Addiction screening tools: Assumptions and effects

Screening tools photo colourisedIn Australia and around the world addiction is defined and rendered measurable with the use of standardised addiction screening and diagnostic questionnaires or ‘tools’. Wherever statements are made about addiction, its effects and appropriate remedies, these tools have played a key part. In 2015, SSAC researchers Dr Robyn Dwyer and Professor Suzanne Fraser began analysing these tools to better understand how they work, their assumptions and their limits. The aim was to illuminate the processes by which the measurement of addiction legitimates it and turns it into an object of knowledge – an apparently objective ‘fact’. As Dr Dwyer explained,

It’s of pressing importance to subject these tools to critical scrutiny because they have considerable potential to either alleviate or exacerbate stigma, justify public policies and programs, and direct resources.

In one recently published article, Dwyer and Fraser critically examine the scientific validation techniques used to give these tools legitimacy and authority. Their analysis first considers the validation techniques on their own terms, identifying contradictory claims, weak results and the inconsistent application of standards. Dwyer and Fraser then analyse validation as a concept in itself. Here they find that what theorists have called ‘symptom learning’ and ‘feedback effects’ create the impression of objectivity and consistency in establishing and measuring addiction. They also found circular logic at work. The tools construct addiction, then the accuracy of this construct is assessed by comparing it to other equally hypothetical constructs also in want of confirmation. In short, there is no independent standard against which to compare tools.  Viewed both on their own terms, and when subject to more radical analysis, it turns out that the tools rely on a range of questionable assumptions and processes, and the validity claims made about them fail to hold up to scrutiny.

In another analytical article currently under review, Dwyer and Fraser look at how the definitions and assumptions embedded in these tools constitute addiction as a viable ‘problem’ and work to make it a specific kind of problem requiring specific actions. This analysis identifies various processes through which the tools work to establish, standardise and reify addiction as a stable, pre-existing disease entity located within individuals. These processes include the progressive ‘reduction’ in the number of questions used in tools to diagnose addiction, the ‘normalisation’ of culturally specific standards as objective markers of pathology, and the ‘quantification’ of results to produce conveniently clear addiction diagnostic cut-off points that also obscure the complex variability in the attributes they supposedly represent. As lead author Dr Dwyer explained,

The effects of these processes are significant. If our tools are very brief, if they erase differences across and within categories, if they rely on culturally specific norms, and if their findings are disaggregated indiscriminately, they’ll be inclined to produce accounts and rates of addiction that favour some social groups and strata and disadvantage others.

The processes, logics and assumptions operating within addiction tools also shape the relationships between addiction and other psychological, physical and social issues. In the next phase of the project, Dr Dwyer and Professor Fraser will critically examine how assumptions about gender are reproduced through the deployment of separate cut-off points for men and women.