Properly trained mental health and addiction workers understand the role, function, and difference between screening tools and clinical measures, and of course no screening tool or clinical measure suffices on its own. In fact, their most important function is to assist practitioners and patients in clinical decision making. In case of screening, the goal is to discover potential risk areas. They are not designed to make a clinical diagnosis.

In an early study from 2004, three instruments were discussed for the screening of substance use disorders (Dom et al. 2004): CAGE (Cut down, Annoyed, Guilty, Eye-opener), the Alcohol Use Disorders Identification Test (AUDIT-10q) or short version AUDIT-C (3 q), the Munich Alcoholism Test (MALT) or short version (MALT-3), and the Dartmouth Assessment of Lifestyle Instrument (DALI). In the UNODC-Treatment program (UCLA 2006), some of these instruments were also suggested besides the availability of similar instruments: the ASSIST (Alcohol, Smoking, and Substance Involvement Screening Test), the Drug Use and Cannabis Disorders Identification Test (DUDIT and CUDIT) (Adamson and Sellman 2003), the DAST-10 (Drug Abuse Screening Test), the CRAFFT (6 q) (Car, Relax, Alone, Forget, Family or friends, Trouble), and the TWEAK (Tolerance, Worried, Eye-opener, Amnesia, Cut down). The Dutch guideline for dual disorder (Kerkmeer et al. 2003) added to that list the Alcohol Dependence Scale (ADS), the CAGE Adapted to Include Drugs (CAGE-AID), the Short Drug Abuse Screening Test (S-DAST), the Mac Andrew Alcoholism Scale (MAC), the Michigan Alcoholism Screening (MAST) and Short MAST (S-MAST), the Reason’s for Drug Use Screening (RDU), and the Severity of Dependence Scale (SDS).

Based on the discussion and commonalities in the conclusions of the three guidelines, we inserted the CAGE, CAGE-AID, AUDIT, AUDIT-C, DUDIT, CUDIT, DAST, and the ASSIST into Table 17.3.

CAGE and CAGE-AID are screening tools for alcohol and drugs, respectively, by means of four items: Cutting Down, Annoyance resulting from criticism, Guilt feeling, and Eye-opener. AUDIT is a brief structured interview, which can also be used as a self-rating list with ten questions. CUDIT and DUDIT were developed for the screening of cannabis and drug use disorder, respectively. Within psychiatric samples, they were all found suitable for use in first episode psychosis (Adamson and Sellman 2003). ASSIST has been developed to detect substance use disorder in primary health care. It screens for all levels of problem or risky substance use in adults. It consists of eight questions covering the main substance categories. DAST, consisting of 28 or 10 (short version) items measuring drug-related problems in the last 12 months has good psychometric qualities and is the only screener that has been validated within a psychiatric sample (Maisto et al. 2000).

CAGE and CAGE-AID are most widely used (Aertgeerts et al. 2000), although AUDIT had better psychometric properties. It is the length of the AUDIT that hampers its use. Drug screens for routine use should be brief. However, for the determination whether further assessment for substance use disorder ought to be implemented, the brief version of AUDIT (AUDIT-C), and their derived instruments DUDIT and CUDIT are advised. Validity of the abbreviated versions has been confirmed as well as the efficiency of the language adapted versions (de Meneses-Gaya et al. 2009). For epidemiologic and/or research purposes, it may be advisable to choose the WHO-screening instrument ASSIST, which has been validated with the MINI-Plus (Tiet et al. 2008). ASSIST and AUDIT are available in different European languages, as well (WHO 2013).

The instruments for problem identification and diagnosis proposed in Dom and colleagues (2004) are the EuropASI: European Addiction Severity Index, the CIWA-AR: Clinical Institute Withdrawal Assessment for Alcohol—revised, the OCDS: Obsessive Compulsive Drinking Scale, the FTND: Fagerström Test for Nicotine Dependence and the RCQ: Readiness to Change Questionnaire, which is more suitable for the assessment of motivational factors related to change in substance abuse.

In the UNODC Treatment program (UCLA 2006), only the Addiction Severity Index (ASI) is suggested for the assessment of substance abuse. Other instruments discussed in the Dutch Guideline for dual disorder (Kerkmeer et al. 2003) are the Alcohol Use Disorder and Associated Disabilities Interview Schedule (DIS), the Composite International Diagnostic Interview (CIDI) (WHO 1997; Andrews and Peters 1998), the Maudsley Addiction Profile (MAP) (Marsden et al. 1998), the Opiate Treatment Index (OTI), the Self-Administered Alcoholism Screening Test (SAAST), the Structured Clinical Interview for DSM Disorders (SCID), the Semi-Structured Assessment for the Genetics of Alcohol (SSAGA).

A more recent Dutch publication (De Weert-Van Oene et al. 2013) promotes the use of a new instrument, combining on the one hand an international classification system of functioning and on the other hand parts of different separate instruments that each time focus on an important aspect to be assessed in case of dual disorder: the Measurement in Addiction for Triage and Evaluation (MATE) (Schippers et al. 2010). The MATE includes the Composite International Diagnostic Interview (CIDI), the Maudsley Addiction Profile—Health Symptoms Scale (MAP—HSS), the Standardized Assessment of Personality Abbreviated Scale (SAPAS), the International Classification of Functioning, disability and health (ICF) (Baron and Linden 2008), the Obsessive Compulsive Drinking (and drug use) Scale (OCDS), and the Depression Anxiety Distress Scales (DASS 21) (De Beurs et al. 2001).

From the instruments mentioned above, EuropASI is the European standardised version of the original American ASI. Primarily, DIS was preceding the CIDI. CIDI and SCID will be discussed in the context of the assessment of comorbidity. Therefore, solely the following are kept in Table 17.4: the EuropASI and all instruments that are fully or partly taken in the MATE, as there are OCDS, MAP-HSS, SAPAS, ICF, and DASS.

OCDS, SAPAS, and DASS could be seen as relevant screeners for strongly prevalent (mental health) comorbidity in populations with substance abuse.

EuropASI has been a gold standard for years, considering treatment demanding people in substance related and/or mental health facilities. Recently a new instrument, elaborated in the Netherlands is gaining attention: the Measurement in the Addictions for Triage and Evaluation (MATE) Table 17.5. The instrument is composed of ten modules, constructed according to the World Health Organisation (WHO) classification systems International Classification of Diseases (ICD), and International Classification of Functioning, Disabilities and Health (ICF). It was decided to arrange the instruments in Table 17.4 in order of priority: firstly, those that refer to WHO classifications and/or instruments (CIDI, ICF); secondly, the common ones in the three guidelines; and thirdly, the MATE. Since not all of the instruments exist in several European languages, preferences could depend on the language issue. There are only poor arguments to prefer one instrument to another due to psychometric characteristics. Preference should be based upon measurement purpose (research, treatment plan, supporting therapeutic alliance, monitoring…), most adapted modality in practice (interview, self-rating scale, screening test or classification system), realism to implement (time to complete, need for training, cost). Instruments combining several of these characteristics are most promising in a decade where outcome measurement and monitoring are upcoming issues. The importance of assessment with feedback to support clinical meetings is essential for implementation (Raes 2012).