What to Expect From a Substance Use Evaluation

At a substance use evaluation, a clinician will ask about your current substance use and your health. Then, they’ll review those answers and recommend next steps.

This guide walks you through the questions that programs rely on, the criteria that they measure, and the rules that apply when a court or an employer orders the evaluation. It also covers what to bring and who gets to see the report, as well as what to ask about billing.

What Is a Drug and Alcohol Assessment?

A drug and alcohol assessment is how a clinician determines whether your drinking or drug use has become a substance use disorder. Programs often call it an evaluation.

A court, DUI program or employer under Department of Transportation rules may require an assessment. It occurs early in the addiction treatment journey.

Clinicians establish a formal diagnosis using the diagnostic criteria (DSM-5-TR). A substance use disorder is diagnosed by evaluating 11 specific behavioral, physical, and psychological criteria. Meeting 2 to 3 criteria generally indicates a mild disorder, 4 to 5 moderate, and 6 or more severe.

If you’re also suffering from a mood or anxiety disorder, this is called a co-occurring condition and it will affect the type of care you need. Clinicians take a comprehensive approach to this step. In addition to asking you questions directly, they may also get information from those close to you and perform a professional screening before making a level-of-care decision.

To get an assessment, you can ask your doctor, contact a treatment program, dial the SAMHSA National Helpline at 1-800-662-HELP (4357), or search FindTreatment.gov. The helpline is a toll-free tool you can use to ask questions about programs, insurance and start dates. Calling does not commit you to any step in the recovery journey. Call now today for help.

Screening vs. Assessment vs. Evaluation

If something turns up in a screening then an assessment will follow. A court, a DUI program or an employer will typically require a version prepared for them in writing.

The NIAAA estimates that a brief alcohol screen will take about 1 to 2 minutes. A screen is a formal check on whether more needs to happen.

Under the Department of Transportation’s workplace rules, the evaluation can happen face-to-face or via remote real-time audio and video. A written report separates a court evaluation from an intake assessment.

Screening Tools Clinicians Use

Most assessments start with a validated questionnaire. It will include fixed questions and is scored the same way every time. This means that identical answers reach identical results.

The AUDIT comes from the World Health Organization (WHO). A score of 8 or above indicates hazardous and harmful use. Its bands run from alcohol education to a referral for diagnostic evaluation and treatment. For women and for men over 65, a cutoff one point lower (at 7) is suggested.

CRAFFT 2.1 is built for ages 12 to 21 where 2 or more signals high risk. The American Academy of Pediatrics recommends substance use screening for all adolescents.

Diagnosis is a necessary step following high positive scoring on the AUDIT. A score narrows what a clinician asks next, including the signs of a drug or alcohol problem that a questionnaire cannot see.

SBIRT: Screening in a Doctor’s Office

Screening, Brief Intervention, and Referral to Treatment is known as SBIRT. It includes a short screen, brief advice, and a referral when treatment is the next step. Medicare pays for SBIRT and for alcohol misuse screening with as many as 4 brief counseling sessions a year.

Questions You May Be Asked

Programs ask about the same territory in their own words. Be prepared to answer questions about your substance use, your health, and life around it. You may also be asked to take a urine drug test. Common questions include:

The NIAAA puts the DSM-5 criteria in everyday words, including “Had times when you ended up drinking more, or longer, than you intended?” One yes is a data point.

Relatives and past providers may also supply collateral information with your permission. Before anyone is contacted, ask who they plan to reach and what you will sign.

Downplaying how much you drink or use can produce a lighter plan than the situation calls for and an honest account lets a clinician match you with the appropriate level of care.

How Your Results Shape Your Level of Care

Many treatment programs use the ASAM Criteria to turn assessment findings into a recommendation. A clinician weighs six areas of your health and daily life to determine a level of care. This might include outpatient therapy while you live at home or hospital based treatment.

The six dimensions are:

ASAM Levels of Care at a Glance

How Long an Assessment Takes

Screening questionnaires take a few minutes. A full assessment runs longer. Evaluations that a court or an employer orders can run past one visit.

DOT is the clearest example. Under federal DOT rules, a Substance Abuse Professional performs an initial evaluation. Then, they’ll conduct a follow-up evaluation after any education or treatment.

What an Assessment Costs and How to Pay

There’s no national price list that sets what an assessment costs. What you pay varies with your state, the provider you choose, and whether a court or an employer requires the assessment. Ask at booking whether the assessment is billed alone or folded into intake.

In DUI cases, Colorado’s fee for the alcohol and drug evaluation is $200, according to the Colorado Office of the State Auditor. In Illinois, evaluators decide their own fees though a reduced fee must be offered to people who cannot pay.

Most health plans pay for treatment but not every plan does. Some limit coverage to certain levels of care. All Marketplace plans cover mental health and substance abuse services as essential health benefits.

Whether Medicaid coverage pays for an assessment depends on your state plan. Medicare covers alcohol misuse screening plus up to four brief counseling sessions a year.

Rehab costs without insurance start with routes that don’t cost as much. Check the SAMHSA National Helpline for free referrals, a sliding-fee scale set by income, and state-funded programs.

Court-Ordered, DUI and DOT Evaluations

Some evaluations are ordered by someone else, like a DUI program, a judge or a DOT-regulated employer. They’ll set the terms, including which evaluators it accepts, and expects the report. Plan to complete what it recommends, and check the paperwork for the approved list first.

DUI and DWI Evaluations

States write their own rules. In Illinois, a DUI arrest leads to an evaluation from a provider licensed through the Illinois Department of Human Services. This will cover your driving record, blood alcohol concentration, a standardized test score and an interview. The result falls into four risk levels. Minimal carries 10 hours of DUI risk education.

Moderate adds at least 12 hours of early intervention spread across four weeks or more. Significant adds at least 20 hours of treatment. High calls for at least 75 hours of treatment. Idaho approves its evaluators through the Department of Health and Welfare and requires at least three approved screening instruments.

Other Court-Ordered Evaluations

Family court, probation officers and diversion programs can require one too. The court gets the result either because you signed a release or because a judge ordered it, so ask what will be shared.

DOT SAP Evaluations

After a DOT-covered employee violates a drug or alcohol rule, the SAP evaluates them, recommends education or treatment, reviews the case again afterward, and sends the employer a follow-up testing plan under 49 CFR 40.291.

Eligibility is narrow. 49 CFR 40.281 lists physicians, psychologists, licensed or certified social workers, employee assistance professionals, state-licensed marriage and family therapists, and counselors certified by recognized national bodies. Everyone on that list also completes SAP training and passes an exam. Follow-up testing runs longer. It includes at least six unannounced tests across the first 12 months under 49 CFR 40.307 and a schedule that can run four more years.

Is Your Assessment Confidential?

An assessment becomes a health record, and federal law limits who can read it, depending on who you see. Most sharing needs your written permission, and one signature can now cover treatment, payment and healthcare operations. Those records stay out of civil, criminal, administrative and legislative cases unless you consent or a court orders it.

Not every evaluator is covered. A private practice with no federal assistance answers to HIPAA and state law instead, and a provider generally cannot tell your employer without your written permission. A court or DOT report goes to whoever ordered it, through your signed release or a court order. A substance abuse professional (SAP) sends recommendations and a plan for follow-up testing to the employer.

Related articleI’m Going to Rehab – What Should I Tell My Employer?Taking time out of your life – and time off work – to go to rehab is a huge step. While addiction treatment may feel like a daunting prospect, it…Olivia Pennelle5 min readUpdated Jun 1, 2026

How to Prepare for Your Assessment

Most of the work happens before the visit. To prepare for your assessment, have the following handy:

It is risky to suddenly stop using alcohol or benzodiazepines before a drug test. For people who drink heavily or take them regularly, withdrawal can be dangerous, so say what you’ve stopped. Withdrawal is managed in safe, supervised detox when it develops.

What Happens After Your Assessment

After your assessment, you’ll receive a recommendation for a level of care and may be enrolled in treatment immediately, depending on your needs. If you have a court, DUI or DOT evaluation then you’ll also get a written report. You’ll start that care from there. This may mean detox first and then rehab or outpatient treatment. Ask questions about the recommendation and how the evaluator reached it.

If a court or DOT process ordered the evaluation then the steps after the appointment matter as much as the interview. Keep copies, and finish each required step by its deadline.

The plan that results from your initial evaluation is a starting point. A treatment plan must be assessed continually so expect the level of care to be reviewed and changed as treatment goes on.

Frequently Asked Questions About Drug and Alcohol Assessments