Assessment Review
for the Addiction Counselor Certification Exam
Dr. Dawn-Elise Snipes, PhD, LPC-MHSP
Podcast Host: Counselor Toolbox and Addiction Counselor Exam Review
12 Assessment Steps
~ Engage
~ Get authorizations and gather information from collateral sources
~ Screen for co-occurring disorders
~ Determine the severity of mental and SUDs
~ Determine appropriate level of care
~ Determine diagnoses
~ Determine disability and functional impairment
~ Identify strengths and supports
~ Identify cultural and linguistic needs and supports
~ Identify additional problem areas (medical, housing, education…)
~ Determine readiness for change
~ Plan treatment
Assessment
~ Screening determines the possible presence.
~ Assessment
~ Is an ongoing process
~ Determines the nature and severity
~ Develops specific treatment recommendations
~ Surveys client strengths and resources for addressing “life problems.” (wrap-around)
~ Substance Abuse Assessment Foci
~ Historical and situational factors contributing to or triggering use
~ Patterns of use
~ Common signs and symptoms
~ Consequences of use
Assessment
~ Examines the context(s) in which the disorder(s) manifest
~ Explores reciprocal interactions of…
~ Family/marital life
~ Social support/interpersonal functioning
~ Physical health needs
~ Spirituality
~ Employment
~ Financial issues
~ Legal issues
~ Other issues which may impact treatment (transportation, childcare)
Assessment
~ Explores reciprocal interactions cont…
~ Gender, cultural, linguistic issues
~ Readiness for change
~ Relapse risk
~ Recovery support
~ Special life circumstances (single parent)
~ Medical conditions
~ Client centered—respecting
~ The client’s perceptions of his problems
~ Goals he wishes to accomplish
~ Strengths he has
Assessment Instruments
~ Forms
~ Standardized interviews
~ Limits interviewer to a script
~ Requires limited training
~ Collects the same information on all clients
~ Structured interviews
~ Probing questions can be asked
~ Requires additional training/knowledge
~ Self-administered tests/questionnaires
~ Require some motivation and reading ability on the client’s part
~ Standardized instruments have:
~ Reliability
~ Validity information
Assessments
~ Sources of information (with written consent)
~ Personal reports
~ Family
~ Other professionals/prior treatment experiences
~ May be the most objective resource
~ Employment history
~ Criminal records
~ Drug tests
~ Collateral information gathered should be confirmed to the extent possible
~ Accurate assessment requires the coherent integration of multiple sources of information to avoid under- or over-estimation of the problem.
Drug Testing in SUD Treatment
~ Drug testing is
~ Part of the initial assessment
~ Used to identify drugs to make most appropriate treatment recommendations
~ Screen to prevent adverse effects of prescribed medications
~ Component of the treatment plan
~ Way to monitor use of substance and compliance with medications
~ Method to assess efficacy of treatment
~ Method to document abstinence for legal matters, disability, custody etc.
~ Drug testing cannot replace an assessment to diagnose a substance use disorder.
Drug Testing in SUD Treatment
~ Drug Testing
~ Can accurately reveal drugs in the system
~ Time frame for detection is limited
~ Dependable for identifying frequent users
~ Less accurate for infrequent or binge users
Types of Drug Tests
~ Breathalizer (hours)
~ Urine (up to a month)
~ On-site
~ Gas chromatograph
~ Can produce false positives
~ Saliva (past day)
~ Sweat and hair
~ drug use patterns over periods of time
~ Cannot discriminate between recent and past drug use
~ Not able to identify use within past 3-8 days
~ Blood
Risk Assessment
~ One of the most important functions at both screening and assessment
~ Presence of any risk warning signs
~ Requires immediate referral (detox, CST, ER)
~ Screening and assessment are inappropriate
~ Assess for:
~ Intoxication
~ Substance toxicity
~ Withdrawal
~ Aggression/danger to others
~ Potential for self-harm or suicide
~ Co-existing mental health issues
Risk Assessment
~ Signs of Drug Toxicity or Intoxication
~ Nausea
~ Vomiting
~ Diarrhea
~ Agitation
~ Lethargy or stupor
~ Increased or decreased heart rate
~ Lack of coordination
~ Slurring words
Risk Assessment
~ Signs of Violence
~ Previous violence
~ Young age at first incident
~ Relationship instability
~ Employment problems
~ Substance use problems
~ Major mental illness
~ Personality traits that deviate from social norms (exploitation, manipulation…)
~ Early maladjustment or trauma
~ Paranoia
~ Failure to respond to treatment in the past
Risk Assessment
~ Suicidality
~ Alcoholism (a factor in 30% of suicides)
~ Psychiatric disorder
~ 90% of people who die by suicide have a mental health disorder
~ 60% of people who die by suicide have depression
~ For alcoholics who are depressed the rate is 75%
~ 3 Domains for Assessment
~ Current presentation of suicidality
~ History
~ Risk management
Risk Assessment
~ Signs of Suicidality
~ Suicidal or self-harming thoughts, plans, behaviors or intent
~ Specific methods identified
~ Evidence of hopelessness, impulsiveness, panic attacks or anxiety
~ Lack of future plans
~ Signs of “tying up loose ends.”
~ Alcohol or other substance use
~ Thoughts, plans or intentions of violence toward others
~ Psychiatric illnesses
Risk Assessment
~ Signs of Suicidality
~ Previous attempts or aborted attempts at suicide or self-harm
~ Family history of suicide attempts, suicide, mental illness, addiction
~ Acute psychosocial crises including financial or changes in socioeconomic status
~ Chronic psychosocial stressors including actual or perceived interpersonal losses
~ Family discord, domestic violence, current or pase sexual or physical abuse
~ Absence of external supports
Mental Health Disorders Common in Co-D
~ Borderline Personality Disorder
~ Pervasive pattern of instability in personal relationships, self image and affect in addition to impulsivity.
~ Antisocial Personality Disorder
~ Pervasive disregard for and violation of the rights of others
~ Inability to form meaningful relationships
~ Lack of empathy
Mental Health Disorders Common in Co-D
~ Major Depressive Disorder
~ Lack of pleasure in most things most days for at least 2 weeks
~ Changes in sleep, appetite, energy, concentration
~ Excessive feelings of worthlessness and/or guilt
~ Suicidal ideation
~ Bipolar Disorder
~ Fluctuations between elation (mania) and depression
Mental Health Disorders Common in Co-D
~ Anxiety Disorders
~ Panic attack
~ Distinct period of intense fear usually peaking within 15 minutes
~ Significant fear-related physiological symptoms
~ Panic disorder
~ Panic attacks + persistent fear of recurrence of attacks
~ Obsessive Compulsive Disorder
~ Anxiety disorder involving obsessive thoughts which cause anxiety and compulsive behaviors to address those thoughts
Mental Health Disorders Common in Co-D
~ Post Traumatic Stress Disorder
~ Exposure to an stressor which involved the threat of death or significant injury to self or another in which there was significant helplessness and horror.
~ Can occur when learning about a trauma which occurred to someone else, especially a significant other
~ Eating Disorders
~ Person is intensely afraid of gaining weight and exhibits a disturbance in the perception of the shape of size of his or her body.
~ Types
~ Anorexia
~ Bulimia
~ Binge Eating Disorder
Mental Health Disorders Common in Co-D
~ Schizophrenia and Psychotic Disorders
~ Psychosis is the term for a severely incapacitated mental and emotional state involving thinking, perception and emotional control
~ Hallucinations –False perceptions
~ Delusions –False beliefs and a deterioration in thinking, judgement or self-control
~ Schizophrenia is the most common psychotic disorder
~ NOT multiple personality
~ Symptoms (often begin to develop before the first psychotic episode)
~ Hallucinations or delusions
~ Disorganized speech
~ Disorganized or catatonic behavior
~ Deficits in functioning
Summary
~ Assessment is an indepth process that involves information from the client and collateral sources to determine the nature, course and severity of the issues
~ Assessment is biopsychosocial in nature
~ Assessment must take into consideration cultural factors regarding having a mental illness, the participants in the treatment process and who the decision makers are for the client
~ It is important to evaluate for multiple-occurring disorders which may have overlapping symptoms.
~ The assessment will guide placement and the development of the treatment plan