Reasoning for assessing AOD
• To make sure that counselors are always considering the possibility of AOD problems in a normal assessment. To figure out if the client is using, misusing, or abusing. If the client has a dependency on the substance. Also, to determine a clients placement on the continuum and decided the appropriate interventions given the level of use, life problems, and relevant client characteristics
Reason for Screening
• Effective first step in determining who needs a more thorough assessment for possible substance use disorder. Be careful of “false positives”, positive on a screening actually don’t have a substance use disorder and “false negatives”, people negative on a screening do actually have a substance use disorder. Screening is mainly done through self-report inventories so must rely heavily on honesty.
Psychosocial History
Gathering information in areas of a client’s life that may relate to the clients difficulties. Purpose is to learn as much about the person as possible. This method ensures that a helping professional rules out possible casual factors.
Use
The ingestion of alcohol or other drugs without the experience of any negative consequences.
Misuse
When a person experiences negative consequences from the use of AOD
Abuse
The continued use of alcohol or other drugs in spite of negative consequences.
Dependency
The compulsive use of alcohol or other drugs regardless of the consequences.
Adolescent assessment: signs of adolescent problems with AOD
Carefully examine adolescents change in behaviors in a variety of areas. Academic performance decreasing, truancy, fights, withdrawal, verbal abuse, and defiance are things to look at. Change in friend group, identify with certain groups “stoners”, gravitate toward music and dress that depict AOD use. Selling things for money to buy drugs. Adolescents may have more cash on them that cannot be explained. Psychosocial can be done, but not as helpful since adolescents have not experienced a lot of serious life problems yet.
Self-report Inventories: Drawbacks of using them
- Michigan Alcohol Screen Test (MAST)
- CAGE
- Alcohol Use Disorders Identification Test (AUDIT)
- Problem-Oriented Screening Instrument for Teenagers (POSIT)
- Addiction Severity Index (ASI)
- Draw back of using these is that they gave validity issues. Client self-reports so they could lie about the information they are providing you with. Never use these assessments in isolation from other assessment data.
ASI: difference between ASI and other self-report inventories
This instrument should only be used by trained professionals in substance abuse treatment settings
MAST: what is it used for?
25-item inventory of drinking habits. A scored test measures alcohol problems.
Referrals: What should a mental health professional consider
If you are unsure about the client’s results of the assessment, you may want to refer clients to any AOD treatment program that conducts assessments. First, make sure you referral source has the training and experience to work with AOD-related problems. Second, it is better to refer to an accredited program with credentials.
DSM-V Diagnosis
- Substance abuse disorders – one or more criteria in the last 12 months, problems in personal, social, family, legal, vocational/educational, or physical areas
- Substance dependence disorder- three or more criteria in the last 12 months, may include tolerance and withdrawal, and considered more serious than substance abuse disorders.
Client engagement
A term used to describe the process of motivating a person to actively engage in treatment or less intensive methods of reducing the harm caused by AOD.
Motivational Interviewing
- Four General principles- empathy, develop discrepancy, roll with resistance, and support self-efficacy.
- Resolving ambivalence- hopefully by choosing change to resolve it. Avoiding certain traps like confrontational traps, question-answer traps, focus trap, and blaming trap. Use basic skills to help resolve client’s ambivalence.
- Elicit change talk- evocative questions can elicit change talk. Another way is to have clients rate the importance on a 1-10 scale of a behavior and then ask what would it take for her to get to a more favorable rating.
- Shifting the focus- putting the focus back on the client through amplified and double sided reflections, agreeing with the client with a twist (agree but then take them in a different direction), emphasize the personal choice and control or the client a s method of reducing resistance. Also reframing.
Stage of change
(1) Precontemplation, (2) Contemplation, (3) Determination, (4) Action, (5) Maintenance, (6) Relapse
Brief Interventions: Types and purposes
FRAMES- 1. Feedback (the client is given info about his or her use of AOD and the risk of his or her use pattern) 2. Responsibility- (the responsibility for change lies with the client) 3. Advice (the clinician gives the client advice) 4. Menu (a variety of options are offered to the client) 5. Empathy (the clinician demonstrates this core condition) 6. Self-efficacy (the clinician helps the client feel empowered)
