1 / 18

CHAPTER 5: Assessment and Diagnosis

CHAPTER 5: Assessment and Diagnosis. Substance Abuse Counseling: Theory and Practice Fifth Edition Patricia Stevens Robert L. Smith Prepared by: Dr. Susan Rose, University of the Cumberlands. Overview of Chapter. Issues in Assessment The Diagnostic Interview DSM-IV-TR Diagnosis

blairt
Download Presentation

CHAPTER 5: Assessment and Diagnosis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. CHAPTER 5:Assessment and Diagnosis Substance Abuse Counseling: Theory and Practice Fifth Edition Patricia Stevens Robert L. Smith Prepared by: Dr. Susan Rose, University of the Cumberlands

  2. Overview of Chapter • Issues in Assessment • The Diagnostic Interview • DSM-IV-TR Diagnosis • Behavioral Characteristics • Assessing the Behavioral Symptoms • Assessing the Social and Family-Related Symptoms • Screening and Assessment Instruments • Diagnosis

  3. Issues in Assessment • No single medical or psychological test can determine with absolute certainty that a person is drug or alcohol dependent • Inconsistencies in social attitudes complicate what actually defines substance abuse • Stigma associated with addiction leads to denial • Several problems interfere with diagnostic process: • Therapist biases about substance abuse clients • Client’s attitude about alcohol or drugs and sense of shame in seeking help may create a barrier to accurate assessment

  4. The Diagnostic Interview • Collateral interviews often help to give a more complete picture of both the user and the impact they are having on others in their environment. • Readiness for Change • Transtheoretical model • Structured Interview format • Substance Use History Questionnaire

  5. DSM-IV Diagnosis • Substance: a drug of abuse, a medication, or a toxin that is used in a manner incongruent with medical treatment. • Substances are grouped in 11 classes: • Alcohol • Amphetamines • Caffeine • Cannabis • Cocaine • Hallucinogens • Inhalants • Nicotine • Opioids • Phencyclidine (PCP • Sedatives/Hypnotics/Anxiolytics (Anti-anxiety drugs)

  6. DSM-IV Diagnosis: Criteria for Substance Dependence • A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by 3 (or more) of the following, occurring at any time in the same 12-month period: • Tolerance • Withdrawal • Substance is taken in larger amounts or over a longer period than was intended • A persistent desire or unsuccessful effort to cut down or control substance use • A great deal of time is spent in activities to obtain the substance, use the substance or recover from its effects • Important social, occupational, or recreational activities are given up or reduced because of substance use • Substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by a substance

  7. DSM-IV Diagnosis: Criteria for Substance Abuse • A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring at any time in the same 12-month period: • Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home • Recurrent substance use in situations in which it is physically hazardous • Recurrent substance-related legal problems • Continued substance use despite having persistent or recurrent social or interpersonal problems caused by exacerbated by the effects of the substance

  8. Behavioral Characteristics • Common presenting problems related to substance abuse: • Marital and family conflict • Child abuse or neglect • Unemployment • Financial problems • Multiple medical problems • Anxiety • Depression • Suicide • Problems with aggression and violence

  9. Behavioral Characteristics • A drug or alcohol problem exists and requires treatment if the use of substance continues despite interference in any on of the six major areas of a person’s life: • Job or school • Relationships with family • Social relationships • Legal problems • Financial problems • Medical problems

  10. Behavioral Characteristics • Phase 1: The Prodomal Phase • In this early phase, the following behavioral changes generally occur: • Increase of tolerance • First blackout or loss of significant time to drug use • Sneaking drinks or drugs • Preoccupation with drinking or drug use • Gulping drinks or hurried ingestion of chemicals • Avoiding reference to drinking or drug use

  11. Behavioral Characteristics • Phase 2: The Crucial Phase • In this second phase, the following behavioral symptoms generally occur: • Loss of control of substance use • Denial and minimization of use • Confrontation by others • Behavioral loss of control • Guilt and remorse • Periodic abstinence or change in patterns of use • Losses • Medical and psychological interventions • Growing alienation and resentment • More frequent substance use

  12. Behavioral Characteristics • Phase 3: The Chronic Phase • In this last phase, the following symptoms appear and often continue in a vicious cycle until the user either dies or finds help: • Continuous use of the substance for longer periods • Indefinable fears and vague spiritual desires • Impaired judgment and irrational thinking • Tremors, malnutrition, overdoses, decreased tolerance, and/other psychological problems with the drug • Obsessive use of the substance until recovery or death

  13. Assessing the Behavioral Symptoms • Questionnaire (Figure 5.1, Pages 133-134) • Social Characteristics • As user becomes more involved in abuse or dependence, the primary relationship in life becomes the relationship with the substance • Family Characteristics • Family members, like the user, progress through different phases in their journey with the addict. • Addiction is often classified as a “family illness” • Four Stages in the Family System of the Addict • Denial • Home Treatment • Chaos • Control

  14. Assessing the Social and Family-Related Symptoms • Important to have family members, friends and/or important others in the addict’s life • Family Questionnaire (Figure 5.2, Page 136) • Information gathered from others can be compared with the responses given by the client in order to assess the degree of minimization or denial • Common Social Consequences: • Frequent job loss • A driving under the influence (DUI) arrest or other legal problems • Break-up of important relationships • A series of moves (“The geographic cure” • History of psychological or medical problems • Lack of interest in activities that were once important

  15. Screening and Assessment Instruments • The Michigan Alchoholism Screening Test (MAST) • The Short Michigan Alcoholism Screening Test (SMAST) • The Drug Abuse Screening Test (DAST-20) • The Cage Questionnaire • The Substance Abuse Subtle Screening Inventory (SASSI-3 & SASSI-A2) • The Alcohol Use Inventory (AUI) • The Addiction Severity Index (ASI) • Adolescent Diagnostic Interview (ADI) • The Millon Clinical Multiaxial Inventory (MCMI-II) • Minnesota Multiphasic Personality Inventory (MMPI-2) • ASAM Criteria for Patient Placement

  16. Diagnosis • Inconsistent attitudes and precise standards for what constitutes an “addiction” have always complicated the diagnosis of substance abuse. • Differential Diagnosis • It is frequently the case that one of the most challenging aspects of diagnosing substance abuse is the interplay of addiction and other mental disorders • Longitudinal approach is useful in differentiating between psychiatric and substance-abuse symptoms • Many symptoms of substance intoxication and withdrawal improve or are alleviated within days or weeks.

  17. Diagnosis • DualDiagnosis • Many individuals with substance abuse problems also meet the criteria for other psychological disorders. • Other social and familial factors appear more frequently in substance-abusing groups. • Genetic factors • Lack of Family Cohesiveness (Early death or divorce or separation of parents) • Adolescent behaviors – Adolescents who later became substance abusers are more likely to: • Identify with groups who shared alcohol and drugs during adolescence • Be more impulsive • Display greater evidence of rebelliousness and/or nonconformity

  18. Diagnosis • Dual Diagnosis cont. • Relationship between suicide and substance abuse • Approximately 25% of substance abusers entering treatment have made a suicide attempt at some point in the past (Francis & Miller, 1991)

More Related