Published on: December 16, 2025
A NABITA Tip of the Week by Linda Abbott, M.S., LMHC
When colleges are working with students or employees who are facing substance use concerns, one of the most common questions Behavioral Intervention Teams (BITs) encounter is: Can we objectively assess substance use? The answer is a resounding yes. In fact, NABITA’s Risk Rubric identifies substance use as a key risk indicator at Deteriorating and Decompensating on the D-Scale.
However, the real challenge lies in determining whether and how further assessment is needed to better understand the risk, and, more importantly, how we might use the results to provide meaningful support. The approach we take can either foster trust and collaboration or unintentionally create barriers that hinder progress.
Gathering the Right Data to Objectively Assess Risk
One of the biggest challenges when working with substance use is navigating bias. Everyone has different personal, cultural, and institutional norms around substance use. That’s why it’s so important to focus on objective indicators like:
- Academic decline
- Driving Under the Influence (DUI)
- Legal trouble
- Disciplinary referrals
The NABITA Risk Rubric helps us standardize our assessment of these risks. It provides a snapshot in time, allowing us to track decompensation or improvement based on real, observable behaviors.
The first step in understanding risk related to substance use is to apply the Risk Rubric to evaluate the specific behaviors, so the team can respond in a way that aligns with that individual’s level of risk and the specific concerns affecting the individual’s well-being and overall functioning. Is the substance use creating significant or frequent negative consequences? Is it presenting a significant but non-life-threatening safety risk? If either or both of those apply, the risk will be rated at Deteriorating on the D-Scale. If the substance use is creating a significant risk to their own safety or the safety of others, then the risk rises to Decompensating on the D-Scale. Once the team understands the risk, it can develop specific interventions to address these concerns. It is at this stage of the process that questions often arise about the need for further assessment.
Our certification course, BIT Standards and Best Practices, uses a case study involving a student who passed out in a parking lot smelling of alcohol. Despite passing a field sobriety test, this individual had a prior DUI and a hospital transport related to substance use, which are objectively high-risk events. And yet, there are times when people assess this case differently. It’s a powerful reminder that our perceptions vary and our own cultures and experiences can color our views on things like substance use, which is why consistent use of an objective rubric matters.
Assessing Risk Without Mandating Assessment
It’s essential to acknowledge that while BITs can mandate a clinical assessment, NABITA generally doesn’t recommend it for substance use concerns. Why? Because:
- Clinical assessments are confidential. In order to view the results of the clinical assessment, the BIT would need a release of information, and even then, the results would likely not be very helpful. When a BIT receives a referral, whether about a student, staff member, or faculty member, the team’s focus should be on understanding the impact of substance use on that individual’s well-being, functioning, and safety, as well as responding to observable behaviors and identifying patterns of concern to best support them and maintain a safe community. This type of support is generally provided by a non-clinical case manager or another team member when supporting students, or by HR or Employee Relations for employees.
- BITs don’t create clinical treatment plans. Knowing if someone meets diagnostic criteria for substance use disorder doesn’t meaningfully impact what interventions the BITs deploy. BITs support individuals struggling with substance use by providing non-clinical interventions such as connecting them with appropriate resources, offering individualized support, and promoting harm reduction strategies that foster safety and well-being. A clinical diagnosis does not change this approach.
- NABITA’s Risk Rubric already captures substance use risks at elevated levels. BITs can use that data, alongside case management, to assess what they need to know without requiring a clinical label.
NABITA advocates general caution around mandated clinical assessments. If the situation warrants it, we suggest working with a clinician; however, that doesn’t always mean we need to know the outcome to support the individual effectively. With substance use concerns, we often see parallel processes in student conduct or HR, where an assessment may be sanctioned as part of a disciplinary process. That’s a different path with a different goal, often focused on education. A BIT’s role remains supportive, non-clinical, and focused on safety and well-being.
One-on-one Support for Substance Use Concerns
For the practitioner providing direct support, it can be helpful to slow down and take time to understand how the individual perceives their own behavior. This approach is not only person-centered but also highly effective. When we push too hard or move too quickly, especially when the individual isn’t ready, we risk losing the opportunity to help them.
One of the best ways to avoid this is by assessing where the person is in the stages of change. Are they aware there’s a problem? Do they view their substance use as an issue? Are they ready to make changes? By understanding their stage of change, we can tailor our approach to meet them where they are, respect their autonomy, and support their progress through each stage.
Another powerful approach for those providing individualized support is harm reduction. That might mean talking about tolerance, frequency of use, or specific risks related to certain behaviors, rather than jumping straight to abstinence. For many individuals, this is a more approachable entry point that reduces harm and builds self-awareness. As practitioners, we’ve worked with countless individuals who weren’t ready to stop using substances but could start by making safer choices, like drinking fewer drinks or choosing not to drive. This approach respects autonomy and meets people where they are, while always prioritizing safety.
Supporting BITs and Institutions
Join us for training on the NABITA Risk Rubric and explore how you can build confidence in assessing and responding to substance use concerns without overstepping or under-supporting.