Screening & Assessing for

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Screening & Assessing for Addictive Disorders W. Bryce Hagedorn, PhD, LMHC, NCC, MAC Part I Definitions, Focus, & Goals The Screening and Assessment Process Screening The intentional focus on discovering
Screening & Assessing for Addictive Disorders W. Bryce Hagedorn, PhD, LMHC, NCC, MAC Part I Definitions, Focus, & Goals The Screening and Assessment Process Screening The intentional focus on discovering if SA is a problems Usually done during the interview When else might screening occur? MHS Who Do We Screen Pregnant women Individuals involved in criminal justice system Patients in the Individuals involved with DSS or CPS victims & perpetrators Individuals with,,, Who Do We Screen Individuals presenting with mental health disorders Individuals experiencing unemployment, disabilities, chronic health problems Individuals who present with issues related to poverty and/or homelessness Individuals seeking drugs of abuse Why Do We Screen Client s may attribute problems to Client s concerns or issues re SA until trust develops may be inclined to attribute problem to something else SA and its related problems are everywhere It is the MHS What We Screen For just what it says use outside directives/legal limits continued use despite negative consequences compulsive use regardless of significant negative consequences How to Begin The Goal exploring the nature of the presenting problem with an of SA indicators Build warmth, respect, positive regard, and empathic understanding Begin with an area least likely to elicit resistance AOD usually this category How to Begin Should be part of psychosocial history leads to your increased comfort with asking Gather where possible Assessing should include legal, medical, educational, occupational, psychiatric/ psychological, family, & treatment history MHS Information to Gather,,,, Concerns either self or others Client s view of use and related problems Predictors of SA problems Use by friends/peers, age of onset, family history, school/job problems, affective problems, Assessment The use of formal and informal tools to further establish whether SA is a problem (contributing or direct) in the client s life Not a substitute for a thorough psycho social social assessment The Multi / Multi approach Formal Assessment Instruments Substance Abuse Subtle Screening Inventory (SASSI A2) 1 page (15/5 minutes), 90%+ accuracy, accounts for minimization/lying Michigan Alcoholism Screening Test Assesses lifetime alcohol related problems and alcoholism, paper/pencil or interview format Alcohol Use Inventory Most comprehensive (228q) MHS Additional Assessment Instruments Alcohol Use Disorders Identification Test Questions about consumption, dependence problems, and other problems resulting from regular use Sexual Addiction Screening Test GA s for compulsive gambling Adjunct Assessments Marital Satisfaction Inventory Revised(MSI R) Parent Child Relationship Inventory (PCRI) MMPI 2 Other assessments for depression, anxiety, etc. Structured Interviews The CAGE and others (BUMP, HALT, etc) The DSM IV TR The WASTE Time MHS The C.A.G.E. Assessing Drug and Alcohol Dependence CAGE History Developed by Ewing and Rouse in 1970 Original use: to determine the likelihood of alcoholism Has demonstrated high internal reliability and criterion validity One of the clinical interviews within the addictions specialty Can be adapted to address drug use as well Appropriate client population: Each letter of the acronym corresponds to one of four clinically relevant items C Have you ever felt as though you should on your substance use? Goal: to determine if the client has attempted to control or quit substance use Corresponds with DSM Criteria 1 and 4: Tolerance There is a or unsuccessful efforts to cut down or control substance use MHS A Have you ever felt by someone who was criticizing your substance use? Goal: to assess Loosely corresponds with DSM Criteria 6: Important social, occupational, or recreational activities are given up or reduced because of substance use G Do you ever feel about your substance use? Goal: to assess individual s insight into use Loosely corresponds with ihdsm Criteria i 5 and 7: A great deal of time is spent in activities Substance is used despite recognized severe consequences E Do you ever use the substance in the morning to steady your nerves or to get rid of a hangover ( )? G l t dt i it f bt Goal: to determine severity of substance use Loosely corresponds with DSM Criteria 2 and 3: Withdrawal Substance taken over a of time than was intended MHS Working with the CAGE Each of these questions can be broadened. Counselor: Charlie, have you ever attempted to cut back or stop using marijuana? Charlie: Yeah, I keep trying to stop, but each time I just end up getting high again and again and again I'm so disappointed in myself for being unable to quit. Counselor: Tell me what that is like for you. Scoring the CAGE One point is given for each question answered affirmatively Clinical interview scores can range between 0 and 4 One affirmative response suggests a possibility of alcohol dependence Two or more affirmative responses suggest alcohol dependence is highly likely Additional Acronyms B.U.M.P. Have you experienced? Do you have usage? Do you use for (depression, anxiety, etc) reasons? Do you find yourself your stash? MHS Additional Acronyms H.A.L.T. Do you use to get? Do you use your substance? Do you find yourself forward to your next use? Have you experienced? Additional Acronyms The Fantastic 4 L s (psychological and physical health) Has drug use affected your mental or psychological health? Have you had any withdrawal symptoms? (sweating, tremor, aches and pains, nausea) (relationships) Has your drug use affected your relationships with your partner, children, friends or co workers? (responsibilities) Do you find your drug use interferes with doing other things in your life? (consequences) Has your drug use ever gotten you in trouble? WASTE Time A Structured Interview to Assess for Process Addictions MHS Some Background Developed by Hagedorn in 2005 as a result of a lack of such instruments Each letter corresponds to one or more of the diagnostic criteria Can be tailored in such a way so as to and denial fit the clinical setting and individual client W Withdrawal How do you feel/what happens with you (i.e. have you experienced any withdrawal symptoms) when you are unable to engage in? Responses may include irritability, anxiety, depression, anger, and/or other negative mood states Clients may also reveal to supplement their addictive behaviors A Adverse Consequences Have you experienced any negative or adverse consequences as a result of your addictive behaviors? Responses may include, lost career opportunities, financial difficulties, physical injury, and/or psychological trauma This can lead to further discussions about the addictive behaviors MHS S Inability to Stop Have you attempted to your addictive behaviors without success, even when you know that continuing will cause you harm? Responses may include multiple attempts at stopping or controlling the addictive behaviors without success, even when faced with the knowledge that a physical or psychological problem T Tolerance or intensity Have you found it necessary to increase the amount or intensity of your addictive behaviors to achieve the same effect? e.g., for sexual addiction, responses may include movement or Levels 1, 2, or 3 You may be surprised at the here if a trusting environment has been established E Escape Do you use the addictive activity as an escape from, such as stress, anxiety, depression, sadness, loneliness, or anger? Responses may include any negative mood state Discussion can move easily into co morbid MHS Time Spent Have you found yourself spending a lot of time preparing for, engaging in, or recovering from your addictive activity? Responses include the involved with the addictive behavior, followed by the amount of time from a binge episode. Time Wasted Have you been spending more time and/or more resources on your addictive activities than you intended? Responses may include spent on the Internet, a loss of sleep due to an entire weekend spent on voyeuristic activities, or a spent on gambling activities Results An affirmative answer to question suggests a for an addictive behavior Similar to a diagnosis of abuse for chemicals Further assessment is warranted Individual id should see a trained counselor An affirmative answer to questions indicates the of an additive behavior Immediate intervention by a trained counselor is warranted Inpatient hospitalization Outpatient counseling Self help support group attendance MHS Part IV The Clinical Family Addictions Assessment Interview (Juhnke & Hagedorn, 2006) The Clinical Family Addictions Assessment Interview Either one long session or over the course of Involves the family Major goals of the Assessment Interview To understand addiction dynamics in the family system To confront addicted members within the system To related to self and other s interactions To promote healthy, systems oriented change The Clinical Family Addictions Assessment Interview Objectives of the Assessment Interview (AFM) Orient other family members to the assessment process Jointly identify AFM s Gather data regarding AFM s behaviors Secure family members commitment to AFM s recovery Respond to family s MHS The Clinical Family Addictions Assessment Interview Six phases of the Assessment Interview Identification Phase Introduction Phase Strengths Assessment Phase Drinking & Drugging History Phase Reestablishing Phase Conclusion Phase Follow up with formal assessment procedures Phase One Part 1 Identification: The Initial Call Goal: to help family decide who should be involved in the assessment & treatment processes Things to consider Age of participants Phase One Part 2 Identification: Individual Interview Goal: to interview the individual client and learn how he/she perceives the major concerns Things to consider Obtain a Hx Investigate impacts of drug use/behaviors Identify persons who may intentionally or unintentionally his/her recovery MHS Phase Two Introduction Goal is to Counselor briefly welcomes family, introduces self, & outlines the session(s) Frame and acknowledge the importance of the family s role as Things to consider Discuss confidentiality Establish Respond to voiced concerns Phase Three Strengths Assessment Goal: to help family members to Describe the AFM is meeting current needs Identifyways the family and counselor can help the AFM be Encourage continued positive behaviors Things to consider Establish trust and rapport Intent is not to presenting concerns Want to reinforce the power of the family system Phase Four Drinking/Drugging/Behaving Hx Goal: to determine the extent of addictive use All family members are included Things to consider Past and current Hx of AOD and behavior use Psychosocial Hx and impact of AOD and behaviors on each element of this Hx Does the drinking/ drugging/behavior history description of his/her drinking/drugging/ behavior history? MHS Phase Five Reestablishing Goal: to ensure that sufficient data has been gathered Teach AFMs how to Communicate and reestablish family members commitment to one another Things to consider Use scaling questions Phase Six Conclusion Goal: to help family gain a sense of closure Recap the session s Discuss any further thoughts or concerns Things to consider Discuss and plan for Determine necessary level of care Follow up Measures If additional information is necessary: Drug detection tests Urine Hair Blood Saliva Breathalyzer 3 Purposes substances & substantiate claims Monitor abstinence & MHS
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