Consider the following scenario:

Terrence is considering next steps for a client, Angela, who has come for therapy at the family counseling center where he works. When Angela scheduled her appointment on the telephone, she had described her concerns with marital difficulties, insomnia, and depression. During her first session, however, Terrence noticed that Angela had a very nervous demeanor, picked at her skin constantly, and had a rasping cough. When Terrence asked Angela about her employment, she admitted that she had lost her job and that her husband was angry about it. She said she was afraid her husband was on the brink of becoming abusive.

Terrence is not sure what to do first. He suspects Angela might have a substance addiction, but clearly she has several interlocking problems, and many are urgent. Should Terrence administer a screening for addiction or a more general clinical assessment? If he does decide to administer an addictions assessment, which of the many that are available should he choose and why?

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