read each statement. Then
1. Have you used drugs other than those required for medical reasons?
2. Have you abused prescription drugs?
3. Do you abuse more than one drug at a time?
4. Can you get through the week without using drugs (other than those required for medical reasons)?
5. Are you always able to stop using drugs when you want to?
6. Do you abuse drugs on a continuous basis?
7. Do you try to limit your drug use to certain situations?
8. Have you had “blackouts” or “flashbacks” as a result of drug use?
9. Do you ever feel bad about your drug abuse?
10. Does your spouse (or parents) ever complain about your involvement with drugs?
11. Do your friends or relatives know or suspect you abuse drugs?
12. Has drug abuse ever created problems between you and your spouse?
13. Has any family member ever sought help for problems related to your drug use?
14. Have you ever lost friends because of your use of drugs?
15. Have you ever neglected your family or missed work because of your use of drugs?
16. Have you ever been in trouble at work because of drug abuse?
17. Have you ever lost a job because of drug abuse?
18. Have you gotten into fights when under the influence of drugs?
19. Have you ever been arrested because of unusual behavior while under the influence of drugs?
20. Have you ever been arrested for driving while under the influence of drugs?
21. Have you engaged in illegal activities in order to obtain drug?
22. Have you ever been arrested for possession of illegal drugs?
23. Have you ever experienced withdrawal symptoms as a result of heavy drug intake?
24. Have you had medical problems as a result of your drug use (e.g., memory loss, hepatitis, convulsions, bleeding, etc.)?
25. Have you ever gone to anyone for help for a drug problem?
26. Have you ever been in a hospital for medical problems related to your drug use?
27. Have you ever been involved in a treatment program specifically related to drug use?
28. Have you been treated as an outpatient for problems related to drug abuse?
Scoring and interpretation: A score of “1” is given for each YES response, except for items 4,5, and 7, for which a NO response is given a score of “1.” Based on data from a heterogeneous psychiatric patient population, cutoff scores of 6 through 11 are considered to be optimal for screening for substance use disorders. Using a cutoff score of 6 has been found to provide excellent sensitivity for identifying patients with substance use disorders as well as satisfactory specificity (i.e., identification of patients who do not have substance use disorders). Using a cutoff score of <11 somewhat reduces the sensitivity for identifying patients with substance use disorders, but more accurately identifies the patients who do not have a substance use disorders. Over 12 is definitely a substance abuse problem. In a heterogeneous psychiatric patient population, most items have been shown to correlate at least moderately well with the total scale scores. The items that correlate poorly with the total scale scores appear to be items 4,7,16,20, and 22.
The alcohol evaluation is required by the court and can have a significant impact on your case. Please take it seriously! Your DUI in Everett, Bellingham, Lynnwood, Marysville, Mount Vernon or any other jurisdiction in Western Washington may depend on a good evaluation and diagnosis. It is our objective to prepare you as best we can so that you can anticipate what to expect and get the most fair and reasonable evaluation possible. The evaluation follows the guidelines set forth by the American Society of Addiction Medicine (ASAM).
The focus on the evaluation will be to determine if you have either a substance abuse problem or if you are risk for developing alcohol/drug-related problems. If the evaluation determines that neither of these is present, then you will be determined to have “No Significant Problem” and will not need treatment (you will still need to do the 8-hour Alcohol Drug Information School, however).
In order to complete the evaluation the treatment provider must have the following information: 1. Police narrative; 2. BAC ticket; and 3. Your Driver’s Abstract from the DOL.
We will forward the narrative and BAC ticket to the treatment center and if we have your driver’s abstract, we’ll send that also. If we do not have your driver’s abstract you must get one from the DOL. Importantly, sign a release at the treatment center that allows only our law firm to receive a copy of the evaluation.
The information on this website is for general information purposes only. Nothing on this site should be taken as legal advice for any individual case or situation. This information is not intended to create, and receipt or viewing does not constitute, an attorney-client relationship. Further, if you are not a United States Citizens we strongly encourage consulting with an immigration attorney to determine how a criminal charge may affect your immigration status.
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LAW FIRM OF DAVID N. JOLLY - OFFICE LOCATIONS
Whatcom County: 218 W. Champion St., Bellingham, WA 98225
Skagit County: 410 Myrtle St., Mount Vernon, WA 98273
Snohomish County: 2731 Wetmore, #401, Everett, WA 98201
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