Substance Abuse: Assessment
Thank you for joining us. We now ask that you take a few transitional moments, setting aside the events of the day and their emotional attachments. Please close your eyes; if you feel you have forced your eyes shut, attempt to loosen the nerves in your face – there you go, feel the difference. Again, please try not to resist, this is a huge aspect of healing from within. Remember that it is resistance that creates tightness. Now, while scanning your body, do you feel any tension? In perhaps a joint, the neck or lower back? If so, acknowledge it, but don’t title it pain. Feel it, see if it lessens. Listen to the silence; enjoy the sound of your breathing. Is it deep, hurried, anxious, or is it shallow, calm and steady? Our breathing tells us much about ourselves, but we are usually too loud to pay attention to it. Up to this point you have been given tasks, which in turn have kept your mind quiet, and your brain occupied. We are going to let go now. If you immediately regain thought, attempt to repeat the procedure while paying particular attention to your breathing. Good luck.
After 4 minutes
Well, how did you fare? Many have a difficult time keeping their mind clear. Give yourself credit for your attempt, however successful it may have been. We have been conditioned since birth to master multi-tasking abilities. We’ll get there.
It is not our intention to browbeat you into submission or to frighten anyone onto recovery. Our intentions are solely to provide guidance to those who may be interested in self-discovery. We are firmly grounded in the belief that despite the quality of one’s life or circumstances as it may be in appearance to others, it is the individual’s privilege to live the life that has been given them as they see fit. Programs of recovery have been based on spiritual principles; we recognize that spirituality cannot be built out of a foundation constructed of fear. Although one may be prompted, even forced into recovery, until they surrender to the need for help they will continue to struggle with certainty. Those who have reached a bottom are suddenly capable of drastic changes and willing to go to any lengths with least resistance. Again it is our intention to promote self-disclosure and identify if there are needs for recovery. If so, we hope to show you how to dis-identify with unwanted characteristics.
Here we provide a basic illustration of the Who, How and What aspects of an assessment.
WHO is deemed appropriate and eligible for treatment of an addiction? One who displays outstanding characteristics of avoidance, unmanageability, loss of interests or significant shift in priorities, negatively influencing productivity, social standing, personal relationships and health? There are those to who have been capable of managing much of their affairs in an acceptable manner while concealing the detriments of addiction. Regardless of the degree of functioning displayed by an addict, they will also exhibit a preoccupation with desires that will ultimately hinder their daily routines. Uncommon mood swings, irrational decision making, financial difficulties, lying, isolation, legal problems, and deteriorating health all contribute to the ongoing recklessness of the addict. Life’s goals have begun to slip away as consumption continues. These behaviors are contradictory of the addict’s core beliefs; they have further created a state of confusion to an already tormented and vulnerable mind. Having been successful in setting and achieving goals in the past, the addict is determined to break and conquer the grips of addiction. Plagued with guilt, shame and a deteriorating set of values, the addict’s needs and problems have far outgrown the coping skills that once stood firmly grounded on a foundation of moral fiber (core beliefs). Temporarily limited to maladjusted and distorted thinking, the addict relies on the very thing that got them to this place – more of the same addictive behaviors and patterns. As Vernon Johnson has suggested, drugs and alcohol can be a very powerful coping mechanism. In addition, I would add that any addictive behavior which results in escapism or avoidance of reality can and will initially appear to lighten one’s burdens. Truth be told, the end result will be additional negative consequences at best.
WHAT are the levels of care? Through the use of diagnostic tools, theories and special skills, we arrive at conclusions determining a level of care for the addict. A treatment plan is then formulated, implemented and eventually a prognosis is reached. The level of care is determined by the client’s needs.
• Basic Education – 15 hours (3-5 hours per week)
• Out Patient (OP) – generally 6 hours weekly based on further analysis.
• Intensive Out Patient (IOP) – 9 hours of group therapy weekly with individual sessions as needed.
• Partial Hospitalization (PHP) – generally those clients are being medicated for coexisting disorders and are under the care of a psychiatrist. Their treatment plan consists of 12 hours of group therapy along with a 1 on 1 session weekly or bi-weekly.
• In-Patient Treatment – usually consists of a 28-day stay in a residential setting. Most inpatient facilities have an on-staff Dr. to provide medical detox.
• Inpatient Medical Detox Long Term – entails most often a 90-day to a year or more stay.
All treatment should include but not limit itself to the education of the disease concept; along with an introduction to a 12 step program, literature, community resources and contacts as well as an aftercare plan. The level of care is designed to meet the specific needs of the individual.
HOW are the stages of addiction determined? One way is thru self-administered questionnaires furnished by 12 step groups. Alcoholics Anonymous, Narcotics Anonymous, Gamblers Anonymous, Over-eaters Anonymous, Sex and Love Addicts Anonymous and Al-Anon can be found on the Internet or in your local phone listings. Some prefer to be assessed by licensed certified professionals using scientific modalities, theories, and practical experiences. The DMS-V multi axial diagnostic and statistic manual is a widely used tool in assessing a patient’s problems and needs.
Collecting collaborative information from resources other than the client, such as family members, co-workers, employers and friends, will assist in identifying specific traits perhaps unrecognized by the patient. It is not a fine line that separates use from abuse or abuse from dependence. The terms are clearly defined and easily substantiated when self-disclosure is honest.
Lets see if you’re getting the hang of it
Tom is a 34-year-old man, married for 12 years, the father of 2 daughters and has been employed for 8 years as a financial consultant. He has a history of alcohol use and at times admits to abusing alcohol. Returning home from a brief stay in the hospital due to an accident, Tom finds himself dependent on painkillers. Frustrated with the availability of prescription drugs, Tom resorts to street drugs and in a short time has become a daily user of intravenous drugs. He has begun to deplete his savings to acquire these drugs. Tom’s wife and children are concerned about his mood swings, loss of interest in them, absence from work, inability to pay the bills, and his change in appearance.
What suggestions would you give to the family?
a) To consult with a professional and arrange an assessment
b) Have family attend Al-Anon and or family counseling
c) Provide family with drug and alcohol resources
d) Offer literature on the disease concept while asking them to be patient, kind and tolerant
e) All of the above
What level of care most appropriately meets Tom’s needs based on the information given.
a) Out patient basic
b) Intensive out patient
c) Long term inpatient
d) Detox inpatient followed by an outpatient after care plan
e) Attend a 12-step group
One more example:
Eileen is a 20-year-old college student recently arrested on-campus for disorderly conduct and public drunkenness. She maintains a B+ average is a member of the drama club and plays intramural volleyball. Eileen’s dad has a history of alcohol abuse but has been abstinent for 2 years. Eileen has no prior history of abuse although recently has been cited for on-campus public drunkenness and disorderly conduct.
What level of care would you provide Eileen with?
a) Intensive out patient
b) Attend Al-Anon
c) Commit to 90 AA meetings in 90 days
d) Out patient basic education
e) No treatment recommended
Here are the results question #1 e; question #2 d; and question #3 d