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Substance Abuse Screening and Assessment

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.

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Substance Abuse Screening and Assessment

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  1. Substance Abuse Screening and Assessment CSD 5970

  2. Today • Disease model • Screening and assessment for substance abuse • Tools • Issues

  3. 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.

  4. 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?

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

  6. Challenges • What are the challenges clinicians face in conducting substance abuse assessments?

  7. Stages of Change • Precontemplation • Contemplation • Preparation • Action • Maintenance • Termination • (Relapse)

  8. Screening • What is a screening? • Instruments • MAST • CAGE • CIWA

  9. Screening • Physical problems • Depression • Suicidal ideation • Source of payment

  10. 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.

  11. 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.

  12. DSM

  13. 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

  14. 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

  15. ASAM

  16. 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

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

  18. Bio-Psych-Social Approach

  19. Dimension 1 • Client description, presenting problem, and context of referral

  20. Dimension 2 • Treatment history

  21. Dimension 3 Substance Use History

  22. Dimension 4 • Medical History

  23. Dimension 5 • Basic Needs

  24. Dimension 6 • Psychological and Emotional Functioning

  25. Dimension 7 • Family history and structure

  26. Dimension 8 • Community/Macro Context

  27. 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.

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