Assessment of Addiction and Co-occurring Disorders
Introduction
It is indeed true, that assessment, treatment and diagnosis of substance disorders is most likely to present challenges (Deborah, 2006). The same concept is alluded to by Chase (2016) who notes that individuals with co-occurring disorders are often encountered with disparities in treatment as well as lack of multidisciplinary treatment and poor continuity of care. While various studies have gone out to highlight assessment of addiction and co-occurring disorders, the perception of the same remain, to an extent, limited. The case in question is about Miguel who is 60 and who has agreed the company’s referral process as part of the Employee Assistance Plan as a result of his own drinking problem. The purpose of this assessment is therefore to determine whether there exists an addiction in the first place and if so, to what extent has it reached. In addition, assessment will aid in evaluating the existence of co-occurring conditions and lastly, to be of aid in the development of a treatment plan.
Evaluation of Assessment Tools
Select and evaluate at least two assessment tools for each of the following:
- Addiction Assessment or Screening.
One of the assessment tools used in addiction assessment or screening is known as AUDIT or the Alcohol Use Disorders Identification Test which is defined as a 10-item screening tool that was initiated by the World Health Organization. Its objective was to assess the level of alcohol consumption, behaviors in drinking and problems that occur as a result of alcohol. Clifford et al (2008) states that it is used to assess whether or not there is a challenge with dependence on alcohol. It is worth mentioning that the Alcohol Use Disorders Identification is never affected by ethnic and sex bias when it is used for screening those with alcohol disorders in primary care (Ferguson & Engel, 1998). The challenge that may be encountered in using AUDIT is that it may not be effective when it is used for patients with occult alcohol problems (Ferguson & Engel, 1998).
The second assessment tool is what is referred to as SADQ or Severity of Alcohol Dependence Questionnaire which, according to Clifford et al (2008), is a brief 20-item questionnaire that is self-administered, and which was designed by the World Health Organization to measure the extent of dependence on alcohol. SADQ is able to calculate the severity of alcohol addiction. According to Stockwell et al (1983), SADQ cores may have low, but significant correlations with indicators of withdrawal severity for individuals treated at Detoxification Unit. In addition, the study conducted by Stockwell et al (1983) states that SADQ scores failed to correlate with indices of liver functioning.
- Assessment of Co-occurring Mental Health Issue.
The mental health screening form-III (MHSF-III) was established so as to address the need in chemical dependency field for those clients that have co-occurring psychiatric difficulties. It is not a sophisticated instrument to use. In most cases, those who undertake this concept usually complete in less than 15minutes (Clifford et al, 2008). It is always recommended that MHSF III be short, inexpensive and easy to use so as to meet the needs of the clinicians.
Severity Disorder-Specific Measures 5 tool is used for those who have met or are close to meeting a diagnosis. There are two types of measures that are undertaken with in this regard and include self administered for adults aged 11-17 years and clinician administered (APA, 2013). In carrying out the self administered concepts one is most likely to measure depression, separation, specific phobia, panic disorder and generalized anxiety disorder (APA, 2013). The best tool to use with the case scenario of Miguel will be Severity Disorder-Specific Measures 5 tool.
CAGE and CAGE-AID is a questionnaire that is used for alcohol abuse and dependence in adults. It is an effective tool to use in assessment of co-occurring mental health issue (Basu et al, 2016). It is important to note that this tool is not used to diagnose disease, but it is only used to indicate whether there is a problem. In addition, the questions seem to be effective when they are undertaken with a general health history in mind.
- Assessment of Risk of Harm.
Suicide Probability Scale is one of the tools that is used to assess risk of harm to an individual. It was developed by John Cull and Wayne with an aim of assisting practitioners to determine the risk of suicidal behavior. It can be used for people who are aged 14 years and above (Boers et al, 2010). In addition, suicide probability scale has been used by inpatient, outpatient and the general population. There are about 36 items that characterizes SPS and which assist in describing behaviors and feelings. It is an exercise that can take up to 15 minutes so as to complete (Boers et al, 2010).
The second tool is referred to as suicide concerns for offenders in prison environment (SCOPE) that is designed to assess the vulnerability to risk of suicide and nonfatal self harm behavior experienced with adults (Both female and young adult male offenders). It contains 28 items coring on two subscales (Perry & Olason, 2008).
Results of Assessment
Diagnosis Based upon the DSM-5
Principal DSM-5 Diagnosis (Focus of treatment): From the analysis of Miguel case, the assessment concludes that he meets the criteria for major depressive disorder, mild with anxious distress (Boers et al, 2010). A closer look at Miguel shows that he is sad, which is part of human experience. In addition, it is easy to notice that he is going through some life challenges. The diagnosis therefore shoes that Miguel suffers from major depressive disorder or MDD.
Additional DSM-5 Diagnoses: An additional diagnosis is that the patient has generalized anxiety disorder that shows that he might be going through challenging time in his life.
Relevant Medical Diagnoses (if known): The relevant medical diagnoses that can be prescribed in this case if for Miguel to use anti-depressant medications. The assessment shows that Miguel looked stressed and to help, there will be need to breakdown components of what is taking part in his brain as regards his present situation. One of the most commonly used in this case is known as the selective serotonin reuptake inhibitors or SSRIs (Chase, 2016). Through the SSRIs, the client will be able to breakdown serotonin that is in the brain and as a result, a higher amount of this neurotransmitter. It is this serotonin that may be causing Miguel to stay late at night stressed and to start drinking (Chase, 2016).
Description of Client Strengths
One of the client’s strengths that come out clearly from the case is that of physical or medical health. The case scenario makes it clear that his life insurance policy is one of the bills that he makes certain to pay. We can consider this as a point of strength. It is also worth mentioning that Miguel is able to have access to medical services like the insurance and this is quite positive despite the challenges that he has that has caused so much stress. The other core strength is that of Miguel’s family. Miguel has made it a habit to start paying bills when his wife and mother have gone to sleep. The case scenario tells us that his family begun to worry that he looked worn out. This shows that the family was concerned about him to which he responds that he is simply tired from the physical demands of his new job.
We can also conclude that Miguel has an emotional strength or optimism. This can be seen through insight, optimism, and perseverance, putting troubles in perspective and having the ability to endure. Miguel has come to the realization that there is a problem which he must face head on. For instance, he is able to note down the things that need action, even though his response is not the best. There are things that he notes down that needs to be paid and even though he forgets to pay some of them, he has the knowledge that something needs to be done. The decision-making aspect is also witnessed in the case scenario. After being confronted, Miguel acknowledges that he needs help, and this is why he makes the decision to go through the Employee Assistance Plan. In addition, we are brought to the realization that Miguel felt concerned about his situation and agreed to the plan.
Description of Challenges to Be Addressed
While the family shows concern about his health, which is strength, they fail to get more information about it. For instance, when a husband continues to stay late at night each and every time, the family needs to sound an alarm. The wife should have engaged Miguel on a one on one basis to find out what the problem was. In terms of a supportive base, the family may prove a great challenge considering that they were reluctant to find out what the problem was. In addition, the mother could have sensed that something was not right with the son staying late in the night. The other challenge worth mentioning is his optimism and decision making. Miguel is able to note down what needs to be paid at a given date. However, he fails to take the initiative to ensure that these bills be paid on time. In some cases, and knowing his situation, it is important to re-strategize, and look for ways through which he can limit expenses by maybe going into a smaller house.
Recommended Level of Care
One of the stages that we have already mentioned is an assessment that has been carried out to determine the cause of the problem (Clifford et al, 2008). It will be important to bring to the attention of Miguel that he needs to become an active participant in his own care if he is to recover fully. The second phase will be to engage Miguel so that we can be able to determine his goals in life. It might be a challenge to explore his past way of life based on the assessment used but an exploration of individual health history and the current condition will be done. In doing so, the assessment may be able to get the biomedical conditions an complications if any (Deborah, 2006). The third concept will be to explore Miguel thoughts, emotions and mental health issues. While we may be effective in carrying out the three stages outlined above, it is important Miguel shows that he is ready to change. Miguel has to show that he is not pushed to come for assistance, but he is interested in changing his way of life. It is vital, to also check his unique relationship with relapse. This might help in determining how to approach the situation and lastly, it is always important to look at the living environment. The assessment will have assisted in getting the problem, but it is the recovery environment that will aid in terminating it. This will highlight the surrounding people, things or places (Boers et al, 2010).
References
American Psychiatric Association. (2013). Clinician-Rated Dimensions of Psychosis Symptom Severity [Measurement instrument].
Basu, D., Ghosh, A., Hazari, N & Parakh, P. (2016). Use of Family CAGE-AID questionnairwe to screen the family members for diagnosis of substance dependence. Indian J Med Res. 2016 Jun; 143(6): 722–730. doi:
Brian, R. & Christopher, K. (2008). Prevalence and Profile of People with Co-occurring Mental and Substance Use Disorders Within a Comprehensive Mental Health System
Boers, M; Brooks, P; Fries, J. F.; Simon, L. S.; Strand, V; et al. (2010). A first step to assess harm and benefit in clinical trials in one scale. Journal of Clinical Epidemiology; Elmsford Vol. 63, Iss. 6: 627-32.
Chase, R.E. (2016). Associations Between Provider Type, Setting of Practice, Experience with Co-occurring Populations, and Treatment Preferences for Co-occurring Disorders. The Chicago School of Professional Psychology, ProQuest Dissertations Publishing,
Clifford, M.C.,Nobert, S & Ashok, M. (2008). Validation of the Alcohol Use Disorders Identification Test and the Drug Abuse Screening Test in First Episode Psychosis. Canadian Journal of Psychiatry; Jan 2008; 53, 1; ProQuest Central pg. 26
Deborah, D. (2006). A critical review of the literature on the assessment, diagnosis, and treatment of co-occurring bipolar and substance disorders. Alliant International University, San Diego, ProQuest Dissertations Publishing.
Perry, E. A & Olason, T.D. (2008). A New Psychometric Instrument Assessing Vulnerability to Risk of Suicide and Self-Harm Behaviour in Offenders. International Journal of Offender Therapy and Comparative Criminology.
Stockwell, T.,Murphy, D & Hodgson, R. (1983). The Severity of Alcohol Dependence Questionnaire: Its Use, Reliability and Validity. British Journal of Addiction Banner.
