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CHAPTER 4: Assessment, Diagnosis, and Treatment Planning

CHAPTER 4: Assessment, Diagnosis, and Treatment Planning. Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory First Edition Todd F. Lewis Developed by Katie A. Wachtel, University of North Carolina at Greensboro. Introduction.

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CHAPTER 4: Assessment, Diagnosis, and Treatment Planning

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  1. CHAPTER 4: Assessment, Diagnosis, and Treatment Planning Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory First Edition Todd F. Lewis Developed by Katie A. Wachtel, University of North Carolina at Greensboro

  2. Introduction • Thorough assessment for substance abuse is essential in fully understanding the impact substance abuse may be having on a client’s functioning • Assessment should be an ongoing process • Proper substance abuse assessment can help to determine possible substance related issues in clients who do not present primarily for substance abuse • This chapter will discuss screening, assessment and diagnosis of substance abuse, as well as treatment planning considerations for substance abuse and addiction

  3. Screening for Substance Use Problems • Not the same as diagnosis or evaluation • Refers to methods and procedures designed to rule out the possibility of substance use problems • Can be formal (diagnostic interview) or informal (observational) • Red flags: • Physiological • Psychological • Behavioral

  4. Screening Instruments and Tools • Many of the existing instruments are in the public domain • Choosing a screening tool can depend on validity, reliability, reading level, clinician familiarity, time commitment, and clinical utility/validity • Examples • CAGE AUI • SASSI-3 ASI • DAST AUDIT • MAST Biological screens

  5. Assessment • Assessment is conducted when the possibility of a substance problem is indicated through screening instruments • Clinical interviews are perhaps the best way to gather information regarding substance use patterns • Key components of the clinical interview: • Referral source • History of use • Prior treatment history • Current life functioning • Family history or use • Religious/Spiritual beliefs • General personal history

  6. Dimensions of Substance Addiction • Interrelated but can operate independently • Continuum from low risk to high risk • Use • Consequences • Physical adaptation • Behavioral dependence • Cognitive impairment • Medical harm • Motivation for change (Miller et al., 2011)

  7. Assessment Protocol Example • Gather information from a general diagnostic interview • If the client shows signs of problematic substance use, administer screening instruments (CAGE, AUDIT, MAST, DAST etc.) • If client appears to have moderate to severe substance use, administer assessment instruments (AUI, ASI, SASSI-3) • Optional: personality inventories (MMPI-2, MCMI-III)

  8. Providing Feedback • Clients can become defensive about the results of their assessment, so it is important to provide feedback in a caring, nonthreatening manner • Elicit-Provide-Elicit • Elicit information about what the client wants to know • Provide information and feedback about results • Elicit client’s thoughts and feelings about the information • (Rollnick, Mason, & Butler, 1999)

  9. Substance-Related Diagnoses • Diagnoses come from the DSM-IV-TR • Separated into Substance Use Disorders (SUD) and Substance Induced Disorders (SID) • SUDs • Abuse • Dependence • SIDs • Intoxication • Withdrawal

  10. Dual Diagnosis • Refers to clients who have one or more Substance Related Disorders and at least one other diagnosis on Axis I or II • A majority of clients who present for substance related issues also suffer from psychological concerns • Mental health diagnoses and substance abuse often have a reciprocal relationship and it can be difficult to determine which came first • Integrated treatment models are most effective for dual diagnoses

  11. Changes in the DSM-V • Renaming the Substance-Related Disorders chapter to Addiction and Related Disorders • This section will include non-chemical addictions, such as gambling and Internet addictions • Integration of abuse and dependence into a single construct • Diagnoses will be given on a continuum of severity • 2-3 criteria = mild • 4-5 criteria = moderate • 6+ criteria = severe • 2 out of 11 criteria meets criteria for a diagnosis • Addition of craving as a criteria for diagnosis • Deletion of withdrawal as a criteria for diagnosis

  12. Treatment Settings • Always provide the least restrictive environment possible • Options: • Medical Detoxification and stabilization • Dual-diagnosis hospital inpatient • Therapeutic communities and residential programs • Partial hospitalization and day treatment • Temporary recovery or halfway homes • Intensive outpatient • Outpatient

  13. The Treatment Plan • Comprehensive treatment plans provide structure and direction for the counseling process • Provides accountability between clients and clinicians • Possible components: • Type of plan • Problem • Indicators • Goals (short and long term) • Objectives • Methods/techniques • Frequency of services provided

  14. DO A CLIENT MAP (Seligman & Reichenberg, 2007) Number Timing Medication Adjunct services Prognosis • Diagnosis • Objectives • Assessments • Clinician characteristics • Location • Interventions • Emphasis

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