Running head: RASTATTER RESEARCH PAPER

Anna Rastatters Research Paper

Anna Rastatter
The Pennsylvania State University

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Section I: Introduction to Selected Assessment

According to the American Psychiatric Association (2013), dependency is the first stage
of addiction. The definition of alcohol and drug dependency depends on whether the use is
compulsive in addition to impeding on the daily functions of ones life. The use of substances
transforms into abuse when it causes problems that do not fulfill the strict criteria for dependence
(Hood & Johnson, 2007). Dependency is problematic drinking that interferes with various areas
of ones life including physical, vocational, spiritual, social, relationship, emotional, mental,
spiritual and sexual activities (Behun, 2013).
Within this first stage, there are seven criteria used to determine AOD dependency: The
first being increased tolerance to the substance manifested by an escalation in substance intake
over time to reach intoxication. The second is the presence of withdrawal symptoms in the
absence of consumption. These symptoms inhibit daily functioning. The third criterion is the
compulsive use of the substance. The fourth standard for dependency is the inability to limit the
use of substance. When a significant amount of time is invested in getting, using, or recovering
from the effects of the substance, the fifth criterion is met. The sixth determining factor is the
reduction or cessation of important social, occupational, or recreational activities due to
substance consumption. Finally, the continued use of the substance regardless of physical or
psychological problems is an indicator of dependency (Hood & Johnson, 2007).
Many tools and assessments can be utilized to determine if ones consumption of alcohol
and other drugs progresses into a dependency. While some are brief assessments, other types can
be a more comprehensive test of excessive, harmful consumption of substances.
Section II: C.A.G.E. Questionnaire

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The C.A.G.E. Questionnaire is a brief assessment used to screen individuals for problems
related to substance use. Composed of four yes/no questions, the C.A.G.E. is appealing because
of its simplicity. The interviewer asks the client if they have ever (1) felt the need to cut down
their drinking (2) become annoyed when others ask them about their drinking (3) felt guilty
about their drinking, or (4) need to consume an eyeopener to start the day. The questionnaire is
especially effective when screening a large population of at-risk drinkers (Hood & Johnson,
2007). The C.A.G.E. is also advantageous because the administration and scoring of the
questionnaire requires minimal time. This assessment provides the interview with a foundation
for discussion if any of these criteria are met by the client.
An issue with the C.A.G.E. is its lack of specificity. Before it was refined, it did not focus
on recent consumption. The use of the word ever before each question left the interviewer with
no set timeframe of the substance use. A modification of the questionnaire was made by
replacing ever with anytime within the past year in order to solidify the pertinence of the
substance use. Two additional questions were later added to inquire about the number of days per
week the client consumes and if consumption happens outside of meals during the week (Hood
& Johnson, 2007). The C.A.G.E. has proved to be less effective among women, college students,
and adolescent patients (Knight, Sherritt, Harris, Gates, & Chang, 2006). According to a review,
the C.A.G.E. missed 41%-62% of white women with alcohol dependency who took the
questionnaire, leaving them untreated (Borges & Cherpitel, 2001). The C.A.G.E. has not
performed as well in different ethnic groups (Hood & Johnson, 2007).
Section III: RAPS4-QF
The Rapid Alcohol Problems Screen (RAPS) is a brief assessment that contains four
items. This instrument has displayed high sensitivity and specificity across genders and ethnic

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groups (Borges & Cherpitel, 2001). The four items convey sensitivity by relating the guilt about
drinking (Remorse), blackouts (Amnesia), failing to do what is typically expected because of
drinking (Perform), and the need for a drink in the morning (Starter) (Hood & Johnson, 2007).
Two additional questions were added to determine the quantity and frequency of the alcohol
consumption (Genestel et al., 2012). This assessment proved to be particularly effective within
emergency rooms and primary care settings (Borges & Cherpitel, 2001). In terms of
psychometrics, validity studies have been completed on the RAPS4-QF. It was found that the
assessment provides a derivation of criterion validity by comparing the information collected
with performance on a standard measure (National Institute on Alcohol Abuse and Alcoholism,
2003).
While the RASP4-QF provides the interviewer with a basic understanding of the clients
substance consumption, it is a brief assessment. More research is necessary to determine the
relative performance in more diverse patient populations and settings (Borges & Cherpitel,
2001).
Section III: AUDIT
Developed by the World Health Organization, the AUDIT stands for the Alcohol Use
Disorders Identification Test (Knight et al., 2006). This assessment consists of ten multiple
choice questions that require approximately 2 minutes for administration and 3 minutes for
scoring. It can be given as an oral interview written questionnaire. The efficiency of the test
allows it to be utilized in a multitude of settings. It focuses on recent alcohol use. Because of its
consistency, the AUDIT has proved valid and reliable across a variety of populations (Babor,
Higgins-Biddle, Saunders, & Monterio, 2001). The assessment has also been translated into
many different languages

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While the AUDIT has proved to be effective in assessing alcohol dependency, its success
can be circumstantial. The effective administration of the exam is dependent on a nonjudgmental,
friendly interviewer. Additionally, the client cannot be intoxicated while taking the test (Babor,
2001). Finally, some of the questions asked by the AUDIT might require further explanation. For
example, the interviewer might have to specify what constitutes a drink because this differs
across cultures (Babor, 2001).
Section IV: Conclusion
Assessments are necessary to provide both the client and interviewer with a basic
understanding of whether excessive, harmful consumption of substances is prevalent. The tests
screen for individuals that have a dependency on AOD that could potentially lead to addiction.
Because the use and abuse of substances is so prevalent in society, it is important to receive
proper treatment. By developing and administering different assessments, excessive consumption
of substances is brought to the forefront in a nonjudgmental, nonthreatening way. The C.A.G.E.,
RAPS4-QF, and AUDIT are efficient assessments that provide screening for problems related to
substance use, specifically excessive alcohol consumption.

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References

American Psychiatric Association. (2013). Addictions. Washington D.C.: American Psychiatric

Association. Retrieved from http://www.apa.org/topics/addiction/index.aspx
Babor, T.F., Higgins-Biddle, J.C., Saunders, J.B., & Monterio, M.G. (2001). AUDIT: The
Alcohol Use Disorders Identification Test. World Health Organization. Retrieved from
http://whqlibdoc.who.int/hq/2001/who_msd_msb_01.6a.pdf

Behun, R.J. (2013). Client Assessment in Rehabilitation and Human Services Settings Lecture.
University Park: The Pennsylvania State University.
Borges, G., & Cherpitel, C.J. (2001, May 1). Selection of Screening Items for Alcohol Abuse
and Alcohol Dependence among Mexicans and Mexican Americans in the Emergency
Department. Journal of studies on alcohol, 62 (3). Retrieved from
http://www.jsad.com.ezaccess.libraries.psu.edu/jsad/downloadarticle/Selection_of_Screening_Ite
ms_for_Alcohol_Abuse_and_Alcohol_Dependence_among/1504.pdf

Cherpitel, C.J., (2000, May 1). A brief screening instrument for problem drinking in the
emergency room : the RAPS4. Journal of studies on alcohol 61 (3), p. 447. Retrieved
from:
http://www.jsad.com.ezaccess.libraries.psu.edu/jsad/downloadarticle/A_Brief_Screening_Instrum
ent_for_Problem_Drinking_in_the_Emergency_Room_Th/827.pdf

Genestel, J., Pereira, B., Arnaud, B., Christol, N., Liotier, J., Blanc, O., . . . Brousse, G. (2012,
March 13). Screening and Identification. In Alcohol and Alcoholism, 47 (3). Retrieved
from http://alcalc.oxfordjournals.org/content/47/3/273.full.pdf+html
Hood, A.B., & Johnson, R.W. (2007). Assessment in Counseling: A Guide to the Use of
Psychological Assessment Procedures. Alexandria, VA: American Counseling
Association.

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Knight, J.R., Sherritt, L., Harris, S.K., Gates, E.C., & Chang, G. (2006, April 11). Validity of
Brief Alcohol Screening Tests Among Adolescents: A Comparison of the AUDIT, POSIT,
CAGE, and CRAFFT. Alcoholism: Clinical and Experimental Research, 27 (1).
Retrieved from http://onlinelibrary.wiley.com.ezaccess.libraries.psu.edu/doi/10.1111/j.15300277.2003.tb02723.x/pdf

National Institute on Alcohol Abuse and Alcoholism. (2003). Rapid Alcohol Problems Screen
(RAPS4). Assessing Alcohol Problems. Retrieved from:
http://pubs.niaaa.nih.gov/publications/AssessingAlcohol/InstrumentPDFs/54_RAPS4.pdf