3 effective screening tools for co-occurring behavioral health conditions

3 effective screening tools for co-occurring behavioral health conditions

According to the Substance Abuse Mental Health Services Administration in 2014, nearly 8 million American adults had co-occurring mental health and substance use disorders. Because substance use and mental illness co-occur with such frequency, physicians believe screening for these conditions at the earliest opportunity is imperative.

Minnesota’s Department of Human Services, Chemical and Mental Health Services Administration published a primer on effective screening methods. The primer recommends three qualities: reliability, validity and efficiency.

With respect to reliability, the tool’s results must be consistent and hold up over time. For a screening tool to be valid, it must assess sensitivity – accurately recording individuals who do possess a disorder (or true positives) – and specificity – accurately capturing negative results from individuals without a disorder (or true negatives). Last, to be efficient the tool must achieve total classification accuracy. This is the sum of all true positives and true negatives.

Examples of effective screening tools include the following:


The K6 detects serious mental illness occurring in the 30 days prior to screening. The tool assesses the frequency of six feelings on a scale of zero to four, standing for “none of the time” to “all of the time”:

  • Nervous
  • Hopeless
  • Restless/fidgety
  • Depressed (to the point nothing provides enjoyment)
  • Exhaustion (every endeavor, regardless of size, requires effort)
  • Worthless

This screening tool has been used in the National Health Interview Survey and the National Household Survey on Drug Abuse.


This screening tool focuses on substance abuse. It, too, involves questions. Unlike the K6, the tool limits responses to yes or no. The questions are:

  • Have you ever felt you ought to cut down on your drinking or drug use?
  • Have you become annoyed by criticism regarding your alcohol or drug use?
  • Have you ever felt bad or guilty about your alcohol or drug use?
  • Have you ever consumed alcohol or used drugs in the morning to steady your nerves or get rid of a hangover?

The CAGE-AID concerns past year substance use but can be adapted for shorter intervals. The tool can also be used to separately gauge alcohol and drug use.


This tool screens for both mental health and substance abuse. GAIN-SS is a proprietary tool owned by Chestnut Health Systems. Minnesota and other users purchase licenses from the company to use the tool. This tool is typically comprised of three parts. Part one focuses on internalizing mental illness. Part two addresses externalizing disorders. Part three detects substance abuse disorders.

Like K6, this tool uses a numeric system to quantify answers. Each of the three parts contains five possible answers to a question. Sample questions include: when was the last time you had significant problems with feeling very trapped, lonely, sad, blue, depressed or hopeless about the future? Respondents are asked to record how often they experienced these feelings in the past month, two to 12 months ago and over one year (or never). This question is taken from part one. Parts two and three are constructed in the same manner.

These three tools meet the diagnostic criteria for effective screening. According to the Minnesota primer, K6 and GAIN-SS are valid among individuals with substance abuse. GAIN-SS and CAGE-AID have validity among individuals with mental illness. All three tools can be used in diverse populations.

White River Academy is located in Delta, Utah. Our student population consists of boys 12 to 17 who have behavioral health issues. Our psychological evaluation and testing process screens for co-occurring conditions. We tailor our treatment plans to the specific needs of each student. Our mission is simple: transform troubled young men into responsible, confident adults. Call our helpline for more information.

About the author:

Darren Fraser is a content writer. He worked two and half years as reporter and researcher for The Yomiuri Shimbun until they realized he did not read, speak or write Japanese and fired him. Undeterred, he channels his love of research into unearthing stories that provide hope to those dealing with addiction and mental illness. Darren loves the Montreal Canadiens hockey club and horror films and would prefer to enjoy these from the comforts of his family’s farm in Quebec. 

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