Substance Abuse Assessment

Is it done regularly, frequently, and habitually?

Is there a compulsive quality indicating lack of control

Does the usage continue despite potential or real consequences

Substance use
-Quantity, frequency, and pattern of use

Problems
-Problems in work, family, school, relationships, for self, and legally

Physical Adaption (tolerance)
-Typical of most substances
-Body adjusts to usage level and effetiveness can decrease

Behavioral Dependence
-Drug is the center of person's life
-Substance is center of day's activities, whether it is recovery from the substance, obtaining it, or using it

Cognitive Impairment
-Acute or chronic effects
-Memory, attention, and intelligence impairment
-Can lead to long term limitations

Medical Harm
-Short term damage to health: Risk taking, overdose, aggression
-Long term damage to health: Links to heart disease, cancer, poor nutrition, and organ damage

Motivation for Change
-Recognizing the need to change

Personal Responsibility Model - failure to self control. your fault.
-Focused on punishment, harsh drug sentencing, and social sanctioning
-War on Drugs

Disposistional/Disease Model
-Primary cause is within the person because of genetics

Social Learning Model
-Focused on the role of experience in shaping addiction
-Influenced by peer modeling
-Interventions include changing environment, patterns of reinforcement, social support, etc.

Sociocultural Models
-Influence of sciety, culture, and larger environmental system
-Certain environments promote risks for addiction

Biopsychosocial model
-Prevalent view
-biology: genetical inheritance, physical handicaps, brain abnormalities
-psychological: Environment, parent-child relationships, and the early events that shaped you/your personality
-Sociological: cultural factors, race, gender, ethnicity

Genetics contribute to addiction significantly
-No single gene, but a combination of genes

DSM-5 Criteria

Mild - 2+ symptoms
Moderate - 4-6 symptoms
Severe - 6+ of 11 diagnostic criteria

Craving to use substtance
Spending a lot of time getting, using, or recovering from the substance
take substance in larger amounts or for longer than you meant to
-Not managing work/life responsibilities
Giving up important activities in life because of substance use
Using it when it puts you in danger
Needing more of it to get effect you want
Development of withdrawal symptoms

Engaging - the client and forming a working relationship
Focusing - in on the goals of treatment
Evoking - the client's own motivations for change
Planning - and implementing strategies for change

Ability to listen to your clients accurately and reflect back to them the essence and meaning of what they said

Accurate empathy is the strongest predictor of a counselor's effectiveness in treatment

Active listening

Empathetic Responding

Communicating validation

Expressing cultural sensitivity

Positive interpersonal attitude

Open Questions
Affirming
Reflecting
Summarizing

Assessment and helping the client

Structured clinical interviews - standardized interview with same questions for all clients

Unstructured Clinical Interviews - INvolve subjective and spontaneous experience

Mixed

You cannot goal set unless the problem has been mutually agreed upon

Collaborate by building rapport, figuring out client strengths, and setting SMART goals with client's input

Used to detect possible presence of a problem and need for furthur evaluation

EX: Clinical questions, self-report questionnaires, biological markers, MAST, Drug abuse screening test

Focuses on onset of use, reason of use, quantity and frequency of use...
-Assess symptoms of dependence
-Mostly done during initial interview for diagnostic data

Standardized intakes exist
-DSM-V structured interview
-SCID alcohol/drug versions

Assess clients motivation to change
-URICA scale

Measure client strengths, self efficacy (belief they can change), and coping skills

Assessment of substance use disorder and contributing factors

When you have a mental health disorder and a substance use disorder occurring simultaneously

-Which one is the primary?

To provide an objective frame of reference to evaluate the progress of treatment

Goals should be collaborative and SMART

A goal is a broad statement of intent that tells us what the client will have changed or improved

Behavioral Objectives specifically tell us what the client should be doing at the end of treatment and how well they should do it, they are written for each goal
-If its too hard, then you need to change the objective or review the goal

Observable behavior, criterion, and conditions

AN action that you can observe while the client or others can observe while the client is doing the task

Criterion is the level of performance that the client will demonstrate with the task (Client will attend group therapy TWICE A WEEK

Three classifications
-Percent/Number Correct
-Time Limit (Within 1 day, during this week)
-Qualitative Descriptions (The client will dress neatly for public, the client will make their house tidy for guests)

A condition is phrase that describes what, when, where, or how much the client will grow towards achievement of a behavioral objective (client will go to school without coercion, client will speak about his children to his wife one time, client will not utilize marijuana in the morning)

1.Time (within 30 minutes/every 3 weeks)
2. Allowances (with assistance, with these tools)
3. Restrictions ( without assistance, from memory, without losing temper, without being late)
4. Combination of all three (Client will pick up children from school 3 times a week without reminders and a notification on his phone)