Substance Abuse Screening and Assessment CSD 5970

Today  Disease model  Screening and assessment for substance abuse  Tools  Issues

Review  Substance abuse happens within a multi-systemic framework. People function in peer groups, families, communities, etc.  Individual response to drugs is dependent on a number of factors.  Different drugs have different pharmacology, potential for addiction, withdrawal etc. Drugs in the same class behave similarly.

Definition  “A process occurring between a worker and a client in which information is gathered, analyzed, and synthesized into a multidimensional formulation”. Johnson  What is the purpose of an assessment?

Purpose  Gather information  Screen for immediate medical, psychiatric concerns  Establish a relationship  Identify issues and patterns  Propose a diagnosis  Identify strengths  Provide hope!

Challenges  What are the challenges clinicians face in conducting substance abuse assessments?

Stages of Change  Precontemplation  Contemplation  Preparation  Action  Maintenance  Termination  (Relapse)

Screening  What is a screening?  Instruments  MAST  CAGE  CIWA

Screening  Physical problems  Depression  Suicidal ideation  Source of payment

Operating Principles  Every client is unique, and so is his/her story.  Successful client engagement is fundamental.  Ask … and act if needed.  There are significant differences between use, abuse, and chemical dependency.

Operating Principles  Chemical dependency is not inevitable.  No single model or theory explains chemical dependency.  Work toward developing a multi-systemic approach.  Be aware of your own prejudices, bias, beliefs, or need for power.

Dependence  A maladaptive pattern of substance abuse characterized by three or more of the following,  Tolerance  Withdrawal  Taken in larger amounts or for longer than intended  Desire or efforts to cut down or quit

Dependence  Time spent in activities necessary to obtain the substance or in drug seeking  Important social, occupational, or recreational activities are given up  Continued use despite adverse consequences

ASAM PPC 2R  American Society for Addiction Medicine consensus document on placement.  Mandated in the State of Illinois for Licensed facilities  Proprietary  Operates on a principle of “least restrictive environment”.  Assesses current level of functioning on 6 dimensions  Recommends level of care

ASAM PPC 2R  Level.5 Early intervention  Level 1 Outpatient  Level 2 IOP  Level 3 All residential settings including detox  Level 4 Medically managed  1Intoxication & withdrawal  2Biomedical  3Emotional/behavioral  4Treatment acceptance/resistance  5Relapse potential  6Recovery environment

Dimension 1  Client description, presenting problem, and context of referral

Dimension 2  Treatment history

Dimension 3 Substance Use History

Dimension 4  Medical History

Dimension 5  Basic Needs

Dimension 6  Psychological and Emotional Functioning

Dimension 7  Family history and structure

Dimension 8  Community/Macro Context

IMPORTANT!  Assessment and placement is an on-going process  Diagnosis is based on the disease model – other models are equally useful in treatment  Everything we do happens in context.