Below is a PDF of a monograph I’ve completed on the topic of screening and assessment of SUDs.
Other than individual and group counseling, it’s hard for me to think of a task more central to the work of addiction counseling than screening and assessment.
And in today’s world, with the pace of change concerning an ever-widening array and availability of new substances with addiction potential, these tasks have perhaps never been more variable more often. Advancements found in research findings also seem to be plentifully available from a variety of sources. And yet, the constraints of the electronic medical record and limits of time that are present for a variety of reasons seem to provide a context that acts something like a default-level implied clinical supervisor.
This work could be considered my response – one that’s centered in my opinions and that provides information and methods I’ve collected over my clinical career. (In that way the work is not authoritative. Nor is it sufficient as a stand-alone resource). And yet the reader will find a relatively broad range of sub-topics related to the areas of screening and assessment.
I’ve purposefully included some content that concerns the interior of the clinician, such as differing definitions of some key terms, things that can be memorized, and awareness of methods that can help improve areas of our approach (rather than us only unconsciously operating out of our static preferences). The reason I’ve included such information, apart from its sheer value, is my awareness of the reality that not every addiction counselor can implement everything they wish they could within a system at a workplace. And sometimes the one area we have more control in improving than any other is the space within ourselves – what and how we think and function on the inside.
I hope that someone finds some portion of this work inspiring or helpful in some way.
Topics in the work are listed below. After the list of topics you’ll find the full document.
- Logic about logic
- Definitions
- Clinical tradition
- Non-clinical settings and services
- Clinical settings and services
- Diagnostic taxonomy and nomenclature
- Associated features
- Hints from psychopharmacology
- Quantitative and qualitative data and sources
- “The Big 5” SUD criteria
- “Palpate the unknown”
- References
- Suggested readings
Recovery Review 
This piece is an essential meditation on the complexities of assessing and understanding substance use disorders (SUDs). What stands out most is the tension between empirical rigidity and the nuanced art of clinical judgment. While standardized tools and diagnostic criteria offer structure, the over-reliance on them risks eclipsing the human elements of care—empathy, intuition, and the capacity to “sit with the unknown.”
In clinical practice, the challenge is often less about identifying “what’s wrong” and more about understanding “who this person is” in the context of their lived experience. The dichotomy between inductive and deductive reasoning discussed here is a valuable framework. It reminds us that while empirical data (toxicology, lab results) are indispensable, qualitative insights—the patient’s narrative, their “qualia” of suffering—are equally vital. It is in listening to the stories behind the symptoms that we gain access to the human heart of addiction.
The author’s emphasis on using diagnostic criteria as guides to judgment rather than strict checklists is particularly insightful. The common practice of reducing screening to a series of yes/no questions transforms a patient into an object of analysis rather than a partner in discovery. By contrast, a more dynamic approach invites the clinician to hold space for ambiguity and complexity. This is where healing begins—not in the binary determination of criteria but in the relational process that underpins assessment.
The integration of top-down (research-based) and bottom-up (phenomenological) methods is a call to transcend the false dichotomy between science and art in clinical work. A great clinician can navigate between these poles, using both evidence and intuition as tools to better understand the whole person. The analogy to a master soup maker adapting recipes based on subtle variables is apt; the skilled clinician adjusts their approach to fit the unique flavor of each patient’s experience.
Finally, the discussion of the “Big 5” criteria introduces an important perspective: not all diagnostic criteria carry equal weight in the lived reality of addiction. Criteria like tolerance or dangerous use may be common, even in those without a disorder, while others—like cravings or withdrawal—carry a more profound diagnostic significance. This layered understanding is crucial in tailoring treatment to the individual rather than the label.
In sum, this work is a compelling argument for a more humanistic, integrative approach to SUD assessment. It challenges us to move beyond rote adherence to diagnostic tools and into a space where science, empathy, and intuition intersect. As clinicians, our task is not merely to diagnose but to deeply connect—holding the complexity of our patients’ stories while guiding them toward healing and recovery.
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